Background . More HIV-infected women are reaching older age and menopause, but there is limited info

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Abstract Full-Text PDF Full-Text HTML Full-Text ePUB Linked References How to Cite this Article Infectious Diseases in Obstetrics and Gynecology Volume 2013 (2013), Article ID 784718, 8 pages http://dx.doi.org/10.1155/2013/784718
1 Division of Infectious Diseases, Department of Medicine, University of Rochester Medical Center, P.O. Box 689 601, Elmwood Avenue, Rochester, NY 14642, USA 2 Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA 3 Division of Geriatrics and Aging, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
Background . More HIV-infected women are reaching older age and menopause, but there is limited information on cervical squamous intraepithelial lesions biv (SILs) on these women. Methods . To assess the effect of HAART and menopause on SILs in HIV-infected women, we reviewed the results of Papanicolaou (Pap) tests obtained between 1991 and 2011 on 245 women. biv Progression to SILs was determined by comparing Pap test results. The association of HAART and transition to menopause on SILs was assessed using survival analysis. Results . Women receiving HAART had a 52% reduced risk in the progression to SILs compared to women receiving any other antiretroviral regimen biv or no regimen (CI: 0.33–0.70, ). A greater biv increase of CD4 + cell counts was associated with a greater reduction on the risk of progression to SILs. Menopausal women had a 70% higher risk of progression to SILs than premenopausal women (CI: 1.11–2.62, ), adjusting for HIV medications, CD4 + count, duration of HIV infection, moderation effect of menopause by age, prior IV drug use, and smoking. Conclusion . HAART had a positive long-term effect biv on the progression biv to SILs. However, being younger and menopausal increases the risk of progression. 1. Introduction
HIV infection increases the risk for invasive cervical carcinoma and its precursors, SILs [ 1 – 4 ]. The introduction of HAART has significantly reduced morbidity and mortality in HIV-infected patients. The effect of HAART on SILs, however, has not been entirely clear. Some studies have reported a beneficial effect of HAART with increase in regression [ 5 – 8 ], or decrease in progression [ 5 ] of SILs. In contrast, other studies report no difference in regression [ 9 ] and progression [ 9 , 10 ] of SILs, when comparing patients on HAART and those not on HAART. It should be noted that some of these studies had a short-term follow-up and the effect of HAART on SILs may not be obvious because it takes years to develop HPV-related lesions. Two seminal studies done recently showed a definitive beneficial effect of HAART on SIL in HIV-infected women; however, these studies did not assess the effect of menopause [ 11 , 12 ].
The number of HIV-infected women reaching menopause and older age is expected to increase due to improved survival on HAART. To date, there have only been limited studies which focused on SIL in HIV-infected menopausal women. biv Therefore, it is not clear whether the general guidelines regarding biv cervical cancer screening [ 13 , 14 ] should be applied to HIV-infected menopausal women. biv
2. Materials and Methods 2.1. Study Population This 20-year retrospective study focused on HIV-infected women who were cared for at Strong Memorial Hospital (SMH) AIDS Center (AC) between January 1991 and December 2011. During this time, SMH AC followed 800–1061 individuals with HIV infection, of which 30% were women. Women were advised to have cervical cytology at baseline and also at 6 months biv and yearly thereafter if the initial Pap test results were normal. Women with abnormal Pap tests were referred to a gynecology clinic for colposcopy and further management. We had access biv to the information regarding cytology results and gynecological procedures from both the SMH AC and the gynecology clinic.
In total, 313 female patients were in the SMH AC database and were reviewed. Included in the study were HIV-infected women who were at least 18 years old and had 2 or more cervical Pap tests. This study was approved by the research subjects review board at the University of Rochester.
Women were excluded if they had had a hysterectomy biv prior to entry into care and/or if they had less than two cervical Pap tests done during the study period. Participants biv were considered to be postmenopausal as indicated by their clinicians in the medical records. Cl