***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The impact of highly active antiretroviral therapy ( HAART ) on the natural history of human papillomavirus ( HPV ) remains uncertain following conflicting reports . Prior studies , however , did not consider patients ' adherence to their regimens or HAART effectiveness ( viral suppression ) . METHODS Human immunodeficiency virus (HIV)-positive women ( N = 286 ) who initiated HAART during follow-up in a prospect i ve cohort were assessed semiannually for HPV infection ( by polymerase chain reaction ) and squamous intraepithelial lesions ( SILs ) . Adherence was defined as use of HAART as prescribed > or = 95 % of the time , and effective HAART was defined as suppression of HIV replication . The prevalence , incident detection , and clearance of HPV infection and /or SILs before versus after HAART initiation were compared ( using women as their own comparison group ) . RESULTS HAART initiation among adherent women was associated with a significant reduction in prevalence ( odds ratio , 0.60 [ 95 % confidence interval { CI } , 0.44 - 0.81 ] ; P = .001 ) , incident detection of oncogenic HPV infection ( hazard ratio [ HR ] , 0.49 [ 95 % CI , 0.30 - 0.82 ] ; P = .006 ) , and decreased prevalence and more rapid clearance of oncogenic HPV-positive SILs ( HR , 2.35 [ 95 % CI , 1.07 - 5.18 ] ; P = .03 ) . Effects were smaller among nonadherent women . The associations of HPV infection and /or SILs with HAART effectiveness were fairly similar to those with HAART adherence . CONCLUSION Effective and adherent HAART use is associated with a significantly reduced burden of HPV infection and SILs ; this may help explain why rates of cervical cancer have not increased during the HAART era , despite greater longevity Objective . To describe outcomes after treatment of cervical intraepithelial neoplasia ( CIN ) in women with HIV . Material s and Methods . Women in two prospect i ve cohort studies , the Women 's Interagency HIV Study ( WIHS ) and the HIV Epidemiology Research Study ( HERS ) , were followed every 6 months after treatment of CIN using human papillomavirus ( HPV ) testing and cytology with colposcopy as indicated . Identification of CIN or a squamous intraepithelial lesion ( SIL ) within 6 months was defined as treatment failure and later disease as recurrence . Results . Follow-up was available for 170 HIV-seropositive and 15 HIV-seronegative women .  Treatment failed in 84 ( 45 % ) women ( 79 HIV seropositive and 5 HIV seronegative ) . Failure was more likely in women with lower CD4 counts ( CD4 < 200 cells/&mgr;L : odds ratio [ OR ] = 2.96 ; 95 % CI = 1.4 - 6.2 ) and detectable HPV DNA ( OR 8.20 ; 95 % CI = 1.8 - 37.4 ; p = .01 ) . After successful treatment , recurrence-free probabilities at 1,2 , 3 , and 5 years were .79 , .64 , .49 , and .34 , respectively . HIV-seronegative women were less likely to recur than HIV-seropositive women ( p = .03 ) . In multivariable analysis of HIV-positive women , recurrence was more likely among women treated for CIN 2,3 ( hazard ratio [ HR ] = 2.4 ; 95 % CI = 1.4 - 4.8 ) , those with CD4 count of less than 200 cells/&mgr;L ( HR = 2.9 ; 95 % CI = 1.3 - 6.5 ) and those with HPV after treatment ( HR 2.9 ; 95 % CI = 1.4 - 6.1 ) ; oncogenic HPV was more strongly associated with recurrence than nononcogenic HPV ( ptrend = .009 ) . Most failures and recurrences were low grade , but one adenocarcinoma was diagnosed 4.2 years after therapy for CIN 1 . Conclusion . Treatment failure and recurrence are common in women with HIV but are usually low grade BACKGROUND Cervical cancer is the leading cause of cancer mortality among women in India . Because Pap smear screening is not feasible in India , we need to develop effective alternatives . METHODS A cluster-r and omized controlled study was initiated in 1998 in Mumbai , India , to investigate the efficacy of visual inspection with acetic acid ( VIA ) performed by primary health workers in reducing cervical cancer mortality . Four rounds of cancer education and VIA screening were