# Spontaneous Regression of Cervical Low-Grade Squamous Intraepithelial Lesions in the Northern Thai Population: Impact of Human Immunodeficiency Virus Infection on Regression Rates and Predictors

## TL;DR

This study found that HIV-positive women in Northern Thailand are less likely to experience spontaneous regression of cervical low-grade lesions compared to HIV-negative women.

## Contribution

The study identifies HIV status and CD4 count as predictors of spontaneous regression of cervical LSIL in a Northern Thai population.

## Key findings

- HIV-positive women had a significantly lower rate of spontaneous regression of LSIL compared to HIV-negative women.
- A CD4 count above 500 cells per μL was associated with spontaneous regression in HIV-positive women.
- Active surveillance and treatment are recommended for HIV-positive women to reduce disease progression risk.

## Abstract

Background/Objectives: Low-grade squamous intraepithelial lesions (LSILs) of the cervix are known to have the ability to regress spontaneously. However, in cases where the patient is human immunodeficiency virus (HIV)-positive and has a weakened immune system, the ability to eliminate abnormal cells from the cervix may be impaired. The aim of this study was to determine whether there is an association between the spontaneous regression of histological LSIL and the HIV status of the patient by evaluating baseline characteristics and CD4 count. Methods: Women with a diagnosis of cervical histological LSIL were included. We analyzed the correlation between a group of women with LSIL who experienced complete spontaneous regression and those who did not regress based on factors such as HIV status, basic characteristics, and baseline Pap smear. As part of the surveillance program, all the women underwent a Papanicolaou (Pap) smear test every 6 months. Results: A total of 127 women were evaluated. The results showed that a higher percentage of women with HIV belonged to the non-regression group compared to the complete regression group ((51.35% vs. 26.67%) p = 0.007). After controlling for other factors, the multivariable analysis revealed that HIV-negative women were more likely to experience spontaneous regression of cervical LSIL than women with HIV [HR = 2.54, 95% confidence interval 1.31–4.49, p = 0.006)]. Conclusions: Cervical histological LSIL had a lower capacity for spontaneous regression in women with HIV. For women who wish to lower their risk of persistent or worsening disease associated with their HIV status, it may be beneficial to undergo active surveillance coupled with additional active treatment or surgery. A CD4 count of over 500 cells per μL is associated with the spontaneous regression of LSIL in women with HIV.