Comparative analysis of cervical disease progression in HIV positive women receiving ART and those not receiving ART in Cape Town, South Africa, from 2002 to 2011

Human papilloma virus (HPV) has been shown to be a necessary cause for the development of cervical cancer. Cervical cancer is a progressive disease, going through pathologically distinct stages ranging from normal cytology to malignancy. Precancerous lesions (low and high grade squamous epithelial lesions (SIL)) are detectable and treatable. In addition, women who are infected with human immunodeficiency virus (HIV) have been shown to be more likely to be infected with HPV than their HIV negative counterparts. Cervical cancer precancerous lesions have also been shown to be more commonly detected in HIV positive than in HIV negative women. Cervical cancer is classified as an acquired immunodeficiency syndrome (AIDS)-defining illness. The advent of antiretroviral therapy (ART) has seen an increase in the life span of HIV positive women. The use of ART has also seen a decline in the incidence of other AIDS-defining illnesses, such as Kaposi sarcoma and non-Hodgkin's lymphoma. Thus, a reduction in the incidence of cervical cancer among HIV positive women using ART is expected. However, the research thus far has been controversial, with some studies showing an increase in the incidence of cervical cancer in HIV positive women, others showing a decrease and still others showing no difference in the incidence. The aim of this project was to determine the incidence of precancerous lesions in HIV positive women receiving ART and to compare this to HIV positive women who are not receiving ART. Four hundred HIV positive women were enrolled into the MACH (Management of abnormal cytology in HIV-positive women) study from two primary health care clinics and one colposcopy clinic, in Cape Town, South Africa. Enrolment into the study was dependent on cervical screening naivety. At the time of enrolment, ART was not available to these women. However, as ART was rolled out in South Africa, women meeting ART eligibility criteria (at the time, CD4 count ≤ 200 cells/ml) were started on ART. Women were followed up at 6 monthly ...