番茄社区

SEATTLE – HIV-infected women who develop high-risk cervical lesions and undergo loop electrosurgical excisional procedures (LEEP) had less risk of recurrence or of cervical cancer than similar women in resource-poor settings treated with cryotherapy, researchers said here.

After 24 months, recurrence was observed in 37% of women who underwent cryosurgery compared with 26% of the women who underwent LEEP (P=0.018) in a randomized trial, reported Sharon Greene, MPH, a PhD candidate at the University of Washington in Seattle.

At a press briefing during the annual , Greene said that difference translates to a 52% reduction in the risk of developing a recurrence if the women undergo LEEP.

She noted that cryotherapy is recommended by the World Health Organization for resource-limited areas because the procedure is easier and less costly to perform than LEEP.

"We found that cryotherapy is associated with a much higher risk of disease recurrence," Greene said. "What that means is that these women still have the disease. The procedure did not clear the disease. In a low resource setting this persistent disease is challenging because now you are looking at either hysterectomy or radiotherapy."

The study randomized 400 women to cryotherapy or LEEP. They were recruited from June 2011 to July 2014 at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya. The women were diagnosed with HIV-infection and cervical intraepithelial neoplasia (CIN) or cervical carcinoma in situ and were treated with either procedure.

In the cryotherapy group, 71 women were found to have CIN2 at baseline; 107 women were diagnosed with CIN3; 11 women were diagnosed with carcinoma in situ, and 11 women were diagnosed with no dysplasia/CIN1. In the LEEP group, 59 women were diagnosed with CIN2; 116 women were found to have CIN3; 10 women were diagnosed with carcinoma in situ, and 15 women were diagnosed with no dysplasia/Cin1. Median follow-up was 2.1 years in both arms.

Greene told 番茄社区 that 85% of the women completed all four follow-up visits which were scheduled every 6 months. Recurrent neoplasia was observed in more women on cryotherapy at 12 months – 27% versus 18% of those who were treated with the LEEP (P=0.031).

The researchers reported that the sociodemographic and biological factors between the groups were well balanced. Participants' median age was 37. About 89% of the women were being treated with highly active antiretroviral therapy. At the time of the intervention, the median CD4-positive count was 380 cell/mm³.

"We know that HIV-infected women are disproportionately affected by cervical cancer. But we have been unsure about what treatment that is commonly used in either high resource settings which is LEEP or a procedure that is more often used in low resource settings which is cryotherapy," she said.

Greene said that the rate of recurrence in women who do not have HIV infection is about 5%.

She said that a "risk-benefit calculation must be done" to determine the worth of cryotherapy versus LEEP.

Another option would be to couple HIV testing with cervical cancer screening and then treat women with both diseases with LEEP, she said. She also suggested that LEEP could be performed as part of HIV clinic services.

medical director of the Center for Young Adult, Adolescent and Pediatric HIV, Northwell Health, Great Neck, N.Y., said that women who have HIV may have recurrence mainly due to immunocompromise. "It may be that these women are being re-infected by human papillomavirus due to ongoing sexual activity, or it could be that the procedures left a few cells behind and these cells have reactivated," he told 番茄社区.

Also commenting on the study, , of Columbia University in New York City, told 番茄社区, "Cervical cancer is the leading cancer among women globally and the leading cause of cancer death among women with women in resource-limited countries bearing the highest burden of the disease.

"Women living with HIV are acknowledged to be at high risk for human papillomavirus infection, the cause of cervical cancer and most importantly women living with HIV have higher mortality from cervical cancer compared to women without HIV infection," she said.

"Therefore screening programs to detect abnormalities in the cervix from HPV infection and to treat them effectively is of critical importance in order to prevent the development of cervical cancer," said El-Sadr, who was not involved in the study.

Comment