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Cervical Lesion Excision Does Not Boost Genital HIV Shedding in Small Cohort
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2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland
Mark Mascolini
A loop electrosurgical excision procedure (LEEP) for precancerous cervical lesions had no impact on cervical shedding of HIV in antiretroviral-treated women, according to results of a prospective study involving 32 women [1] The finding adds to evidence indicating that cervical lesion treatment in women with HIV does not boost HIV transmission risk.
Human papillomavirus (HPV) infection, the most frequently transmitted sexual infection in the United States and many parts of the world, can lead to cervical intraepithelial neoplasia (CIN), which can be a prelude to cervical cancer.
Researchers from the University of California, San Francisco (UCSF) reported earlier that half of 180 HIV-positive Kenyan women undergoing LEEP for CIN 2 or 3 experienced some bleeding, discharge, or pain [2]. But 99% of women reported very mild to mild symptoms, 1% reported moderate symptoms, and none reported severe symptoms. Still, ulceration or bleeding could raise the risk of HIV shedding and transmission.
Other investigators gauged the impact of cryotherapy (freezing) for CIN 2 or 3 in 50 HIV-positive Kenyan women, 40 of them taking antiretrovirals and 10 not on treatment [3]. In the whole study group, cervical viral load 2 and 4 weeks after cryotherapy was similar to cervical load before the procedure. In the 10 women not taking antiretrovirals, cervical viral load was 4 times higher 2 weeks after the procedure, but that increase was not statistically significant (odds ratio 4.02, 95% confidence interval 0.53 to 30.79, P = 0.2). Four week after the procedure, cervical viral load in these 10 women had returned to baseline levels.
In the LEEP study [1], age averaged 31.8 years and CD4 count averaged 331. All women were taking antiretrovirals for more than 3 months, and treatment duration averaged 54.6 months. All reported better than 90% antiretroviral adherence. No women had a sexually transmitted infection, and all women agreed to abstain from intercourse before study visits.
Before LEEP, 9 of 32 women (28%) had detectable HIV RNA in blood (range 52 to 81,231 copies, median 137 copies), while 4 of 32 women (12%) had detectable HIV RNA in genital secretions (range 99 to 2389 copies, median 730 copies).
Two women with detectable genital virus before LEEP (1272 and 2389 copies) had detectable HIV RNA throughout follow-up. But cervical HIV load in these women did not change significantly in relation to time since LEEP.
Twenty-five women (78%) had no HIV detected at any time during the study. All women with detectable HIV in genital secretions before LEEP had detectable virus in blood. Seven women (22%) had detectable HIV shedding during at least one visit after LEEP. Only 2 women (6%) had sustained HIV shedding throughout the study. The researchers observed no shedding pattern in relation to time after LEEP.
The UCSF investigators believe their findings "increase confidence that LEEP would be unlikely to increase the risk of HIV transmission."
References
1. Huchko MJ, Woo VG, Liegler T, et al. Surgical excision of cervical intraepithelial neoplasia 2/3 is not associated with increased detection of genital HIV-1 among women on HAART. 2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland. Abstract O_8.
2. Woo VG, Cohen CR, Bukusi EA, Huchko MJ. Loop electrosurgical excision procedure: safety and tolerability among human immunodeficiency virus-positive Kenyan women. Obstet Gynecol. 2011;118:554-559.
3. Chung MH, McKenzie KP, Richardson BA, et al. Cervical HIV-1 RNA shedding after cryotherapy among HIV-positive women with cervical intraepithelial neoplasia stage 2 or 3. AIDS. 2011;25:1915-1919.
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