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- Title
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.
- 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
- 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.
- Subjects
KENYA; HIV infection genetics; HIV infection transmission; HIV infections; THERAPEUTICS; INFECTIOUS disease transmission; ANTIRETROVIRAL agents; TREATMENT of cervical intraepithelial neoplasia; BIOLOGICAL assay; CERVICAL intraepithelial neoplasia; CERVIX uteri; COLD therapy; ELECTROSURGERY; HIV-positive persons; MATHEMATICS; POSTOPERATIVE period; RISK management in business; RNA; HUMAN sexuality; RANDOMIZED controlled trials; GENETICS; DIAGNOSIS; DISEASE risk factors
- Publication
Clinical Infectious Diseases, 2018, Vol 66, Issue 11, p1778
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cix1096