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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.
- Source :
- Clinical Infectious Diseases; Jun2018, Vol. 66 Issue 11, p1778-1784, 7p
- Publication Year :
- 2018
-
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. [ABSTRACT FROM AUTHOR]
- Subjects :
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Volume :
- 66
- Issue :
- 11
- Database :
- Complementary Index
- Journal :
- Clinical Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 129723090
- Full Text :
- https://doi.org/10.1093/cid/cix1096