conducted at 24-month intervals in the screening group , whereas cancer education was offered once at entry to the control group . The study was planned for 16 years to include four screening rounds followed by four monitoring rounds . We present results after 12 years of follow-up . Poisson regression method was used to calculate the rate ratios ( RRs ) ; two-sided χ(2 ) was used to calculate the probability . RESULTS We recruited 75360 women from 10 clusters in the screening group and 76178 women from 10 comparable clusters in the control group . In the screening group , we achieved 89 % participation for screening and 79.4 % compliance for diagnosis confirmation . The incidence of invasive cervical cancer was 26.74 per 100000 ( 95 % confidence interval [ CI ] = 23.41 to 30.74 ) in the screening group and 27.49 per 100000 ( 95 % CI = 23.66 to 32.09 ) in the control group . Compliance to treatment for invasive cancer was 86.3 % in the screening group and 72.3 % in the control group . The  screening  group showed a statistically significant 31 % reduction in cervical cancer mortality ( RR = 0.69 ; 95 % CI = 0.54 to 0.88 ; P = .003 ) . CONCLUSIONS VIA screening by primary health workers statistically significantly reduced cervical cancer mortality . Our study demonstrates the efficacy of an easily implementable strategy that could prevent 22000 cervical cancer deaths in India and 72600 deaths in re source -poor countries annually OBJECTIVES : To estimate the safety , tolerability , and acceptability of loop electrosurgical excision procedure ( LEEP ) for cervical intraepithelial neoplasia ( CIN 2 or 3 ) in human immunodeficiency virus (HIV)–positive women performed by nonphysician health care providers in an HIV care and treatment clinic . METHODS : We performed a prospect i ve cohort study among women undergoing LEEP for biopsy-confirmed CIN 2 or 3 at the Family Acquired Immunodeficiency Syndrome Care and Education Services Clinic in Kisumu , Kenya . Women were followed-up 4 weeks after the procedure and question ed for abstinence as well as presence and severity of side effects after the procedure . The results were analyzed using descriptive statistics and univariable and multivariable analysis . RESULTS : Among the 180 ( 91 % ) women who returned for a 4-week follow up after LEEP , 52 % reported at least one postprocedure symptom , including bleeding , discharge , or pain . Using a Likert scale for severity of symptoms , 179 ( 99 % ) reported very mild to mild symptoms , whereas one ( 1 % ) participant described the symptoms as moderate . No participants reported severe symptoms . Mean CD4 + count was significantly higher among women who reported any symptoms compared with women who reported no symptoms after LEEP ( 419 cells/mm3 compared with 349 cells/mm,3 P<.05 ) , an association that remained significant after adjustment for antiretroviral treatment . The presence or severity of postprocedure symptoms did not differ among women who reported sexual activity ( 16 % ) less than 4 weeks after the procedure . CONCLUSION : LEEP performed by clinical officers was well-accepted by HIV-positive women and appears safe , result ing in minimal side effects , even among women with early resumption of intercourse . LEVEL OF EVIDENCE : Objective : To determine the impact of HAART on incidence , regression , and progression of cytopathological abnormalities in HIV-infected women . Design : Prospect i ve cohort . Methods : HIV-infected women ( N = 1123 ) from Soweto , South Africa underwent serial cervical smears  that were analyzed and reported using the Bethesda System . The results of HAART and non-HAART users were compared using two statistical approaches : a survival analysis assessing risk of incident smear abnormality among women with baseline normal smear results ; and analysis with marginal models assessing for an association between HAART use and likelihood of regression/progression in consecutive smears . Results : After multivariate survival analysis , women using HAART with a normal baseline smear were 