Surgery and HAART are an effective combination for treating HPV-associated lesions
Graham McKerrow HIV, i-Base
Data from an Italian study indicate that highly active antiretroviral therapy (HAART), per se, does not prevent the occurrence of high grade cervical and anal human papillomavirus (HPV) associated lesions but they do suggest that lesion excision in conjunction with an effective antiretroviral therapy achieves a good response in the majority of cases.
Annarosa Del Mistro and colleagues at Padua and Vincenza looked at the effect of ART on the natural history of HPV associated genital lesions in 201 HIV-positive women who were followed up for 16 years. HPV sequences in cervico-vaginal cells were repeatedly detected in 126 women; 29 had transient HPV infection. Genital lesions were found in 137 patients; prevalence was comparable in women on different regimens.
The authors report that regression of low grade lesions was more prevalent among patients receiving HAART than among those receiving other regimens. High grade lesions regressed in most cases regardless of ARV regimen. HPV infection persisted in nearly 80% of the women.
They also report that rates of anal lesions in a group of 98 men during the pre-HAART period were similar to those reported during the HAART era.
The authors write: “Our data indicate that patients with HIV infection benefit from surgical therapy when performed in conjunction with any antiretroviral therapy regimen.” They say their findings suggest that lesion excision in conjunction with an effective antiretroviral therapy achieves a good response in the majority of cases. And they add: “Moreover, early intervention also appears determinant in avoiding more extensive surgery such as abdominal hysterectomy, that involves an increased risk of complications in HIV-infected women.”
Del Mistro A, Bertorelle R, Franzetti M et al. Antiretroviral therapy and the clinical evolution of human papillomavirus-associated genital lesions in HIV-positive women. Clin Infect Dis. 2004 Mar 1;38(5):737-42. Epub 2004 Feb 18.