Influence of Adherent and Effective Antiretroviral Therapy Use on Human Papillomavirus Infection and Squamous Intraepithelial Lesions in Human Immunodeficiency Virus—Positive Women

• Published in: The Journal of infectious diseases 2010-03, Vol.201 (5), p.681-690
• Main Authors: Minkoff, Howard, Zhong, Ye, Burk, Robert D., Palefsky, Joel M., Xue, Xiaonan, Watts, D. Heather, Levine, Alexandra M., Wright, Rodney L., Colie, Christine, D'Souza, Gypsyamber, Massad, L. Stewart, Strickler, Howard D.
• Format: Article
• Language: English
• Subjects: Adult; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Cervical cancer; Cohort Studies; Female; Fundamental and applied biological sciences. Psychology; Highly active antiretroviral therapy; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV/AIDS; Human immunodeficiency virus; Human papillomavirus; Human viral diseases; Humans; Infections; Infectious diseases; Lesions; Male; Medical sciences; Medication Adherence - statistics & numerical data; Microbiology; Middle Aged; Miscellaneous; Modeling; Neoplasia; Neoplasms, Squamous Cell - epidemiology; Neoplasms, Squamous Cell - virology; Papillomaviridae - drug effects; Papillomavirus Infections - epidemiology; Papillomavirus Infections - virology; Prevalence; Prospective Studies; Squamous cell neoplasms; Uterine Neoplasms - epidemiology; Uterine Neoplasms - virology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Virology; Viruses; Young Adult
• ISSN: 0022-1899; 1573-6613; 1537-6613
• DOI: 10.1086/650467

Background. The impact of highly active antiretroviral therapy (HAART) on the natural history of human papillomavirus (HPV) remains uncertain following conflicting reports. Prior studies, however, did not consider patients' adherence to their regimens or HAART effectiveness (viral suppression). Methods. Human immunodeficiency virus (HIV)-positive women (N = 286) who initiated HAART during follow-up in a prospective cohort were assessed semiannually for HPV infection (by polymerase chain reaction) and squamous intraepithelial lesions (SILs). Adherence was defined as use of HAART as prescribed ⩾95% of the time, and effective HAART was defined as suppression of HIV replication. The prevalence, incident detection, and clearance of HPV infection and/or SILs before versus after HAART initiation were compared (using women as their own comparison group). Results. HAART initiation among adherent women was associated with a significant reduction in prevalence (odds ratio, 0.60 [95% confidence interval {CI}, 0.44–0.81]; P = .001), incident detection of oncogenic HPV infection (hazard ratio [HR], 0.49 [95% CI, 0.30–0.82]; P = .006), and decreased prevalence and more rapid clearance of oncogenic HPV-positive SILs (HR, 2.35 [95% CI, 1.07–5.18]; P = .03). Effects were smaller among nonadherent women. The associations of HPV infection and/or SILs with HAART effectiveness were fairly similar to those with HAART adherence. Conclusion. Effective and adherent HAART use is associated with a significantly reduced burden of HPV infection and SILs; this may help explain why rates of cervical cancer have not increased during the HAART era, despite greater longevity.