title: Impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on HIV-1 genital shedding: a prospective cohort study.
abstract: OBJECTIVE
  We sought to examine the impact of the loop electrosurgical excision procedure (LEEP) on the rate and magnitude of HIV-1 genital shedding among women undergoing treatment for cervical intraepithelial neoplasia 2/3 (CIN2/3).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Women infected with HIV-1 undergoing LEEP for CIN2/3 in Kisumu, Kenya.
  
  
  METHODS
  Participants underwent specimen collection for HIV-1 RNA prior to LEEP and at 1, 2, 4, 6, 10, and 14 weeks post-LEEP. HIV-1 viral load was measured in cervical and plasma specimens using commercial real-time polymerase chain reaction (PCR) assays, to a lower limit of detection of 40 copies per specimen.
  
  
  METHODS
  Presence and magnitude of HIV-1 RNA (copies per specimen or cps) in post-LEEP specimens, compared with baseline.
  
  
  RESULTS
  Among women on highly active antiretroviral therapy (HAART), we found a statistically significant increase in cervical HIV-1 RNA concentration at week 2, with a mean increase of 0.43 log10 cps (95% CI 0.03-0.82) from baseline. Similarly, among women not receiving HAART, we found a statistically significant increase in HIV-1 shedding at week 2 (1.26 log10 cps, 95% CI 0.79-1.74). No other statistically significant increase in concentration or detection of cervical HIV-1 RNA at any of the remaining study visits were noted.
  
  
  CONCLUSIONS
  In women infected with HIV undergoing LEEP, an increase in genital HIV shedding was observed at 2 but not at 4 weeks post-procedure. The current recommendation for women to abstain from vaginal intercourse for 4 weeks seems adequate to reduce the theoretical increased risk of HIV transmission following LEEP.
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, CA 94105, USA. megan.huchko@ucsf.edu
authors: M J
authors: MJ
authors: Huchko
authors: V G
authors: VG
authors: Woo
authors: T
authors: T
authors: Liegler
authors: H
authors: H
authors: Leslie
authors: K
authors: K
authors: Smith-McCune
authors: G F
authors: GF
authors: Sawaya
authors: E A
authors: EA
authors: Bukusi
authors: C R
authors: CR
authors: Cohen
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002584:Cervix Uteri / Q000378:metabolism / Q000821:virology*; D016001:Confidence Intervals; D004598:Electrosurgery; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission / Q000821:virology*; D015497:HIV-1; D006801:Humans; D007630:Kenya; D011446:Prospective Studies; D012367:RNA, Viral / Q000378:metabolism; D012725:Sexual Behavior; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000601:surgery*; D019562:Viral Load; D017201:Virus Shedding; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000601:surgery*
chemical_list: D012367:RNA, Viral
keywords: Cervical dysplasia; HAART; HIV; Kenya; genital shedding
references: Obstet Gynecol. 2011 Sep;118(3):554-559
references: 21860283
references: Sex Transm Infect. 2004 Apr;80(2):108-12
references: 15054170
references: Sci Transl Med. 2011 Apr 6;3(77):77ra29
references: 21471433
references: Am J Obstet Gynecol. 2001 Feb;184(3):279-85
references: 11228474
references: J Infect Dis. 2000 Jun;181(6):1950-6
references: 10837174
references: Cytopathology. 2009 Feb;20(1):27-35
references: 18510550
references: Int J Gynaecol Obstet. 2010 Oct;111(1):89-90
references: 20630528
references: J Sex Res. 2011 Nov-Dec;48(6):511-9
references: 21318922
references: J Infect Dis. 2012 Feb 1;205(3):358-65
references: 22241800
references: AIDS. 2011 Sep 24;25(15):1915-9
references: 21716072
references: Curr Infect Dis Rep. 2008 Nov;10(6):505-11
references: 18945393
references: J Infect Dis. 2001 Nov 1;184(9):1187-91
references: 11598843
references: AIDS. 2007 Feb 19;21(4):501-7
references: 17301569
references: AIDS Res Hum Retroviruses. 2006 Aug;22(8):788-95
references: 16910835
references: Gynecol Oncol. 1999 Feb;72(2):199-201
references: 10021301