@article{cd06b86ec9cc47eca6688088597f03a1,
title = "Loop electrosurgical excision procedure (LEEP) plus top hat for HIV-infected women with endocervical intraepithelial neoplasia in Kenya",
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.",
keywords = "Endocervical curettage, Endocervical intraepithelial neoplasia, HIV, Kenya, Loop electrosurgical excision procedure, Resource-limited, Top hat",
author = "Chung, {Michael H.} and {De Vuyst}, Hugo and Greene, {Sharon A.} and Topazian, {Hillary M.} and Shahin Sayed and Zahir Moloo and Anthony Cagle and Evans Nyongesa-Malava and Stanley Luchters and Marleen Temmerman and Sakr, {Samah R.} and Mugo, {Nelly R.} and McGrath, {Christine J.}",
note = "Funding Information: This research has been supported by the President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreements GH002036 and GH002001. Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/WHO. Funding Information: This research has been supported by the President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreements GH002036 and GH002001. Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/WHO. Publisher Copyright: {\textcopyright} 2020 International Federation of Gynecology and Obstetrics",
year = "2021",
month = jan,
doi = "10.1002/ijgo.13466",
language = "English",
volume = "152",
pages = "118--124",
journal = "International Journal of Gynecology and Obstetrics",
issn = "0020-7292",
publisher = "John Wiley and Sons Ltd",
number = "1",
}
