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Impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on HIV ‐1 genital shedding: a prospective cohort study
Author(s) -
Huchko MJ,
Woo VG,
Liegler T,
Leslie H,
SmithMcCune K,
Sawaya GF,
Bukusi EA,
Cohen CR
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12258
Subject(s) - cervical intraepithelial neoplasia , medicine , prospective cohort study , viral load , sex organ , cohort , viral shedding , loop electrosurgical excision procedure , human immunodeficiency virus (hiv) , gynecology , cervical cancer , obstetrics , immunology , cancer , virus , biology , genetics
Objective We sought to examine the impact of the loop electrosurgical excision procedure ( LEEP ) on the rate and magnitude of HIV ‐1 genital shedding among women undergoing treatment for cervical intraepithelial neoplasia 2/3 ( CIN 2/3). Design Prospective cohort study. Population Women infected with HIV ‐1 undergoing LEEP for CIN 2/3 in Kisumu, Kenya. Methods Participants underwent specimen collection for HIV ‐1 RNA prior to LEEP and at 1, 2, 4, 6, 10, and 14 weeks post‐ LEEP . HIV ‐1 viral load was measured in cervical and plasma specimens using commercial real‐time polymerase chain reaction ( PCR ) assays, to a lower limit of detection of 40 copies per specimen. Main outcome measures Presence and magnitude of HIV ‐1 RNA (copies per specimen or cps) in post‐ LEEP specimens, compared with baseline. Results Among women on highly active antiretroviral therapy ( HAART ), we found a statistically significant increase in cervical HIV ‐1 RNA concentration at week 2, with a mean increase of 0.43 log 10 cps (95% CI 0.03–0.82) from baseline. Similarly, among women not receiving HAART , we found a statistically significant increase in HIV ‐1 shedding at week 2 (1.26 log 10 cps, 95% CI 0.79–1.74). No other statistically significant increase in concentration or detection of cervical HIV ‐1 RNA at any of the remaining study visits were noted. Conclusions In women infected with HIV undergoing LEEP , an increase in genital HIV shedding was observed at 2 but not at 4 weeks post‐procedure. The current recommendation for women to abstain from vaginal intercourse for 4 weeks seems adequate to reduce the theoretical increased risk of HIV transmission following LEEP .