Research

Cervical intra-epithelial neoplasia in HIV-positive women after excision of transformation zone – does the grade change?

Firdousi Kabir, Cyril van Gelderen, James McIntyre, Pam Michelow, Dianne Turton, Yasmin Adam

Abstract


Objective. After previously reporting the presence of disease by cytology findings after treatment for cervical intra-epithelial neoplasia (CIN) in 64.6% of HIV-infected women and in 13.0% of HIV-negative women, we aimed to determine the severity of cytological disease after treatment in HIV-infected women.

Methods. We studied HIV-infected (N=571) women treated at the Colposcopy Clinic at Chris Hani Baragwanath Hospital, Gauteng, between April 2003 and December 2006. We compared the initial histology results with Pap smears ≥6 months later, and evaluated factors associated with reduction in the grade of disease.

Results. Mean age was 36.68 (SD+7.33) years; mean parity was 2 (SD+1.46); mean CD4+ count was 242.70 cells/mm3 (SD+187.56); 262 (45.80%) were receiving antiretroviral treatment. Persistent disease was detected on the repeat Pap smear in 199 (65.03%); of these, 223 (72.88%) were of a lesser grade than in the original histology results. Of the 152 with histologically confirmed CIN3, 67 (44.08%) had improved to a lesser grade, and 54 (44.63%) had normal cytology results. Among the latter two subject groups (n=141) who had CIN2 histologically, 91 (64.53%) had improved, 29 (20.57%) remained unchanged, and 20 (14.88%) had CIN3; 13 (4.25%) patients with CIN1 returned for follow-up; 11 (84.62%) of these had normal Pap smears and 2 (15.38%) had CIN3.

Conclusion. Recurrences were of a lesser degree than initial histology results. This reduction in the grade of disease was related to CD4+ count, complete excision and parity. Antiretroviral therapy use did not improve outcome, perhaps owing to low initial CD4 counts.

Authors' affiliations

Firdousi Kabir, Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg

Cyril van Gelderen, Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg

James McIntyre, Anova Health Institute, Johannesburg, and School of Public Health, University of Cape Town

Pam Michelow, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, and National Health Laboratory Services, Johannesburg

Dianne Turton, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, and National Health Laboratory Services, Johannesburg

Yasmin Adam, Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg

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Keywords

Cervical intraepithelial neoplasia; squamous intraepithelial lesion; HIV; Persistence; Recurrence;South Africa.

Cite this article

South African Medical Journal 2012;102(9):757-760. DOI:10.7196/SAMJ.5050

Article History

Date submitted: 2011-06-05
Date published: 2012-08-06

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