title: Outcomes Up to 12 Months After Treatment With Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Among HIV-Infected Women.
abstract: BACKGROUND
  HIV-infected women may have higher rates of recurrent cervical precancer after treatment. Knowledge about rates and predictors of recurrence could impact guidelines and program planning, especially in low-resource settings.
  
  
  METHODS
  In this prospective cohort study in Western Kenya, we followed HIV-infected women at 6 and 12 months after treatment for cervical intraepithelial neoplasia 2 or greater (CIN2+) after treatment with loop electrosurgical excision procedure (LEEP). All women underwent follow-up colposcopy with biopsy as indicated for the diagnosis of CIN2+. We calculated the incidence and predictors of primary disease recurrence after treatment.
  
  
  RESULTS
  Among the 284 women who underwent LEEP and had at least 1 follow-up visit, there were 37 (13%) cases of CIN2+ detected by 12-month follow-up. Four (10.8%) of the recurrences were invasive cancer, all stage IA1. The 6- and 12-month rates of recurrence were 13.7 and 12.8 cases per 100 person-years of follow-up, respectively. Antiretroviral therapy use did not significantly impact the rate of recurrence (hazard ratio: 1.24, 95% confidence interval: 0.59 to 2.79). The only significant predictor of recurrence in the multivariate analysis was CD4(+) nadir <200 cells per cubic millimeter (adjusted hazard ratio: 3.14, 95% confidence interval: 1.22 to 8.08).
  
  
  CONCLUSIONS
  The overall rate of treatment failure within a year of LEEP was low in this cohort of HIV-infected women. Among the women with recurrence, there was a significant amount of invasive cancer. The relatively high rate of cancer after treatment suggests that HIV-infected women merit continued close follow-up after treatment.
authors: *Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA; †Department of Epidemiology, University of California, Berkeley, CA; and ‡Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors: Megan J
authors: MJ
authors: Huchko
authors: Hannah
authors: H
authors: Leslie
authors: May
authors: M
authors: Maloba
authors: Jennifer
authors: J
authors: Zakaras
authors: Elizabeth
authors: E
authors: Bukusi
authors: Craig R
authors: CR
authors: Cohen
mesh_terms: D000328:Adult; D001706:Biopsy; D002277:Carcinoma / Q000453:epidemiology; D015331:Cohort Studies; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007630:Kenya; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D002578:Uterine Cervical Dysplasia / Q000601:surgery*
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