Do human immunodeficiency virus-positive postmenopausal women on highly active antiretroviral therapy show reduced cervical atrophy

Abstract

Background It has been anecdotally observed that postmenopausal Human Immunodeficiency Virus (HIV) infected women on Highly Active Antiretroviral Therapy / combined antiretroviral therapy (cART) show a lesser degree of cervical epithelial atrophy on cervical Papanicolaou (Pap) smears than is expected in women of this age group. There is currently no literature to support or discredit this observation. Aim The aim of this study is to determine whether postmenopausal HIV positive females on cART show reduced cervical atrophy than expected in the postmenopausal state. Materials and methods Routine Pap smears from postmenopausal HIV positive women submitted to the NHLS Braamfontein Cytology department from Helen Joseph Themba Lethu Clinic, over a four year period, were assessed by use of the Maturation Index to determine whether the epithelium was predominantly atrophic or mature. iv Results Of a total of 135 smears, 50% were predominantly mature, which is a significantly larger proportion to what is expected in postmenopausal women. Although not statistically significant, 52% on cART were predominantly mature while 38% not on cART were predominantly immature. There was a significant difference in maturation between the women who started cART before the onset of menopause compared to those who were initiated after menopause. There was no statistically significant trend with CD4 count, duration of cART use, cART regimen, and duration of menopause. Conclusion With the advent of cART, HIV-infected individuals are expected to live longer and the number of HIV-infected postmenopausal women will increase. Thus it is important to determine the effects of HIV and cART on the cervix. This study reveals less than expected atrophy in HIV infected women, especially those who were started on cART before menopause.