1. Risk factors for cervical intraepithelial neoplasia recurrence after loop electrosurgical excision procedure in HIV-1-infected and non-infected women
Maria Inês Miranda LIMA (1)
Victor Hugo MELO (2)
Celso Pedro TAFURI (1)
Luiza Miranda LIMA (3)
Angela Cristina Labanca ARAÚJO (1)
Mark Drew Crosland GUIMARÃES (1)
(1) School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
(2) Belo Horizonte City Health Department
(3) Medical Science School of Medicine

2. Background CERVICAL CANCER:
High incidence of Cervical Cancer in Brazil
(22/100,000 women in 2005)
Cervical Intraepithelial Neoplasia (CIN) is a precursor of cervical cancer and is highly associated with HPV infection
Early Dx of CIN can prevent new cases of CC
(Cytology, Colposcopy, Biopsy)
LEEP (Electrosurgical Excision Procedure) has been extensively used in Brazil

3. Background AIDS epidemic in Brazil (up to 2005: 370,000 cases)
Women
Heterosexual transmission
Lower income and education
HIV – Cervical cancer:
Higher incidence of CIN and CC among HIV positive women
Evidence of higher incidence of recurrence of CIN among HIV positive women
There is no published data in Brazil regarding recurrence of CIN comparing HIV positive and negative women

4. Objective
To assess factors associated with recurrence of cervical intraepithelial neoplasia after conization by LEEP in HIV infected and non-infected women

5. Methods Colposcopy Biopsy DYNAMIC COHORT STUDY Population:
Public Cervical Pathology Referral Service, Belo Horizonte, Brazil
Referred from other public primary care units or HIV services
Screening criteria:
Abnormal cytology (Bethesda,1999) OR
Normal cytology with Positive Schiller test
Colposcopy
Biopsy

6. Methods Elegibility criteria for LEEP: Age > 18 years old
Informed consent
Dx of Cervical Intraepithelial Neoplasia (CIN):
HSIL lesions or persistent LSIL lesions for HIV negative women
HSIL or LSIL for HIV positive women
Exclusions:
Pregnant women
Other Dx: Cervicitis, Invasive Cancer, Micro-invasive Cancer

7. Methods Recurrence of CIN: First recurrence Cytology and Colposcopy
If abnormal or normal with positive Schiller test
Biopsy:
HSIL lesions or persistent LSIL lesions

8. Methods Statistical analysis:
Cox Proportional Hazard Model (Univariate and Multivariate)
Kaplan-Meier Survival Curves
Variables of interest: HIV status, Histology, Glandular involvement, Margins, Number of sex partners, Age, Smoking Hx, HPV, Viral Load and CD4+ Cell count.

10. Results n ( % ) or Mean SCREENED AND BIOPSIED 206 (100)
EXCLUDED ( 2)
PARTICIPANTS ( 98)
BIOPSIED DURING FOLLOW-UP ( 36)
Cumulative incidence ( 20)
Incidence / 1,000 women-months
Mean number of visits
Mean Time of follow-up (Median) (18.6)

11. Results Variable n (%) Age (> 35y.o.) 126 (63)
Number of lifetime partners (< 6) 142 (71)
Smoking Hx (34)
HIV Positive (47)
Cytology (HSIL) (31)
Biopsy (HSIL) (57)
Histopathology (HSIL) (64)
Positive margins (24)
Glandular involvement (10)

17. Results: Multivariate Analysis
Variable RH (95% CI) p-Value
HIV Status (Pos) (1.38 – 6.48)
Glandular involvement (1.71 – 7.01)
Positive Margin (1.05 – 3.98)
RH=Relative Hazard

18. Positive margins and glandular involvement
Normal Duct
Positive margin
Positive margin
Glandular involvement

19. Conclusions
The incidence of CIN recurrence in this population is high.
HIV infection, positive margins and glandular involvement are independent co-factors.
More careful follow-up of these women is necessary, specially among HIV positive ones.
Histopathology indicates HPV infection in over 95%.
However, PCR is recommended for sub-typing and is currently under way.
Adherence to ARVT and Viral load will be further explored among HIV positive women.