Antiretroviral therapy and detection of high-grade cervical intraepithelial neoplasia (CIN2+) at post-CIN management follow-up among women living with HIV: A systematic review and meta-analysis

BACKGROUND: We evaluated the association of antiretroviral therapy (ART), CD4+ count and HIV plasma viral load (PVL) on high-grade cervical intraepithelial neoplasia (CIN2+) detection at follow-up after CIN management among women living with HIV (WLHIV). METHODS: Medline, Embase, Global Health and PubMed were searched from January 1, 1996 to January 15, 2020. Eligible studies investigated the association of ART, CD4+ count or HIV PVL on histology-confirmed CIN2+ detection at follow-up. Summary estimates were obtained using random-effects meta-analyses; heterogeneity was examined using I2 statistic. PROSPERO registration:CRD42018115631. RESULTS: Eight studies representing 9 populations were identified, including 1,452 WLHIV followed between 6 to 33 months post-CIN management. Pooled data from 8 populations (n=1,408) suggested weak evidence of a decreased risk of CIN2+ detection at follow-up among ART users compared to ART-naive women (crude odds ratio [cOR]=0.70, 95% CI: 0.36–1.36; I2=64.5%, p=0.006; adjusted risk ratio [aRR] from 3 studies=0.66, 95%CI: 0.20–2.24; I2=78.7%, p=0.009). A significant association was observed in high-income countries (cOR=0.24, 95%CI: 0.13–0.45; I2=0.0%, p=0.77) but not in low and middle-income countries (cOR=1.13, 95%CI: 0.67–1.92; I2=18.8%, p=0.30).In three populations, ART users with HIV PVL <50 copies/ml were less likely to have CIN2+ detection at follow-up (vs. >/=50 copies/ml: cOR=0.55, 95%CI: 0.32–0.94; I2=0.0%, p=0.23).There was weak evidence of decreased CIN2+ detection at follow-up among WLHIV with higher contemporary CD4+ cell counts (>/=200 cells/microl vs. <200 cells/microl [cOR=0.36, 95%CI: 0.04–3.13; I2=81.3%, p=0.021]) and significant evidence among women with a higher nadir CD4+ count (>/=350 cells/microl vs. <200 cells/microl [adjusted hazard ratio [aHR]=0.35, 95%CI: 0.15–0.84; I2=0%, p=0.64]). CONCLUSION: ART may reduce the risk of CIN2+ detection at follow-up; this effect is most likely enhanced by a combination of adequate HIV control and excisional CIN treatment. Our findings support recommendations of early ART and the integration of CIN2+ screening and management into HIV care

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Co-morbidities
  • Cancer
  • Other