Persistent or recurrent cervical dysplasia in women with HIV after treatment for high-grade dysplasia in Botswana.

Abstract

Objective: To determine histopathologic outcomes 1 year after loop electrosurgical excision procedure (LEEP) for CIN2/CIN3 in women living with HIV on antiretroviral therapy (ART) in Botswana and assess whether a 12-month follow-up interval is appropriate.

Methods: This was a prospective cohort study of women with HIV who previously underwent LEEP for confirmed CIN2/CIN3. Participants underwent follow-up approximately 12  months later, either through Ministry of Health or a standardized sub-study protocol, with colposcopy or visual inspection with acetic acid (VIA) and tissue sampling performed per clinical algorithm. The primary outcome was histopathologically confirmed CIN2+ at follow-up. Associations between clinical factors, demographics, and CIN2+ were evaluated; chi-square and two-sample T -test were used to compare data and risk ratios were calculated.

Results: Of 127 eligible participants, 90 attended follow-up at a median of 16 months (IQR 13-20). Almost all were on ART with a mean CD4 + cell count of 728 (SD ± 310) cells/μl. Of 66 participants with histopathology results, 29% had CIN2+ and one participant had invasive cancer. Positive endocervical margins at baseline were associated with increased risk of CIN2+, while age, time on ART, and CD4 + cell count were not. Follow-up interval of at least 24  months was associated with more than double the risk of CIN2+ at follow-up (crude risk ratio 2.3, 95% confidence interval 1.1-4.7).

Conclusion: In a cohort of women with HIV on ART, 29% had persistent/recurrent CIN2+ at follow-up. Follow-up interval and endocervical margin status were the strongest predictors. These data support the WHO recommendation for a 12-month follow-up interval in women living with HIV who are well controlled on ART.