Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting.

We conducted a cross-sectional study with 385 HIV-positive women in Bangkok to assess the prevalence and predictors of cervical abnormalities on Papanicolaou (Pap) smear. Low-grade squamous intraepithelial lesions (LSIL), high-grade SIL (HSIL) and invasive cervical cell cancer (ICC) were assessed by cytological examination after Pap smear and logistic regression models were used to assess associations with patient characteristics. Overall prevalence of LSIL, HSIL and ICC were 11.2% (95% confidence interval [CI] 8.2-14.7%), 4.7% (95%CI 2.8-7.3%) and 0.5% (95%CI 0.06-1.9%), respectively. In multivariate models, only the nadir CD4 count and income remained significantly associated with cytological abnormalities, whereas smoking, hormonal contraceptive or antiretroviral use, condom use, parity and number of lifetime sexual partners were not associated. The odds ratio for having cytological abnormalities was 2.6 (95% CI 1.24-5.34) in those with a nadir CD4 count <200 cells/mm3 compared with those with a higher nadir CD4 count, and 1.99 (1.11-3.57) in those with an income of <125 US dollars/month compared with those with higher incomes. In settings where access to affordable treatment is improving, this study reinforces the importance of regular Pap smear screening in HIV-positive women, particularly those with low nadir CD4 counts and lower incomes.

CD4-guided scheduled treatment interruptions compared with continuous therapy for patients infected with HIV-1: results of the Staccato randomised trial.

BACKGROUND: Stopping antiretroviral therapy in patients with HIV-1 infection can reduce costs and side-effects, but carries the risk of increased immune suppression and emergence of resistance. METHODS: 430 patients with CD4-positive T-lymphocyte (CD4) counts greater than 350 cells per muL, and viral load less than 50 copies per mL were randomised to continued therapy (n=146) or scheduled treatment interruptions (n=284). Median time on randomised treatment was 21.9 months (range 16.4-25.3). Primary endpoints were proportion of patients with viral load less than 50 copies per mL at the end of the trial, and amount of drugs used. Analysis was intention-to-treat. This study is registered at ClinicalTrials.gov with the identifier NCT00113126. FINDINGS: Drug savings in the scheduled treatment interruption group, compared with continuous treatment, amounted to 61.5%. 257 of 284 (90.5%) patients in the scheduled treatment interruption group reached a viral load less than 50 copies per mL, compared with 134 of 146 (91.8%) in the continued treatment group (difference 1.3%, 95% CI-4.3 to 6.9, p=0.90). No AIDS-defining events occurred. Diarrhoea and neuropathy were more frequent with continuous treatment; candidiasis was more frequent with scheduled treatment interruption. Ten patients (2.3%) had resistance mutations, with no significant differences between groups. INTERPRETATION: Drug savings with scheduled treatment interruption were substantial, and no evidence of increased treatment resistance emerged. Treatment-related adverse events were more frequent with continuous treatment, but low CD4 counts and minor manifestations of HIV infection were more frequent with scheduled treatment interruption.

Mortality in the Swiss HIV Cohort Study (SHCS) and the Swiss general population.

Because of high death rates in the past, patients with HIV-1 cannot obtain life insurance. We measured mortality rates in the Swiss HIV Cohort Study (SHCS) from 1997 to 2001 and compared them with those of the Swiss reference population. In patients who were successfully treated with highly active anti-retroviral therapy (HAART), and who were not also infected with the hepatitis C virus, excess death rates were below five per thousand per year. Patients with successfully treated cancer have much the same excess death rates but are not excluded from life insurance policies.