Women who are HIV positive are at increased risk for the development of abnormal growths on their cervix. In some cases, these growths may shrink or disappear without treatment. In other cases, the abnormal cells may become cancerous and spread.

In the time before highly active antiretroviral therapy (HAART), abnormal cervical growths were more likely to become pre-cancerous and grow relatively more quickly in HIV positive women than in women without HIV. Although the use of HAART has been able to prolong survival and decrease the risk of death due to common, life-threatening infections, its effect on cervical growths is less clear. To understand more about the impact of HAART on cervical growths, researchers at London's Royal Free Hospital conducted a study.

Study Details

Researchers recruited 71 HIV positive women with the following profile:

• average age: 32 years
• average CD4+ cell count: 162 cells
• average viral load: about 63,000 copies
• 41% had never previously used HAART (they were "treatment-naive")
• 39% were currently cigarette smokers
• 13% were ex-smokers

At the start of the study, all women received cervical exams, which consisted of Pap smears and colposcopies (and biopsies if abnormal cervical growths were detected). Those women who had abnormal cervical growths had them removed by means of a small electrical current. After completing their cervical exams, all of the women received HAART. Researchers reported results after collecting data for an average of about 10 months.

Results: Abnormal Cells

At the start of the study, researchers found that about 55% of the women had abnormal cells on their cervix. Ten months later, this figure increased to 62% but the change was not statistically significant. In 13% of the women, abnormal cervical growths shrank and disappeared without treatment (zapping them with an electrical current). In these women, CD4+ cell increases as a result of HAART were greater (143 cells) compared to increases among women whose lesions did not regress (38 cells). No other factor appeared to be related to the disappearance of abnormal cells.

In 15 women, doctors had to remove abnormal cervical growths because they were judged to be pre-cancerous.

Key Points

Overall, the results from this short-term study suggest that the use of HAART did not significantly alter the risk of women developing abnormal growths on their cervix.

It is possible that taking HAART for a period greater than 10 months is needed for the immune system to recover sufficient immunity in order to control the growth of abnormal cells on the cervix, but this theory needs to be tested. What is clear from this study is that HIV positive women who use HAART need regular gynecologic care and monitoring.

Reference

1. Moore A.L., Sabin C.A., Madge S., et al. Highly active antiretroviral therapy and cervial intraepithelial neoplasia. AIDS 2002;16(6):927-929.