THE EFFECT OF HAART ON CERVICAL DYSPLASIA IN HIV INFECTED WOMEN

D Money¹, C Hankins^2,3, A Rachlis⁴, F Coutlee⁵, W Wobeser⁶, K Pourreaux², J-O Shu², and the Canadian Women's HIV Study Group
¹Oak Tree Clinic, Children's and Women's Health Centre of British Columbia and the Department of Obstetrics and Gynecology, University of British Columbia; ²Direction de la santé publique de Montréal-Centre;³Department of Epidemiology and Biostatistics, McGill University and Institut de santé publique du Québec; ⁴Sunnybrook Health Science Centre; ⁵Centre hospitalier de l'Université de Montréal; ⁶Queen's University

Objectives: To determine the effect of HAART on the regression of cervical dysplasia in HIV infected women.
Method: Women participating in the Canadian Women's HIV Study (CWHS) have pap smears and HPV sampling performed at 6 monthly intervals. All participating women have baseline questionnaires with 6 month follow up questionnaires focusing on demographics, HIV status, virologic status and use of HAART. All women with dyskaryosis were eligible for this analysis. To calculate progression, regression or no change in dysplasia and persistence in HPV, results were compared for 2 consecutive visits called Time_t (index visit) and Time_t+1.
Results: Of the total cohort (743 women), PAP results were received for 643, of which 129 (20%) had dyskariosis. 103/129 women had follow up data for analysis resulting in 120 events (Time_t + Time_t+1). 94/120 (78%) had LSIL at Time_t, 25 began with HSIL, and 1 event started with cervical cancer. 74/120 (61.7%) regressed, 5 (4.2%) progressed and 41(34.2%) persisted. HAART was used in 34 events (28.3%) between Time_t and Time_t+1. Regressors were more likely to be on HAART than progressors and persistors combined (36.5 vs 15.2% - p=0.01). They were also more likely to have CD4 counts below 500 (80.6 vs 37.8% - p<0.0001). HPV was found in 103 (93.6%) of women with dyskariosis and persistence of high risk HPV types was detected in 69/96 (71.9%) of samples at Time_t. Regressors were less likely to have persistent high risk HPV types (64 vs 87.5% - p=0.02).
Conclusions: In this cohort of HIV infected women with dyskaryosis, HAART was associated with regression despite co-existing immune suppression. Further analysis is required to tease out the influence of positive factors among regressors such as lower levels of persistence of high risk HPV types known to be associated with cervical cancer.

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