Table 2. Incidence of Recurrence of CIN Grade 2 or Higher and HSIL or More Severe Disease During 2-Year Follow-up by Baseline HIV Factors.
| Cryotherapy (n = 200) | LEEP (n = 200) | Absolute Difference per 100 Person-Years (95% CI) | P Value | |||||
|---|---|---|---|---|---|---|---|---|
| No. of Recurrences | Person-Years of Follow-up | Rate per 100 Person-Years (95% CI) | No. of Recurrences | Person-Years of Follow-up | Rate per 100 Person-Years (95% CI) | |||
| CIN Grade 2 or Highera | ||||||||
| Overall | 60 | 313.2 | 19.2 (14.9-24.7) | 37 | 329.9 | 11.2 (8.1-15.5) | −7.9 (−14.0 to −1.9) | .01 |
| Baseline ART use | ||||||||
| ≥2 y | 30 | 154.6 | 19.4 (13.6-27.8) | 24 | 178.6 | 13.4 (9.0-20.1) | −6.0 (−14.7 to 2.8) | .18 |
| <2 y | 21 | 113.2 | 18.5 (12.1-28.4) | 11 | 121.9 | 9.0 (5.0-16.3) | −9.5 (−19.1 to 0) | .05 |
| No ART | 9 | 45.3 | 19.8 (10.3-38.1) | 2 | 29.3 | 6.8 (1.7-27.3) | −13.0 (−29.1 to 3.0) | .16 |
| Baseline plasma viral load, copies/mL | ||||||||
| <60 | 31/123 | 203.7 | 15.2 (10.7-21.6) | 22/126 | 206.7 | 10.6 (7.0-16.2) | −4.6 (−11.5 to 2.4) | .20 |
| ≥60 | 28/72 | 101.0 | 27.7 (19.1-40.2) | 13/67 | 111.7 | 11.6 (6.8-20.0) | −16.0 (−28.2 to −4.0) | .01 |
| Baseline CD4 cell count, /μL | ||||||||
| <250 | 20 | 56.5 | 35.4 (22.8-54.9) | 7 | 52.1 | 13.4 (6.4-28.2) | −22.0 (−40.4 to −3.5) | .02 |
| 250-499 | 21 | 132.2 | 15.9 (10.4-24.4) | 15 | 135.1 | 11.1 (6.7-18.4) | −4.8 (−13.6 to 4.8) | .29 |
| ≥500 | 19 | 123.4 | 15.4 (9.8-24.1) | 15 | 142.1 | 10.6 (6.4-17.5) | −4.8 (−13.6 to 3.9) | .28 |
| HSIL or More Severe Diseaseb | ||||||||
| Overall | 74 | 296.2 | 25.0 (19.9-31.4) | 52 | 311.2 | 16.7 (12.7-21.9) | −8.0 (−15.6 to −1.0) | .03 |
| Baseline ART use | ||||||||
| ≥2 y | 35 | 144.9 | 24.2 (17.3-33.6) | 33 | 163.5 | 20.2 (14.4-28.4) | −4.0 (−14.5 to 6.6) | .46 |
| <2 y | 28 | 108.1 | 25.9 (17.9-37.5) | 15 | 117.9 | 12.7 (7.7-21.1) | −13.2 (−24.7 to −1.6) | .02 |
| No ART | 11 | 43.2 | 25.4 (14.1-45.9) | 4 | 29.9 | 13.4 (5.0-35.7) | −12.0 (−32.0 to 8.0) | .28 |
| Baseline plasma viral load, copies/mL | ||||||||
| <60 | 42/123 | 187.3 | 22.4 (16.6-30.3) | 29/126 | 197.4 | 14.7 (10.2-21.1) | −7.7 (−16.4 to 0.9) | .08 |
| ≥60 | 31/72 | 100.3 | 30.9 (21.7-43.9) | 19/67 | 104.9 | 18.1 (11.6-28.4) | −12.8 (−26.4 to 0.8) | .07 |
| Baseline CD4 cell count, /μL | ||||||||
| <250 | 22 | 54.5 | 40.3 (26.6-61.3) | 13 | 48.9 | 26.6 (15.4-45.8) | −13.8 (−36.0 to 8.5) | .24 |
| 250-499 | 29 | 121.9 | 23.8 (16.5-34.2) | 19 | 126.6 | 15.0 (9.6-23.5) | −8.8 (−19.7 to 2.2) | .12 |
| ≥500 | 23 | 118.7 | 19.4 (12.9-29.2) | 20 | 135.2 | 14.8 (9.5-22.9) | −4.6 (−14.8 to 5.6) | .38 |
Abbreviations: ART, antiretroviral treatment; CIN, cervical intraepithelial neoplasia; HSIL, high-grade squamous intraepithelial lesion; LEEP, loop electrosurgical excision procedure.
Cervical intraepithelial neoplasia is a histopathological diagnosis that describes the degree and extent of morphological changes in the cervical epithelial cells; CIN grade 2 indicates moderate changes and CIN grade 3 indicates more severe changes. Moderate to severe changes are more likely to progress to invasive cancer.
High-grade squamous intraepithelial lesions are detected by a screening examination of the squamous cells lining the cervix with a cytologic smear stained with the Papanicolaou technique. If cytoplasmic changes are observed, then a cervical biopsy is required to diagnose the extent of neoplasia.