Recurrence of cervical intraepithelial neoplasia in human immunodeficiency virus-infected women treated by means of electrosurgical excision of the transformation zone (LLETZ) in Rio de Janeiro, Brazil

• Published in: São Paulo medical journal Vol. 131; no. 6; pp. 405 - 410
• Main Authors: Russomano, Fábio, Paz, Bruno Reis, Camargo, Maria José de, Grinstejn, Beatriz Gilda Jegerhorn, Friedman, Ruth Khalili, Tristao, Maria Aparecida Pereira, Oliveira, Caroline Alves
• Format: Journal Article
• Language: English
• Published: Brazil Associação Paulista de Medicina - APM 2013; Associação Paulista de Medicina
• Subjects: Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - drug therapy; Adult; Antiretroviral Therapy, Highly Active; Brazil - epidemiology; CD4 Lymphocyte Count; Cervical intraepithelial neoplasia; Cohort Studies; Colposcopy - methods; Electrosurgery; Electrosurgery - methods; Female; Follow-Up Studies; HIV; Humans; Incidence; Kaplan-Meier Estimate; MEDICINE, GENERAL & INTERNAL; Neoplasm Recurrence, Local; Recurrence; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Uterine Cervical Dysplasia - surgery; Uterine Cervical Neoplasms - surgery; Brazil; Recurrence; HIV; Cervical intraepithelial neoplasia; Cohort studies; Electrosurgery; Estudos de coortes; Neoplasia intra-epitelial cervical; Eletrocirurgia. Recidiva
• ISSN: 1806-9460; 1806-9460
• DOI: 10.1590/1516-3180.2013.1316578

Human immunodeficiency virus (HIV)-infected women have higher incidence, prevalence, persistence and recurrence of pre-invasive cervical lesions (CIN II or III). The aim here was to investigate the risk of recurrence of CIN II/III among HIV-infected women (HIV+) and uninfected women in a cohort treated by means of large-loop excision of the transformation zone (LLETZ).
Cohort study conducted at Instituto Fernandes Figueira/Fundação Oswaldo Cruz (IFF/Fiocruz).
60 HIV+ and 209 HIV-negative patients were included in a cohort for follow-up after undergoing LLETZ to treat CIN II/III. A histopathological diagnosis of CIN II/III during the follow-up was taken to constitute recurrence. The following possible confounding variables were assessed: age at treatment and at end of follow-up; histological grade of intraepithelial disease treated; surgical margin involvement; adequacy of colposcopy during the follow-up; CD4+ lymphocyte count; HIV viral load; and type of antiretroviral therapy.
Among the 60 HIV+ women, six showed recurrent disease during the follow-up. However, among the 209 HIV-negative women, seven showed a new precursor lesion. The relative risk of disease recurrence in the HIV+ women was 4.21 (95% CI = 1.42 to 12.43). The Kaplan-Meyer curve showed that the risk of recurrence was significantly higher among HIV+ women (log-rank test: P = 0.0111).
The HIV+ women in our cohort presented a risk of CIN II/III recurrence at least 42% higher than among the HIV-negative women. These patients should form part of a rigorous screening and follow-up protocol for identification and appropriate treatment of cervical cancer precursor lesions.