AIDS (London, England) · 2025
Cervical dysplasia in women with HIV in the modern treat-all era: elevated risk remains despite long-term ART and normal CD4 + cell count.
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Luckett Rebecca, Ramogola-Masire Doreen, Zash Rebecca, Sears Ellen, Lan Jessie, Gompers Annika, Modest Anna, Moloi Thabo, Harris Devon A, Joshi Avina, Gutfreund Rachel, Moyo Sikhulile, Kashamba Thanolo, Kula Maduke, Dreyer Greta, Masheto Gaerolwe, Botha Matthys H, Hacker Michele R, Shapiro Roger L
Аннотация
OBJECTIVE: To evaluate the impact of antiretroviral therapy (ART) duration and CD4 + cell count on risk for high grade cervical dysplasia in women with HIV (WWH) compared to women without HIV in the treat-all era with integrase strand inhibitors (INSTIs).
DESIGN: A prospective longitudinal cohort study in Botswana.
METHODS: From February 2021 to July 2022, baseline HPV self-sampling was offered to women with and without HIV. Those HPV+ underwent biopsy for histopathological diagnosis. Using women without HIV as reference, risk ratios were calculated for HPV, cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+), and CIN3+, stratified by ART duration and CD4 + cell counts.
RESULTS: Of 3000 women enrolled, 2953(98.4%) underwent HPV testing, which was positive in 823(55.7%) WWH and in 654(44.3%) women without HIV. Histopathology was available for analysis in 1291(87.4%) women (709 WWH, 582 women without HIV). Over 99% of WWH had an undetectable HIV viral load and 94.4% were on a dolutegravir-based ART regimen. WWH had a higher risk of HPV [risk ratio 1.27, 95% confidence interval (95% CI): 1.18-1.37], CIN2+ (risk ratio 1.52, 95% CI: 1.16-1.98), and CIN3+ (risk ratio 1.75, 95% CI: 1.25-2.45) compared to women without HIV. There was attenuation of risk for CIN2+ with higher recent CD4 + cell count, and those with higher nadir CD4 + cell count had similar risk to those without HIV (nadir CD4 + ≥500 CIN2+ risk ratio 1.15 [95% CI: 0.56-2.37], CIN3+ risk ratio 1.81 [95% CI: 0.86-3.79]; nadir CD4 + 350-499 CIN2+ risk ratio 1.23 [95% CI: 0.71-2.12], CIN3+ risk ratio 1.34 [95% CI: 0.68-2.64]).
CONCLUSION: Although some attenuation of risk for CIN2+ was observed with higher recent and nadir CD4 + cell counts, WWH continue to have a higher risk of CIN2+/CIN3+ compared to women without HIV. These findings support tailored cervical screening algorithms for WWH.
DESIGN: A prospective longitudinal cohort study in Botswana.
METHODS: From February 2021 to July 2022, baseline HPV self-sampling was offered to women with and without HIV. Those HPV+ underwent biopsy for histopathological diagnosis. Using women without HIV as reference, risk ratios were calculated for HPV, cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+), and CIN3+, stratified by ART duration and CD4 + cell counts.
RESULTS: Of 3000 women enrolled, 2953(98.4%) underwent HPV testing, which was positive in 823(55.7%) WWH and in 654(44.3%) women without HIV. Histopathology was available for analysis in 1291(87.4%) women (709 WWH, 582 women without HIV). Over 99% of WWH had an undetectable HIV viral load and 94.4% were on a dolutegravir-based ART regimen. WWH had a higher risk of HPV [risk ratio 1.27, 95% confidence interval (95% CI): 1.18-1.37], CIN2+ (risk ratio 1.52, 95% CI: 1.16-1.98), and CIN3+ (risk ratio 1.75, 95% CI: 1.25-2.45) compared to women without HIV. There was attenuation of risk for CIN2+ with higher recent CD4 + cell count, and those with higher nadir CD4 + cell count had similar risk to those without HIV (nadir CD4 + ≥500 CIN2+ risk ratio 1.15 [95% CI: 0.56-2.37], CIN3+ risk ratio 1.81 [95% CI: 0.86-3.79]; nadir CD4 + 350-499 CIN2+ risk ratio 1.23 [95% CI: 0.71-2.12], CIN3+ risk ratio 1.34 [95% CI: 0.68-2.64]).
CONCLUSION: Although some attenuation of risk for CIN2+ was observed with higher recent and nadir CD4 + cell counts, WWH continue to have a higher risk of CIN2+/CIN3+ compared to women without HIV. These findings support tailored cervical screening algorithms for WWH.