|
Excisional therapy outcomes for cervical intraepithelial neoplasia (CIN) in a South African population with high HIV prevalence
Presented by Priya Batra (United States).
P. Batra1, L. Kuhn2, L. Denny3
1Columbia University College of Physicians and Surgeons, New York, United States, 2Columbia University College of Physicians and Surgeons, Gertrude H. Sergievsky Center, New York, United States, 3University of Cape Town, Health Sciences Faculty, Department of Obstetrics and Gynaecology, Cape Town, South Africa
Background: Cervical cancer is the most common cancer among South African women, and is known to be more aggressive and refractory to treatment among HIV-infected women. We investigated treatment outcomes of cervical intraepithelial neoplasia (CIN) excision in a large population of women referred for colposcopy from Cape Town and surrounding areas.
Methods: A retrospective review of patient charts and pathology databases at the Groote Schuur Hospital colposcopy clinic was conducted. Data captured included: demographics, cervical cancer risk factors, cytology (Pap) results and histological diagnoses. The sample included all new patients referred from the community for a Pap abnormality from 2006-2008.
Results: The records of 2031 women were reviewed. The median age was 35 years and 50.3% were HIV-positive. Half (51.3%) of the HIV-positive women were receiving highly-active antiretroviral therapy (HAART). 494 women underwent large loop excision of the transformation zone (LLETZ) for treatment of CIN and returned for follow-up. Treatment failure was defined as persistent low-grade CIN or higher-grade Pap at 4 months and occurred among 30.2% of women. Women who were HIV-positive were more likely to fail (45.0%) than HIV-negative women (16.8%), p< 0.0001. Among HIV-positive women, treatment failure occurred among 51.8% who were receiving HAART and 37.1% who were not receiving it (p=0.0335). Involvement of LLETZ excision margins was also associated with failure. Age, use of injectable progestin contraception and histological grade of lesion were not associated with treatment outcome.
Conclusions: Over half of women referred for colposcopy in Cape Town were HIV-positive, suggesting that Pap screening efforts may be targeting these women. LLETZ treatment was more likely to fail among HIV-positive women and outcomes were not improved among those receiving HAART. Cervical cancer prevention guidelines may need to be revised to address the special needs of HIV-infected women and to achieve better population-wide screening coverage.
|