Loop electrosurgical excision procedure (LEEP) plus top hat for HIV-infected women with endocervical intraepithelial neoplasia in Kenya

Michael H. Chung, Hugo De Vuyst, Sharon A. Greene, Hillary M. Topazian, Shahin Sayed, Zahir Moloo, Anthony Cagle, Evans Nyongesa-Malava, Stanley Luchters, Marleen Temmerman, Samah R. Sakr, Nelly R. Mugo, Christine J. McGrath

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Abstract

Objective: To determine the utility of detecting endocervical cervical intraepithelial neoplasia (CIN) 2+ with endocervical curettage (ECC) and treating with loop electrosurgical excision procedure (LEEP) plus top hat (+TH) among women with HIV. Methods: Cytology was followed by coloscopy-directed biopsy if participants had HSIL or ASC-H and biopsy plus ECC if there were glandular cells present. CIN2/3 on ECC and/or inadequate colposcopy (ENL) was treated with LEEP+TH, while CIN2/3 on ectocervix (ECL) received LEEP alone. Recurrent CIN2+ were compared over a 2-year follow-up. Results: Of 5330 participants, 160 underwent ECC, 98 were CIN2/3 on ECC, and 77 received LEEP+TH. ECC detected 15 (9%) more women with CIN2/3 than biopsy alone. Women were more likely to have ENL if they were older (≥45 vs <35 years) (adjusted relative risk [aRR] 2.14; P = 0.009) and on antiretroviral treatment longer (≥2 vs <2 years) (aRR 3.97; P < 0.001). Over the 2-year follow-up, 35 (29%) ENL had recurrent CIN2+ after TH compared to 19 (24%) ECL after LEEP (hazard ratio 1.32; 95% confidence interval 0.75–2.31; P = 0.338). Conclusion: Among HIV-infected women, adding ECC did not increase detection of pre-cancerous disease significantly and treatment with LEEP+TH for ENL was comparable to treatment with LEEP for ECL.

Original languageEnglish
Pages (from-to)118-124
Number of pages7
JournalInternational Journal of Gynecology and Obstetrics
Volume152
Issue number1
DOIs
Publication statusPublished - Jan 2021

Keywords

  • Endocervical curettage
  • Endocervical intraepithelial neoplasia
  • HIV
  • Kenya
  • Loop electrosurgical excision procedure
  • Resource-limited
  • Top hat

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