Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts WePpB2093-WePpB2096 33

WePpB2093 Favorable impact of virological response to
HAART on AIDS related non-Hodgkin's
lymphomas
J.T. Navarro', J.M. Ribera2, A. Oriol 2, J.L. Mate3, J. Romeu4, G. Siera4,
F. Milla2, E. Feliu2. 1Hospital Universitari Germans Trias i Pujol, Badalona,
Spain; 2Hematology Dept., Hospital Universitari Germans Trias i Pujol;
3Pathology Dept., Hopspital Universitari Germans Trias i Pujol; 4HIV Unit
Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Background: The use of highly active antiretroviral therapy (HAART) for the treatment HIV infected patients has changed the natural history of AIDS. Recent studies carried out in AIDS-related lymphomas (ARL) have shown improvements in
the response and outcome of these patients.
Objective: To study the influence of HAART on the outcome of ARL and the possible influence of the virological response to HAART on complete response (CR)
rate and survival.
Patients: From our series of ARL treated with CHOP two groups of patients
were studied: 1) 44 patients who did not take HAART when the lymphoma
was diagnosed, and 2) 26 patients treated with HAART concomitantly and after
chemotherapy.
Results: There were 4 (9%) women in group 1 versus 11 (42%) in group 2
(P=0.01), and no other differences were found between these groups. The response rate to CHOP was higher in group 2 (15 out of 23, 65%) than in group 1
(16 out of 44, 36%) (P=0.025). The factors associated with improvement of CR
in the multivariate analysis were HAART (P= 0.004) and International Prognostic Index (IPI) score  2 (P=0.006). Among group 2 patients, those with
a virological response to HAART and with IPI score  2 had better response rate to chemotherapy (odds ratios 9.3 and 11.8). The median (95% CI)
overall survival (OS) for group 1was 7 (3-11) months, whereas it has not been
reached for group 2 (P=0.002). The only parameters influencing OS in the multivariate analysis were HAART (P=0.003), as a protective factor and IPI score >
2 (P=0.015) with negative influence. Among patients treated with HAART, those
with virological response had higher OS probability (P=0.004), whereas those
with IPI score > 2 had an unfavourable prognosis (P=0.014). The only variable
with statistical significance for disease free survival (DFS) in the univariate and
multivariate analyses was HAART (P=0.0168 and P=0.028).
Conclusions: HAART is an independent prognostic factor for CR attainment, OS
and DFS in patients with ARL treated with CHOP. Those patients with virological
response to HAART had a better survival.
Presenting author: Jose-Tomas Navarro, Hospital Germans Trias i Pujol., Ctra.
de Canyet s/n, 08916 Badalona, Universitat Autonoma de Barcelona, Spain, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePpB2094 HIV related lung cancer in the pre and post HAART
era
T. Powles, M. Nelson, S. Mandalia, B.G. Gazzard, M. Bower. Chelsea &
Westminster Hospital, London, United Kingdom
Background: HAART has lead to a decrease in the incidence of both Kaposi's
sarcoma and non Hodgkin's lymphoma. However little is known about its impact
on lung cancer, which is more common in HIV compared to age matched controls.
Since 1986, clinical data on 8,636 HIV-positive patients, representing 36,158 patient years of follow up, has been prospectively collected in our unit, 10 patients
have developed lung cancer. See table below.
Conclusion: Patients with HIV and lung cancer present with advanced disease
and have a poor outcome. This small study suggests the incidence of the disease
may be rising in the HAART era, despite improved immune function.
Presenting author: Tom Powles, Chelsea and Westminster Hospital, Fulham
Road, London, SW10 9NH, United Kingdom, Tel.: [phone], Fax: +208 746
8537, E-mail: [email protected]
WePpB2095 The efficacy of standard treatment modalities for
cervical squamous intraepithelial lesions in
HIV-infected compared to uninfected women
T.C.W. Wright', T.J.B. Bush2, D.S. Sawo', L.J.C. Conley2, F.W. Wu',
T.V.E. Ellerbrock2. Columbia University New York, United States; 2Centers for
Disease Control, Atlanta, GA, United States
Background: About half of HIV-infected women will develop cervical squamous

intraepithelial lesions (SIL). However, little is known about the natural history of,
or the best way to manage, SIL in these women.
Methods: A total of 122 HIV-infected and 257 uninfected women with biopsyconfirmed SIL were enrolled in a multi-arm clinical trial. Women with satisfactory
colposcopic exams and low-grade SIL (LoSIL) were randomized to either observation or cryotherapy, while those with high-grade SIL (HiSIL) were randomized to
cryotherapy or a loop electrosurgical excision procedure (LEEP). Women with unsatisfactory colposcopic exams had either a cold-knife or LEEP diagnostic conization. Follow-up exams including colposcopy, cervical cytology, and, if indicated,
cervical biopsy, were performed at 4-month intervals for up to 12 months.
Results: Mean length of follow-up was 10 and 11 months for HIV-infected and
uninfected women, respectively Cervical disease status at last visit is presented
below.

