title: A comparison of loop electrosurgical excision procedures between human immunodeficiency virus-seropositive and -seronegative women.
abstract: OBJECTIVE
  The purpose of this study was to compare preoperative and postoperative factors between human immunodeficiency virus (HIV)-seropositive and -seronegative women having a loop electrosurgical excision procedure (LEEP). Our hypothesis is that cervical intraepithelial neoplasia (CIN) presents differently in immunocompromised women.
  
  
  METHODS
  A database of LEEPs performed from October 2004 to November 2009 at John H. Stroger Jr. Hospital, Cook County, Illinois, was created. Patients were considered to have persistent/recurrent disease if they had a cytological diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, or worse with no histology or a histological diagnosis of CIN 1 or worse at any time after their LEEP. χ2 Analysis was performed to evaluate differences between HIV-seropositive and -seronegative women.
  
  
  RESULTS
  There were 886 LEEPs performed during the study period, 92 among HIV-seropositive and 794 among HIV-seronegative women. Overall, 64.7% had any cytology or histology performed after their procedure, and seropositive women were more likely to follow up (p = .004). Preoperative cytological and cervical histological diagnoses were not different between seropositive and negative women; however, a preoperative endocervical curettage, which was positive, was more common among seropositive women (p < .0001). Human immunodeficiency virus-seropositive women were more likely to have CIN on LEEP histology (p = .04), and more likely to have positive margins (p < .0001) and recurrent/persistent disease (p < .0001).
  
  
  CONCLUSIONS
  The spectrum of cervical disease was very different between HIV-seropositive and -negative women having LEEPs in our study. Practitioners managing HIV-infected women should be aware of these differences and counsel and follow up appropriately.
authors.affiliation: Department of Obstetrics and Gynecology, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA. hcejtin@gmail.com
authors.forename: Helen E
authors.initials: HE
authors.lastname: Cejtin
authors.forename: Radha
authors.initials: R
authors.lastname: Malapati
authors.forename: Sushma
authors.initials: S
authors.lastname: Chaparala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007087:Illinois; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000601:surgery*