title: Cervical HIV-1 RNA shedding after cryotherapy among HIV-positive women with cervical intraepithelial neoplasia stage 2 or 3.
abstract: OBJECTIVE
  To determine the effect of cryotherapy on HIV-1 cervical shedding.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Five hundred HIV-positive women enrolled at an HIV treatment clinic in Nairobi, Kenya were screened for cervical cancer. Women diagnosed with cervical intraepithelial neoplasia stage 2 or 3 (CIN 2/3) by histology were offered cryotherapy treatment. The first 50 women had cervical swabs taken at baseline and at 2 and 4 weeks following treatment. Swabs were analyzed for HIV-1 RNA and compared using General Estimating Equation (GEE) with binomial or Gaussian links.
  
  
  RESULTS
  Of the 50 women enrolled, 40 were receiving antiretroviral therapy (ART) and 10 were not receiving ART at the time of cryotherapy and during study follow-up. Among all women, the odds of detectable cervical HIV-1 RNA did not increase at 2 weeks [odds ratio (OR) 1.18; 95% confidence interval (CI) 0.65-2.13] or 4 weeks (OR 1.29; 95% CI 0.71-2.33) following cryotherapy. Among 10 women not receiving ART, the OR of detectable shedding at 2 weeks was higher, but not statistically significant (OR 4.02; 95% CI 0.53-30.79; P = 0.2), and at 4 weeks remained unchanged (OR 1.00; 95% CI 0.27-3.74).
  
  
  CONCLUSIONS
  There was no increase in detectable cervical HIV-1 RNA among HIV-positive women after cryotherapy. The risk of HIV-1 transmission after cryotherapy may not be significant, particularly among women already on ART at the time of cervical treatment. However, further investigation is needed among women not receiving ART.
authors.affiliation: Department of Global Health, University of Washington, Seattle, USA. mhchung@uw.edu
authors.forename: Michael H
authors.initials: MH
authors.lastname: Chung
authors.forename: Kevin P
authors.initials: KP
authors.lastname: McKenzie
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
authors.forename: Robert W
authors.initials: RW
authors.lastname: Coombs
authors.forename: Hugo
authors.initials: H
authors.lastname: De Vuyst
authors.forename: Julia W
authors.initials: JW
authors.lastname: Njoroge
authors.forename: Evans
authors.initials: E
authors.lastname: Nyongesa-Malava
authors.forename: Samah R
authors.initials: SR
authors.lastname: Sakr
authors.forename: Nelly R
authors.initials: NR
authors.lastname: Mugo
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017679:Cryotherapy / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012367:RNA, Viral; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy* / Q000821:virology; D017201:Virus Shedding; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology / Q000628:therapy* / Q000821:virology
chemical_list: D012367:RNA, Viral