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Objective. We assessed the association of cigarette smoking with the effectiveness of highly active antiretroviral therapy (HAART) among low-income women. Methods. Data were analyzed from the Women’s Interagency HIV Study, a multisite longitudinal study up to 7.9 years for 924 women representing 72% of all women who initiated HAART between July 1, 1995, and September 30, 2003. Results. When Cox’s regression was used after control for age, race, hepatitis C infection, illicit drug use, previous antiretroviral therapy, and previous AIDS, smokers on HAART had poorer viral responses (hazard ratio [HR]=0.79; 95% confidence interval [CI]=0.67, 0.93) and poorer immunologic response (HR=0.85; 95% CI=0.73, 0.99). A greater risk of virologic rebound (HR=1.39; 95% CI=1.06, 1.69) and more frequent immunologic failure (HR=1.52; 95% CI=1.18, 1.96) were also observed among smokers. There was a higher risk of death (HR=1.53; 95% CI=1.08, 2.19) and a higher risk of developing AIDS (HR=1.36; 95% CI=1.07, 1.72) but no significant difference between smokers and nonsmokers in the risk of death due to AIDS. Conclusions. Some of the benefits provided by HAART are negated in cigarette smokers.

Objectives. We sought to describe the reproductive health of adolescent girls perinatally infected with HIV. Methods. We estimated the incidence of first pregnancy, genital infections, and abnormal cervical cytology for 638 girls aged 13 years and older in the Pediatric AIDS Clinical Trials Group protocol 219C. Results. Thirty-eight girls became pregnant, for a first pregnancy rate of 18.8/ 1000 person-years; 7 of these girls had additional pregnancies (95% confidence interval [CI]=13.3, 25.7). Thirty-two pregnancies resulted in live births. All girls received antiretroviral therapy during pregnancy. One infant was HIV infected, 29 were uninfected, and 2 had unknown infection status, for a rate of mother-to-child transmission of HIV in infants with known infection status of 3.3% (95% CI=0.1, 18.6). Condylomata and trichomoniasis were the most frequent genital infections. Forty-eight (47.5%) of 101 girls with Papanicolaou test examinations had abnormal cervical cytology, including atypical cells of undetermined significance (n=18), low-grade squamous intraepithelial lesions (SIL; n=27), and high-grade SIL (n=3). Many abnormalities persisted despite intervention. Conclusions. Pregnancy rates were lower and cervical abnormalities were higher than among non–HIV-infected adolescents. These findings underscore the importance of Papanicolaou tests and promotion of safer sexual practices in this population.

We would like to thank Woo and Sterling1 for their suggestion of alternative or complementary modes of transmission for the genital condylomata that we observed in young girls enrolled in the Pediatric AIDS Clinical Trials Group protocol 219C who had been perinatally infected with human immunodeficiency virus.2 We speculated that these cases of genital condylomata might have occurred through perinatal transmission of the human papilloma virus (HPV), transmission of HPV through sexual activity, or through sexual abuse, the latter of which was identified as the likely cause of HPV infection in 31% of 55 children following a retrospective review of clinical data.3 We did not discuss the possibility of nonsexual, postnatal transmission of HPV as raised by Woo and Sterling. Indeed, close nonsexual contact and self-inoculation are possible modes of HPV transmission, and should have been included. Unfortunately, HPV typing was not collected in protocol 219C, and we were unable to include these findings as discussed in our paper.2 However, we were able to correlate the presence of genital condylomata at a young age with the occurrence of abnormal cervical cytology during adolescence. A total of 4 of 23 girls with genital condylomata documented before 13 years of age had subsequent cervical Papanicolaou smears recorded in protocol 219C. All 4 of these girls had abnormal cervical cytology, 3 had low-grade squamous intraepithelial lesions, and 1 had abnormal cells of undetermined significance. The multiple potential modes of HPV transmission and frequency of childhood genital condylomata cases documented in this and other studies3,4 underscore the need for additional research in this area.