LEEP more effective than cryotherapy as effective treatment for CIN lesions in women living with HIV and without HIV in western Kenya
This work was published before the author joined Aga Khan University.
Abstract
Objectives: Cervical intraepithelial neoplasia (CIN) in women with HIV (WHIV) is over twice as likely to progress in severity than in women without HIV. This study assessed the results of cryotherapy or LEEP for CIN among WHIV compared to women without HIV in Western Kenya.
Methods: A total of 120 WHIV (60 cryotherapies, 60 LEEP) and 120 women without HIV (60 cryotherapies and 60 LEEP) were intended to be enrolled after a positive visual inspection with acetic acid (VIA). However, only 86 WHIV (39 cryotherapies, 47 LEEP) and 89 women without HIV (46 cryotherapies, 43 LEEP) who had follow-ups within 24 months were included in this analysis. Women were eligible for cryotherapy if the lesion covered b75% of the transformation zone, did not extend into the endocervical canal, and was not N CIN 2 on histology. Women ineligible for cryotherapy underwent colposcopy/ biopsy, and those with confirmed CIN 2/3 underwent LEEP. Women had a follow-up every 6 months with VIA, Pap smear, or colposcopy/ biopsy. Cryotherapy failure was defined as N low-grade intraepithelial lesion (LSIL) on Pap smear or N CIN 1 on histology. LEEP failure was defined as a high-grade intraepithelial lesion (HSIL) on Pap smear or N CIN 2 by histology after treatment. χ2 and Fisher's exact tests were used to compare the proportions.
Results: There was a significant difference in treatment failure rates between WHIV and women without HIV (15.12% vs 5.62%, P = 0.04). The population average odds of treatment failure were higher in HIVpositive subjects compared to HIV-negative subjects (OR: 4.39, 95% CI: 1.23–15.64). There was a significant difference in treatment failure rates between WHIV compared to women without HIV who underwent cryotherapy (18.00% v 2.20%, P = 0.021). Among patients who underwent LEEP, no difference was observed in the treatment failure rates between WHIV and women without HIV (12.80% vs 9.30%, P = 0.74). There was no association between treatments and these covariates: married (OR: 3.55, 95% CI: 0.4–31.29), widowed (OR: 2.8, 95% CI: 0.19–40.97), secondary education (OR: 1.50, 95% CI: 0.42–5.39), college/university education (OR: 1.75, 95% CI: 0.25–12), unemployment (OR: 2.30, 95% CI: 0.39–13.18), age group 31–40 (OR: 0.91, 95% CI: 0.26–3.17) and aged 41+ (OR: 0.36, 95% CI: 0.08–1.74). For the patients in the LEEP arm of treatment, there was no association between these covariates and treatment failure: age at first sexual encounter (OR: 1.15, 95% CI: 0.91–1.45), condom use in the last 6 months (OR: 0.91, 95% CI: 0.56–1.49), HIV status (OR: 3.97, 95% CI: 0.66–23.96), self-employed (OR 0.63, 95% CI: 0.07–6.08), secondary education (OR 3.89, 95% CI: 0.42–30.54) and married (OR: 0.32, 95% CI: 0.01–7.87).
Conclusions: In our experience, LEEP is a more effective treatment for WHIV compared to women without HIV for CIN in Western Kenya