Objective: Our purpose was to determine the rates of recurrence, persistence, and progression of cervical intraepithelial neoplasia in women who were seropositive for human immunodeficiency virus ...after excisional therapy with and without highly active antiretroviral therapy. Study Design: The records of 118 women with cervical intraepithelial neoplasia, 56 of whom were infected with human immunodeficiency virus and 62 of whom were not infected, were examined to compare outcomes. Demographic, behavioral, and clinical indices were analyzed. Results: Of 54 women infected with human immunodeficiency virus, 31 (57.4%) had persistent or recurrent cervical intraepithelial neoplasia, in comparison with 10 (16.7%) of 60 noninfected women (P <.01). Progression occurred in 4 (16.7%) of 54 in the infected group and in 3 (5.0%) of 60 in the noninfected group (P <.05). In 21 (60.0%) of 35 infected women, in comparison with 8 (32%) of 25 noninfected women, disease persisted 6 months after diagnosis if treatment was not given (P <.05). Of 19 infected women, 10 (52.6%) had recurrent disease after treatment, compared with 2 (5.7%) of 35 noninfected women (P <.01). Risk factors for recurrence in women who were seropositive for human immunodeficiency virus included margin involvement of specimens obtained by loop electrosurgical excision (87.5% vs 20.0%l; P <.05). Exposure to highly active antiretroviral therapy, including therapy with protease inhibitors, was associated with a lower recurrence or persistence rate (17.6% vs 70.3%; P <.05) and a lower progression rate (0% vs 24%; P <.05). Conclusion: Women infected with human immunodeficiency virus had high rates of recurrent and persistent cervical intraepithelial neoplasia despite standard therapy. Low CD4+ levels and margin involvement of specimens obtained by loop electrosurgical excision are risk factors for recurrence. The use of highly active antiretroviral therapy is associated with a lower risk of recurrence, persistence, and progression of cervical intraepithelial neoplasia. (Am J Obstet Gynecol 2001;184:538-43.)
Objective: The purpose of this study was to determine whether the progression of low-grade squamous intraepithelial lesions of the cervix in women with the human immunodeficiency virus can be ...predicted reliably by standard cytologic testing. Study Design: As part of a previously reported trial, 288 biopsy specimens were collected from 117 women with the human immunodeficiency virus. These specimens underwent central and local interpretation, which were compared and correlated with cytologic results. Ninety-two subjects had matched cytologic/histologic pairs at study termination, which were compared to determine whether cytologic testing was predictive of progression. Results: Of the central histologic interpretations, 26 of 288 interpretations (9%) differed from local results, 97 of 246 cytologic/histologic pairs (39%) were discordant, and 21 subjects had progression to high-grade squamous intraepithelial lesions by histologic evidence. Cytologic testing showed high-grade squamous intraepithelial lesions in 4 of 21 specimens (sensitivity, 19%). The remaining cytologic specimens were either low-grade squamous intraepithelial lesions or were normal. Conclusion: This substudy of pathologic results from a randomized clinical trial suggests that, although the risk of progression of low-grade squamous intraepithelial lesions is low, follow-up cytologic testing is unreliable. Colposcopic evaluation with directed biopsies should be continued.
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Background: HAART has been demonstrated effective at maintaining immunocompetence (as measured in part by CD4 levels) and reducing the occurrence and severity of cervical cancer in ...HIV-infected women. Conversely, rapid disease progression, poor treatment response and the development of multiple cancers has been associate with suboptimal HIV therapy and low CD4 counts. Methods: 17 HIV-infected women presenting to an inner-city, academic medical center from 1996-2016 were diagnosed with cervical cancer and at least one other HPV-associated cancer. Data recorded include: year of diagnosis and treatment for cervical cancer; the type, year of diagnosis and treatment of subsequent HPV-associated cancers; compliance with HAART and CD4 counts at diagnosis and death (if applicable). Results: 15/17 (88.2%) used HAART and had CD4 counts > 200 at cervical cancer diagnosis. The time from diagnosis of cervical cancer to a second HPV-associated cancer was 0-19 years, with 52.9% developing a second cancer within 3 years. Second cancer diagnoses included vulvar(9), vaginal(2), anal(3), oropharyngeal(1), urethral(1), and bladder/urethral(1). Seven patients developed third cancers: anal(3), oropharyngeal(3), vaginal(1). Conclusions: Despite the effective use of HAART, HIV-infected women appear to be at risk for the development of multiple cancers following a diagnosis of cervical cancer, even years to decades later. Screening for HPV-associated cancers (including oropharyngeal) should therefore be maintained and emphasized, even in highly compliant subjects with adequate CD4 levels.
A report from the journal Science Education focusing on the Harrison and Treagust article Learning about Atoms, Molecules, and Chemcial Bonds: A Case Study.
This column summarizes a paper by Susan M. Land entitled Cognitive Requirements for Learning with Open-Ended Learning Environments (Educational Technology Research and Development 2000 48, 61-78), ...which discusses the cognitive demands on learners imposed by three important components of computer simulations. For each of these components, Land describes the cognitive demands placed on the learner, the problems associated with these demands, and the consequent implications for design of simulations and other OELEs that assist a learner in developing the skills necessary to meet the demands.
To estimate the incidence and severity of bone loss in menopausal women diagnosed with cancer who receive treatment with chemotherapy. Also, to evaluate the use of bone loss prevention agents in this ...population.
A total of 25 postmenopausal women with newly diagnosed cancers who received chemotherapy for a minimum of six cycles were enrolled in this pilot study. All subjects underwent baseline bone mineral density (BMD) testing of the lumber spine (LS), left hip (LH), and femoral neck (FN). Of the 25 women, 22 also underwent follow-up BMD testing at 6 months.
The median age of the subjects was 61 years (range 41-76 years) and the median age of menopause was 50 years (range 34-55 years). Of the 25 subjects, 9 used at least 1 g oral calcium daily, 4 used alendronate, 2 used raloxifene, and 1 used oral estrogen. The mean BMDs (g/cm2) with standard deviation above or below the mean for young adult women at baseline were: LS 0.996 (-0.5 SD), LH 0.876 (-0.5 SD), and FN 0.760 (-0.7 SD). The following values were obtained at 6 months: LS 0.965 (P<0.001), LH 0.847 (P<0.001), and FN 0.739 (P=0.009).
Menopausal women diagnosed with cancer appear to have a high incidence of baseline bone loss, with significant additional loss during treatment. Use of agents for prevention/treatment of bone loss in this group is infrequent. A prospective, controlled analysis is indicated to determine the optimal utility of bone densitometry testing and osteoporosis prevention strategies in this population.
: We previously identified sperm protein 17 (Sp17) as a normal testicular protein aberrantly expressed in a proportion of multiple myeloma (MM). However, recent studies have generated controversies ...on the normal tissue expression of Sp17 and whether or not it is a suitable target for immunotherapy. In this study, we have used a combination of real time polymerase chain reaction and immunohistochemistry on a large panel of normal tissues. Although Sp17 transcripts could be detected in some normal tissues, the levels of expression were <2% of those in normal testis. In contrast, Sp17+ myeloma cells expressed 3–18% of normal testis levels of Sp17 transcript. Immunohistochemistry using two Sp17 murine monoclonal antibodies, each directed at a non‐overlapping B‐cell epitope, showed Sp17 protein to be expressed only in testis and not any other normal tissues. Specificity of binding of the antibodies to testis was also confirmed in competitive binding assays. Our results therefore further suggest Sp17 as a cancer‐testis antigen in MM and support its suitability as a target for immunotherapy.
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