Increased Cervical HIV RNA Shedding Among HIV-Infected Women Randomized to Loop Electrosurgical Excision Procedure (LEEP) compared to Cryotherapy for Cervical Intraepithelial Neoplasia 2/3

Abstract

Background

Treatment of HIV-infected women to prevent cervical cancer may stimulate HIV RNA cervical shedding and risk HIV transmission.

Methods

Between 2011 and 2014, 400 HIV-infected women diagnosed with cervical intraepithelial neoplasia (CIN) 2/3 in Kenya were randomized to loop electrosurgical excision procedure (LEEP) or cryotherapy. Cervical and plasma samples were collected at baseline and weekly intervals for three weeks. Samples were tested for HIV RNA using Gen-Probe Aptima HIV assay with a minimum detection level of 60 copies/swab and analyzed using generalized estimating equations.

Results

Women receiving LEEP had significantly higher cervical HIV RNA levels than those receiving cryotherapy at weeks 2 [adjusted incident rate ratio (aIRR), 1.07; P=0.038] and 3 (aIRR, 1.08; P=0.046) post-treatment. Within the LEEP arm, significantly higher cervical HIV RNA was found at weeks 2 (2.03 log₁₀ copies/swab; P<0.001) and 3 (2.04 log₁₀ copies/swab; P<0.001) 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=0.003) and in ART-naïve women (1.13 log₁₀ copies/swab increase; P<0.001) compared to baseline. In the cryotherapy arm, cervical HIV RNA increased in ART-naïve women (0.72 log₁₀ copies/swab increase) 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 for up to 3 weeks after treatment. While the benefits of cervical cancer prevention outweigh risk of HIV sexual transmission, our findings underscore the importance of risk reduction counselling following treatment.