Increased Cervical Human Immunodeficiency Virus (HIV) RNA Shedding Among HIV-Infected Women Randomized to Loop Electrosurgical Excision Procedure Compared to Cryotherapy for Cervical Intraepithelial Neoplasia 2/3. (20th December 2017)

• Record Type: Journal Article
• Authors: Greene, Sharon A; McGrath, Christine J; Lehman, Dara A; Marson, Kara G; Trinh, T Tony; Yatich, Nelly; Nyongesa-Malava, Evans; Kiptinness, Catherine; Richardson, Barbra A; John-Stewart, Grace C; De Vuyst, Hugo; Sakr, Samah R; Mugo, Nelly R; Chung, Michael H
• Is Part Of: Clinical infectious diseases. Volume 66:Number 11(2018)
• Page Start: 1778
• Page End: 1784
• Publication Date: 2017-12-20
• Subjects: cervical cancer -- cervical HIV shedding -- HIV -- loop electrosurgical excision procedure (LEEP) -- cryotherapy; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/cix1096
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : Human immunodeficiency virus (HIV)–infected women with cervical intraepithelial neoplasia 2/3 randomized to loop electrosurgical excision procedure (LEEP) had higher mean cervical HIV RNA at 2 and 3 weeks after intervention compared to women treated with cryotherapy. Cervical HIV shedding after LEEP occurred both on and off antiretroviral therapy. Abstract: Background: Treatment of human immunodeficiency virus (HIV)–infected women to prevent cervical cancer may stimulate HIV RNA cervical shedding and risk HIV transmission. Methods: From 2011 to 2014, 400 HIV-infected women diagnosed with cervical intraepithelial neoplasia 2/3 in Kenya were randomized to loop electrosurgical excision procedure (LEEP) or cryotherapy. Cervical samples were collected at baseline and 3 weekly intervals. Samples were tested for HIV RNA using the Gen-Probe Aptima HIV assay with a minimum detection level of 60 copies/swab and analyzed using generalized estimating equations. Results: Women who received LEEP had significantly higher cervical HIV RNA levels than those who received cryotherapy at weeks 2 (adjusted incident rate ratio [aIRR], 1.07; P = .038) and 3 (aIRR, 1.08; P = .046). Within LEEP, significantly higher cervical shedding was found at weeks 2 (2.03 log10 copies/swab; P < .001) and 3 (2.04 log10 copies/swab; P < .001) compared to baseline (1.80 log10 copies/swab). Cervical HIV RNA was significantly higher following LEEP for up to 3 weeks among women on antiretroviral treatment (ART) (0.18 log10 copies/swab increase; P = .003) and in ART-naive women (1.13 log10 copies/swab increase; P < .001) compared to baseline. Within cryotherapy, cervical shedding increased in ART-naive women (0.72 log10 copies/swab increase; P = 0.004) but did not increase in women on ART. Conclusions: Women randomized to LEEP had a larger increase in post-procedural cervical HIV shedding than cryotherapy. Benefits of cervical cancer prevention outweigh the risk of HIV sexual transmission; our findings underscore the importance of risk-reduction counseling. Clinical Trials Registration: NCT01298596.