Outcomes Up to 12 Months After Treatment With Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Among HIV-Infected Women

被引:19
作者
Huchko, Megan J. [1 ]
Leslie, Hannah [2 ]
Maloba, May [3 ]
Zakaras, Jennifer [1 ]
Bukusi, Elizabeth [3 ]
Cohen, Craig R. [1 ]
机构
[1] Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA USA
[2] Univ Calif Berkeley, Dept Epidemiol, Berkeley, CA 94720 USA
[3] Kenya Govt Med Res Ctr, Ctr Microbiol Res, Nairobi, Kenya
关键词
cervical cancer screening; cervical intraepithelial neoplasia; HIV infection; Kenya; HUMAN-IMMUNODEFICIENCY-VIRUS; PAPILLOMAVIRUS-ASSOCIATED CANCERS; ACTIVE ANTIRETROVIRAL THERAPY; POSITIVE WOMEN; RISK-FACTORS; LESIONS; RECURRENCE; IMMUNOSUPPRESSION; PREVALENCE; REGRESSION;
D O I
10.1097/QAI.0000000000000565
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Introduction: HIV-infected women may have higher rates of recurrent cervical precancer after treatment. Knowledge about rates and predictors of recurrence could impact guidelines and program planning, especially in low-resource settings. Methods: In this prospective cohort study in Western Kenya, we followed HIV-infected women at 6 and 12 months after treatment for cervical intraepithelial neoplasia 2 or greater (CIN2+) after treatment with loop electrosurgical excision procedure (LEEP). All women underwent follow-up colposcopy with biopsy as indicated for the diagnosis of CIN2+. We calculated the incidence and predictors of primary disease recurrence after treatment. Results: Among the 284 women who underwent LEEP and had at least 1 follow-up visit, there were 37 (13%) cases of CIN2+ detected by 12-month follow-up. Four (10.8%) of the recurrences were invasive cancer, all stage IA1. The 6- and 12-month rates of recurrence were 13.7 and 12.8 cases per 100 person-years of follow-up, respectively. Antiretroviral therapy use did not significantly impact the rate of recurrence (hazard ratio: 1.24, 95% confidence interval: 0.59 to 2.79). The only significant predictor of recurrence in the multivariate analysis was CD4(+) nadir <200 cells per cubic millimeter (adjusted hazard ratio: 3.14, 95% confidence interval: 1.22 to 8.08). Discussion: The overall rate of treatment failure within a year of LEEP was low in this cohort of HIV-infected women. Among the women with recurrence, there was a significant amount of invasive cancer. The relatively high rate of cancer after treatment suggests that HIV-infected women merit continued close followup after treatment.
引用
收藏
页码:200 / 205
页数:6
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