Document Type

Article

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Objectives: Cervical cancer is the third most common cancer worldwide and the most common cancer among Kenyan women, with an age-standardized incidence rate of 33.8% in 2018. Cervical intraepithelial neoplasia (CIN) caused by human papillomavirus (HPV) in HIV+ women is over twice as likely to progress in severity compared to HIV- women. Conflicting reports exist as to the efficacy of cryotherapy or loop electrosurgical excision procedure (LEEP) as treatment for CIN among HIV+ women. This study assesses the results of cryotherapy or LEEP for CIN among HIV+ compared to HIV- women in Western Kenya.

Methods: One-hundred and twenty HIV+ (60 cryotherapy, 60 LEEP) and 120 HIV- (60 cryotherapy and 60 LEEP) women were intended to be enrolled after a positive visual inspection with acetic acid (VIA). However, only 86 HIV+ (39 cryotherapy, 47 LEEP) and 89 HIV- (46 cryotherapy, 43 LEEP) who had follow-up of 24 months were included in this analysis. Women were eligible for cryotherapy if the lesion covered low grade intraepithelial lesion (LSIL) on Pap smear or ≥ CINI on histology, LEEP failure was defined as high grade intraepithelial lesion (HSIL) on Pap smear or ≥ CIN 2 after treatment. Chi square and Fishers’ exact tests were used to compare the proportions.

Results: There was no statistically significant difference in treatment failure rates between HIV+ and HIV- patients (10.1% v 19.8% p =0.09). Among patients who underwent cryotherapy, there was no statistically significant difference in treatment failure between HIV+ and HIV- women (18% v 4.4%, p = 0.073). No statistically significant difference in treatment failure was observed among HIV+ and HIV- women who underwent LEEP (16.3% v 21.3%, p = 0.599). No statistically significant difference in treatment failure was observed between all patients in the LEEP arm compared to those in the cryotherapy arm (10.6% v 18.9% p =0.141). Seventy-four percent of HIV+ women were on antiretroviral therapy (ART) during the study, and 91% had been on ART during or prior to the study. Mean CD4 count among HIV+ women was 580.

Conclusions: In our experience, cryotherapy and LEEP are effective treatment for HIV+ and HIV- women if done for appropriate CIN lesions in low-resource settings.

Comments

This work was published before the author joined Aga Khan University.

Publication ( Name of Journal)

American Journal of Obstetrics & Gynecology

DOI

https://doi.org/10.1016/j.ajog.2021.11.1325

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