Cervical SIL Drugs Less Effective in HIV Patients

SEATTLE—The standard treatments for cervical squamous intraepithelial lesions (SIL) are significantly less effective in HIV-infected women than in HIV-uninfected women, according to the results of a study presented at the 9th Conference on Retroviruses and Opportunistic Infections (abstract LB16).

"About half of HIV-infected women will develop cervical SIL. However, little is known about the natural history of, or the best way to manage, SIL in these women," said Thomas C. Wright, MD, associate professor of pathology, Columbia University.

The study included 122 HIV-infected women and 257 HIV-uninfected women with biopsy-confirmed SIL.

Women with low-grade SIL were randomly assigned to observation or cryotherapy. Women with high-grade SIL were randomly assigned to cryotherapy or loop electrosurgical excision procedure (LEEP). Women with unsatisfactory colposcopic examinations underwent cold-knife or LEEP conization.

Cervical cytology and/or histology was reassessed after a mean of 10 and 11 months in HIV-infected and HIV-uninfected women, respectively.

In women with low-grade SIL assigned to observation, the rate of spontaneous regression to normal cervical cytology or histology was significantly lower in HIV-infected women than in HIV-uninfected women (24% vs 61%), but the rate of progression to biopsy-confirmed high-grade SIL did not differ significantly between the two groups (4% vs 9%).

All three SIL treatment modalities were markedly less effective in the HIV-infected women. In women with low-grade SIL who underwent cryotherapy, the percentage of women with normal cervical cytology or histology at follow-up was significantly lower in HIV-infected women than in HIV-uninfected women (56% vs 95%).

The difference was also significant in women with high-grade SIL who underwent cryotherapy (29% vs 93%) or LEEP (42% vs 85%) and in women with unsatisfactory colposcopic examinations who underwent conization (45% vs 86%). In the HIV-infected women, failure rates for the three treatment modalities did not differ significantly.

The findings indicate that currently used treatment modalities for SIL are less effective in HIV-infected women than in HIV-uninfected women and that there is no evidence that any of the three treatment modalities is more effective than the others in HIV-infected women, Dr. Wright said. The findings also argue against aggressive treatment for women with low-grade SIL.

"The high failure rate of treatment for low-grade SIL and the low rate of progression to high-grade SIL in the absence of treatment suggest that conservative observation should be considered in managing biopsy-confirmed low-grade SIL in HIV-infected women," Dr. Wright concluded.