The effect of HAART on cervical intraepithelial neoplasia in women with HIV: a systematic review

Objectives: to review studies on the effect of antiretroviral therapy on the short term incidence, prevalence, regression, recurrence and the progression rates of pre-malignant conditions of the cervix in women infected with HIV. Outcome measures: the effect of HAART therapy on the incidence, prevalence, regression, progression and recurrence rates of cervical intraepithelial neoclassic. Inclusion criteria: prospective or retrospective studies, either comparative or non-comparative, that present data on regression, progression, recurrence, incidence or prevalence rates of cytologically or histologically diagnosed cervical intraepithelial neoplasia Exclusion criteria: Studies with incomplete data for analysis were excluded Study population: HIV positive women receiving HAART. Comparative groups were: o HIV positive women with cervical intraepithelial neoclassic who had not been commenced on antiretroviral therapy o HIV positive women with cervical intraepithelial neoplasia on any other antiretroviral therapy other than the HAART combinations o HIV negative women with cervical intraepithelial neoplasia Materials and methods: a systematic review of studies with results on the effect of HAART on CIN was conducted. Electronic databases were searched; reference lists of identified studies were searched. Results: Seven studies were included in this review with a total of 1018 HIV infected women. The studies were carried out in three developed countries (America, France and Italy). Two studies assessed the effect of HAART on the prevalence rates of CIN, while the other five evaluated the effect of HAART on the recurrence, progression and regression rates of CIN. One study found a statistically significant decrease in prevalence rates with HAART use. One study showed a non-statistically significant decrease in the prevalence rates with HAART use. Three studies showed increased rates of regression rates with HAART use, one study showed that regression rates were comparable in all the groups and while one showed statistically significant increase in progression rates with HAART use. Conclusions: The question of the effect of HAART on CIN has not been adequately addressed by the studies in this review. The current recommendations of close cervical cancer screening surveillance in women infected with HIV should still be followed even in women on HAART until there is enough evidence to suggest otherwise. There is still a need to conduct large multicentre trials to address this question.