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OBJECTIVE: We sought to estimate rates of progression and regression of grad e 1 cervical intraepithelial neoplasia (CIN 1) among women with human immunodefici ency virus (HIV). METHODS: In a multicenter prospective cohort study, HIV-serop ositive and HIV-seronegative women were evaluated colposcopically after receivi ng an abnormal cytology test result between November 1994 and September 2002. Wo men with CIN 1 were included, except those who had undergone hysterectomy, cervi cal therapy, or had CIN 2-3 or cervical cancer. Those women who were included w ere followed cytologically twice yearly, with colposcopy repeated for atypia or worse. RESULTS: We followed 223 women with CIN 1 (202 HIV seropositive and 21 HI V seronegative) for a mean of 3.3 person-years. Progression occurred in 8 HIV- seropositive women (incidence density, 1.2/100 person-years; 95%confidence int erval [CI] 0.5-2.4/100 person-years) and in no HIV seronegative women. Regress ion occurred in 66 (33%) HIV-seropositive women (13/100 person-years, 95%CI 10-16/100 person-years) versus 14 (67%) seronegative women (32/100 person-ye ars, relative risk 0.40, 95%CI 0.25-0.66; P < .001). In multivariate analysis, regression was associated with human papillomavirus ( HPV) detection (hazard ratio [HR] for low risk 0.28, 95%CI 0.13-0.61, P=.001; and for high-risk 0.34,95%CI 0.20-0.55, P < .001 versus no HPV detected) and Hispanic ethnicity (HR 0.48, 95%CI 0.23-0.98; P = .04); HIV serostatus was onl y marginally linked to regression (HR 0.52, 95%CI 0.27-1.03; P=.06), but serop ositive women were less likely to regress when analysis was limited to 146 women with HPV detected at CIN 1 diagnosis (HR 0.18, 95%CI 0.05-0.62; P = .006). CO NCLUSION: Grade 1 cervical intraepithelial neoplasia infrequently progresses in women with HIV. Thus, observation appears safe absent oilier indications for tre atment.
METHODS: In a multicenter prospective cohort study, HIV-serop ositive and HIV-seronegative women were evaluated colposcopically after receivi ng an abnormal cytology test result between November 1994 and September 2002. Wo men with CIN 1 were included, except those who had undergone hysterectomy, cervi cal therapy, or had CIN 2-3 or cervical cancer. Those women who were included w ere followed cytologically twice yearly, with colposcopy repeated for atypia or worse. RESULTS: We followed 223 women with CIN 1 (202 HIV seropositive and 21 HI V seronegative) for a mean of 3.3 person-years. Progression occurred in 8 HIV-seropositive women (incidence density, 1.2 / 100 person-years; 95% confidence int erval [CI] 0.5-2.4 / 100 person-years) and in no HIV seronegative women. seropositiv e women (13/100 person-years, 95% CI 10-16 / 100 person-years) versus 14 (67%) seronegative women (32/100 person-ye ars, relative risk 0.40, 95% CI 0.25-0.66; P <.001). In multivariate analysis, regression was associated with human papillomavirus (HPV) detection (hazard ratio [HR] for low risk 0.28, 95% CI 0.13-0.61, P = .001; and for high-risk 0.34, 95% CI 0.20-0.55, P <.001 vs. no HPV detected) and Hispanic ethnicity (HR 0.48, 95% CI 0.23-0.98; P = .04); HIV serostatus was onl y marginally linked to regression (HR 0.52, 95 % CI 0.27-1.03; P = .06), but seropositive women were less likely to regress when analysis was limited to 146 women with HPV detected at CIN 1 diagnosis (HR 0.18, 95% CI 0.05-0.62; P = .006 ). CO NCLUSION: Grade 1 cervical intraepithelial neoplasia infrequently progresses in women with HIV. Thus, observations appeared safe absent oilier indications for tre atment.