Clinical Group
LoSIL-observation
LoSIL-cryotherapy
HiSIL-cryotherapy
HiSIL-LEEP
HiSIL-cone

HIV-uninfected
No. Normal LoSIL HiSIL
70 61% 30% 9%
64 95% 5% -
41 93% 5% 2%
46 85% 11% 4%
36 86% 8% 6%

HIV-infected
No. Normal LoSIL HiSIL
25 24% 72% 4%
25 56% 40% 4%
7 29% 43% 29%
12 42% 33% 25%
53 45% 30% 25%

All treatments were highly effective in HIV-uninfected women, but significantly less
so in infected women (all p<0.01). Failure rates of cryotherapy, LEEP, and cone
biopsy were similar in HIV-infected women (p=0.63).
Conclusions: All standard treatments for SIL are significantly less effective in
HIV-infected, compared to uninfected, women, and no single treatment appears
to be more effective in HIV-infected women. The high failure rate of treatment for
LoSIL and the low rate of progression to HiSIL with no treatment suggests that
conservative observation should be considered in managing biopsy-confirmed
LoSIL in HIV-infected women.
Presenting author: Lois Conley, 1600 Clifton Rd, Atlanta, GA 30333, United
States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePpB2096 Correlates of recurrent cervical dysplasia in HIV+
women after excisional treatment
J. Keller, C. Sewell, C. Trimble, J. Lee, J. Anderson. Johns Hopkins University,
600 n wolfe st, baltimore, maryland, United States
Background: This study evaluates cervical dysplasia (CD) recurrence rates after
excisional treatment and correlation with CD4 count, viral load (VL), antiretroviral
treatment and pathology results.
Methods: Retrospective review of 53 HIV+ women between 1992 and 2001 with
cervical conization (CC) or large loop excision of the transformation zone (LLETZ)
for CD with at least 6 month follow up (f/u) with pap smear of biopsy. Summary
statistics, fishers exact, and chi-square were performed.
Results: Mean age at surgery: 34.4 years; Race: Black- 81%, White- 19%; HIV
risk: IDU 49%, Heterosexual 28%, other/unknown 23%. Excisional treatment: CC
62%, LLETZ 38%; Surgical pathology: High grade squamous lesion (HSL) 75%,
+ margins (n=38) 50%, + endocervical curretage (n=37) 22%. Median CD4 (f/u)
266/mm3; median VL (f/u) (n=52) 4070 c/ml; undetectable VL at f/u 45%. Mean f/u
time 798 days. Antiretroviral treatment at f/u (n=47) 70%. F/u pap/piopsy results:
normal 41%, atypical squamous cells or low grade lesion 38%, HSL 19%, atypical glandular cells 2%. Abnormal f/u was associated with VL (n=52) >400 c/ml
vs. <400 c/ml: 80% vs. 20%, (p=.001); and + vs. - surgical margins (n=38): 62%
vs. 38%, (p=.05). Normal f/u was associated with antiretroviral treatment vs. no
antiretrotroviral treatment (n=47); 86% vs. 14%, (p=.03). CD4 was not associated
with f/u.
Conclusion: Recurrent cervical dysplasia after excisional treatment was significantly associated with higher VL at f/u and positive margins on surgical pathology.
Antiretroviral treatment at f/u was associated with normal pap or biopsy. Optimal
HIV treatment may play a role in reducing the incidence of recurrent CD in HIV+
women.
Presenting author: jean keller, 600 n wolfe st, baltimore, maryland, United
States, Tel.: [phone], Fax: [phone], E-mail: [email protected]

Abstract WePpB2094 - Table
Pre HAART 1986 - 1996 Post HAART 1996-2001 1996 SE England data for HIV neg people
Patient follow up years 22,694 13.464
Lung cancer cases 3 7
Median age cases (range) 48 (41-61) yr 45 (31-58)yr 68 yr
Histology (% NSCLC) 100% 83% 71%
Cancer event rate/10,000 people/year (95% CI) 1.3 (0.3-3.9) 5.2 (2.1-10.7) 1.5 (age matched figures)
Stage IV disease 66% 100% 48%
Median pack years smoked 40 30
Median CD4 at diagnosis (range) 70 (50-320)/mm 3 342 (117-995)/mm 3
Median survival (range) 2 months (1-8) 2 months (1-14+) 7 months (for stage IV)
NSCL=non small cell lung cancer