38 % less likely to have an incident smear abnormality during follow-up than nonusers [ confidence interval ( CI ) 0.42–0.91 ; P = 0.01 ] . Multivariate marginal models analysis identified a significantly increased likelihood ( odds ratio 2.61 ; CI 1.75–3.89 ; P < 0.0001 ) of regression of cervical lesions among women on HAART . Conclusion : Our large prospect i ve cohort study adds significant weight to the side of the balance of clinical research supporting the positive impact of HAART on the natural history of human papillomavirus-related cervical disease in HIV-infected women OBJECTIVES To evaluate the recurrence rates of cervical intraepithelial neoplasia ( CIN ) in a cohort of HIV-infected and noninfected women who underwent the loop electrosurgical excision procedure ( LEEP ) .  METHODS A prospect i ve cohort study of 94 HIV-positive and 107 HIV-negative women , both with CIN , treated with LEEP .  The diagnosis of recurrence was established after biopsy . The Kaplan-Meier method was used for survival analysis and multivariate analyses were carried out using the Cox proportional hazards regression model . RESULTS There was a predominance of low- grade lesions in HIV-positive compared with HIV-negative women ( P<0.01 ) . Recurrence was more frequent with compromised margins and gl and ular involvement ( P<0.01 ) . A multivariate analysis showed that HIV-infection , gl and ular involvement , and positive margins were independently associated with recurrence of lesions . CONCLUSIONS Recurrence rate of CIN in HIV-positive women was higher than in HIV-negative women . The factors associated with recurrence were HIV infection , gl and ular involvement , and positive margins The objective of this study was to evaluate the treatment outcomes and complications in human immunodeficiency virus (HIV)–infected women undergoing loop electrosurgical excision procedure ( LEEP ) for cervical neoplasia . The medical record of 60 evaluable HIV-infected women who had abnormal Papanicolaou ( Pap ) smear and underwent LEEP following colposcopy at Chiang Mai University Hospital between May 1998 and June 2004 was review ed . Thirty-one ( 51.7 % ) had associated genital infection at screening . Twenty-five ( 41.7 % ) had opportunistic infection , but only 18 ( 30.0 % ) were treated with antiretroviral therapy . The most common abnormal Pap smear was high- grade squamous intraepithelial lesion ( 46.7 % ) , followed by low- grade squamous intraepithelial lesion ( 40.0 % ) . Forty ( 66.7 % ) women had clear surgical margins after LEEP . Only one ( 1.7 % ) woman had severe intraoperative hemorrhage . Early and late postoperative hemorrhage were noted in three ( 5 % ) women of each period . Localized infection of the cervix was detected in seven ( 11.7 % ) women . Two ( 3.3 % ) women developed cervical stenosis at 6 months after LEEP . There was no significant difference in overall complications between HIV-infected women and the control group ( P = 0.24 ) . Among 60 HIV-infected women , no statistical difference in the rate of margins involvement ( P = 1.00 ) and complications ( P = 0.85 ) could be demonstrated between HIV-infected women who received antiretroviral therapy and those who did not . Disease-free rate at 6 and 12 months were 97.1 % and 88 % , respectively . These data demonstrated that LEEP appears to be safe and effective in HIV-infected women Objective . To compare the treatment outcome of cervical intraepithelial neoplasia ( CIN 2,3 ) on HIV-infected and uninfected women treated by cryotherapy or loop electrosurgical excision procedure ( LEEP ) . Methods . A total of 147 women were recruited into the study between April 1997 and May 1998 .  Cryotherapy was performed in 75 women and LEEP in 72 women after r and omization . Results . A total of 109 ( 74.1 % ) women tested positive and 38 ( 25.9 % ) tested negative for HIV-1 . At 12 months follow-up visit 
    Output:
    
Dysplasia prevalence and recurrence were higher among HIV-infected compared with HIV-uninfected women but morbidity from treatment was similar .