Transcript n=53 on HAART - International AIDS Society

Anal and Cervical Cytologic Abnormalities
among HIV-Infected Women on HAART Remain
Prevalent at 12 months in the Study to
Understand the Natural History of HIV/AIDS in
the Era of Effective Therapy (SUN Study)
Erna Milunka Kojic, Susan Cu-Uvin, Lois Conley, Tim Bush,
Elizabeth R. Unger, Keith Henry, John Hammer, E.
Turner Overton, Teresa Darragh, John T. Brooks
The findings and conclusions in this presentation have not been formally
disseminated by the Centers for Disease Control and Prevention and should
not be construed to represent any agency determination or policy
Study to Understand the
Natural History of HIV/AIDS in
the Era of Effective Therapy (SUN)
• 5-year prospective observational cohort study
• 682 adults at 7 clinics in 4 U.S. cities
• HAART only or no treatment for HIV
• Monitor complications of treatment and prolonged survival,
morbidity and mortality related to HIV infection
• Testing at baseline and every six months, including anal and
cervical HPV typing and cytology
Minneapolis
Providence
Denver
St. Louis
Demographics (n=53 on HAART)
Age, years: mean (range)
Race/Ethnicity:
39 (23-59)
n
(%)
White, non-Hispanic
17 (32)
Black, non-Hispanic
27 (51)
Hispanic
6 (11)
Other/unknown
3 ( 6)
Nadir CD4 cell count (cells/µl)
Baseline CD4 cell count (cells/µl)
171
465
Hormonal birth control history
32 (60)
Smoking, history
27 (51)
Smoking current
22 (42)
HPV Prevalence
p < 0.001
p < 0.001
100%
90%
80%
70%
87
92
83
60%
90
83
67
71
73
71
50%
50
40%
52
48
30%
20%
10%
0%
All Types
Baseline
All Types
12-month
High-Risk High-Risk
Baseline 12-Month
Low-Risk
Baseline
Low-Risk
12-month
Anus
Cervix
Cytology
Prevalence (n=53 on HAART)
Cervical cytology
N=53
Anal cytology
N=53
Baseline
cytology
Baseline
n (%)
12 month
n (%)
Baseline
n (%)
12 month
n (%)
Normal
38 (72)
35 (66)
35 (66)
36 (68)
Abnormal
15 (28)
18 (34)
18 (34)
17 (32)
22 women had abnormal
cervical cytologies at baseline or
12 months
24 women had abnormal anal
cytologies at baseline or
12 months
Cytology
(n=53 on HAART)
Anus
Cervix
Anus baseline
Cervix baseline
72%
9%
66%
2% 15%
21%
11%
4%
Normal
ASC
Cervix 12 months
Low-SIL
High-SIL
Anus 12 months
66%
8%
67%
13%
19%
21%
6%
Cytology
Persistence (n=53 on HAART)
12 Month cervical cytology
N=53
Baseline
cytology
Normal
Abnormal
12 Month anal cytology
N=53
Normal
Abnormal
Normal
27/38
71%
11/38
29%
26/35
74%
9/35
26%
Abnormal
8/15
53%
7/15
47%
10/18
56%
8/18
44%
HPV and Anal Sex
Risk for Detection of Prevalent HPV
• At baseline, history of any anal sex was reported
by 36 (40%) women
• No significant difference between women
reporting a history of anal sex compared with
women who did not
Any HPV
detected
Self – reported anal sex
p-value
Yes
No
Anal HPV+
86%
89%
0.73
Cervical HPV+
79%
86%
0.54
Conclusions
• In HIV-infected women on HAART, HPV infection of the anus and
the cervix remains prevalent
• In this cohort of HIV-infected women on HAART, about one-third
had abnormal cytology in the cervix and anus at both baseline
and 12 months
• Almost half of the women with abnormal anal and cervical
cytology at baseline remained abnormal at 12 months
• There is no difference in HPV-related cytologic abnormalities
between women who report a history of anal sex and those who
do not
• There is a need to further elucidate the clinical significance of
anal HPV infection in HIV infected women
SUN Study Sites and Laboratories
CDC/ Division of HIV/AIDS Prevention
John T. Brooks
Lois Conley
Tim Bush
Cerner Corporation
Kathleen Wood
Rose Baker
Cheryl Lapierre
Hennepin County Medical Center (Minneapolis)
Keith Henry
Ellen Kane
Abbott-Northwestern Hospital (Minneapolis)
Frank Rhame
Jenny Dahlke
Brian Goodroad
Park-Nicollet Institute (Minneapolis)
Hal Martin
Meaghan Morton
Miriam Hospital (Providence)
Charles Carpenter
Susan Cu-Uvin
Kenneth Mayer
Milu Kojic
Jennifer Florczyc
Washington University School of Medicine (St. Louis)
Kristin Mondy
E. Turner Overton
Lisa Kessels
Denver Infectious Disease Consultants (Denver)
John Hammer
Barbara Widick
Cheryl Stewart
Sarah Kressy
University of Colorado Health Science Center ( Denver)
Kenneth Lichtenstein
CDC/ Division of Viral and Rickettsial Diseases
Elizabeth Unger
Ruth Ann Tucker
Kara Duncan
David Swan
END
Inclusion Criteria
 Documented HIV infection
 Age > 18 years
 Attended > 2 consecutive visits at clinic in the
preceding year
 Expected to receive care at clinic for > 2 years
 Limited antiretroviral (ARV) exposure:
 If < 30 days total prior ARV exposure
• CD4 100-500
 If > 30 days total prior ARV exposure
• Only received HAART and only since
July 1, 1997
• CD4 > 100
Most Prevalent High-Risk HPV Types
in Anus and Cervix at Baseline
35
Percent
25
16
53
45
Cervix
Anus
52
20
15
10
5
0
16 18 26 31 33 35 39 45 51 52 53 56 58 59 66 67 68 69 70 73 82 IS39
High-risk HPV types
Most Prevalent High-Risk HPV Types
in Anus and Cervix at 12 Months
53
Percent
25
20
45
16
18
Cervix
Anus
52
73
35
15
10
5
0
16 18 26 31 33 35 39 45 51 52 53 56 58 59 66 67 68 69 70 73 82 IS39
High-risk HPV types