Loop electrosurgical excision procedure for HIV positive women more likely to rule out high-risk HPV infection than cryotherapy for CIN


A secondary analysis from a clinical trial indicated that women positive for human immunodeficiency virus and who underwent electrosurgical loop excision for cervical intraepithelial neoplasia had an increased likelihood of clearing the human immunodeficiency virus. higher risk human papilloma than women who have undergone cryotherapy.

Women positive for human immunodeficiency virus who underwent electrosurgical loop excision (LEEP) for grade 2 cervical intraepithelial (CIN2) neoplasia were more likely to clear human papillomavirus ( HPV) at higher risk than women who received cryotherapy over a 24-month period. (RR, 1.40; 95% CI: 1.03-1.90; P = .03), according to the results of the secondary analysis of a study (NCT01298596) published in JAMA Oncology.

At baseline, the overall prevalence of any hrHPV was 92%, with a specific hrHPV prevalence of 90% in the cryotherapy arm and 94% in the LEEP arm (P = .24). The most common types of hrHPV detected in patients were 16 (27%), 58 (27%), 35 (26%), 52 (20%), and 18 (17%).

“This secondary analysis of a [randomized clinical trial] supports the clinical advantages of LEEP over cryotherapy if this method is available and accessible in low- and middle-income countries, ”the investigators wrote. “Screening for hrHPV after cervical treatment is helpful in ruling out recurrent cervical disease in women living with HIV and could be given as early as 6 months after treatment. “

Women living with HIV were recruited from the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya, and provided written informed consent to participate in the study. Eligibility criteria required that patients be 18 years of age or older, HIV positive, sexually active, non-pregnant, and the cervix intact.

According to the categorization of the International Agency for Research on Cancer of the World Health Organization, 12 types of HPV were considered high risk, including types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59.

The primary outcomes of this secondary analysis were hrHPV positivity and disease recurrence, which was defined as CIN2 or greater.

HIV-positive women were included in the trial between June 2011 and September 2016, of which 354 were confirmed CIN2-positive by directed colposcopy biopsy. The population was evenly divided, with 177 women each receiving treatment with cryotherapy or RAD. The demographics between the cryotherapy and LEEP groups were similar, with most patients having a monthly household income of less than $ 150 per month (62% vs. 64%; P = 0.79) and at least 2 years of antiretroviral therapy (ART) at the time of enrollment (51% vs. 57%; P = .20). In addition, 29% of patients in the cryotherapy arm and 27% of patients in the LEEP arm were also immunocompromised, with a CD4 count below 250 cells / mm3 (P = .75)

After 12 months of treatment, the persistence of baseline type-specific hrHPV was higher in women who underwent cryotherapy (61%) compared to those who underwent ARD (49%; P = .04). In addition, persistence was higher for the cryotherapy arm compared to the LEEP treatment arm in people with type 16 hrHPV (69% vs. 48%; P = .046) and type 51 disease (44% vs. 12%; P = .04).

A notable number of women with type-specific hrHPV persistence at 12 months experienced recurrent CIN2 positivity during the 2-year follow-up period. Persistence of hrHPV and recurrent CIN2 positivity were observed in patients who had a single type-specific hrHPV detection at the time of inclusion (61%), hrHPV types 16 and / or 18 (48%), all hrHPV type specific (42%), multiple type – specific hrHPV (32%).

Persistence of type-specific hrHPV maintained a high and statistically significant association with CIN2-positive recurrence in multivariate analyzes, including treatment intervention and CD4 count (aHR, 4.70; 95% CI: 2.47-8.95; P <.001>

“Further study is needed to determine the cost-effectiveness of LEEP and the long-term implications of persistence of hrHPV after treatment on cervical cancer and mortality in women living with HIV” , the researchers concluded.


Chung MH, De Vuyst H, Greene SA, et al. Persistence of human papillomavirus and association with recurrent cervical intraepithelial neoplasia after cryotherapy vs electrosurgical loop excision procedure in HIV-positive women: a secondary analysis from a randomized clinical trial. JAMA Oncol. 2021; 7 (10): 1514-1520. doi: 10.1001 / jamaoncol.2021.2683

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