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For HIV–positive women, cryotherapy less effective than LEEP in fighting cervical precancer
SEATTLE — Cryotherapy was associated with a significantly higher risk of recurrence of cervical precancer in women with HIV than a costlier electric excision process, according to a 3-year study.
The results of the study comparing cryotherapy and loop electrosurgical excision procedure (LEEP) were presented at the annual Conference on Retroviruses and Opportunistic Infections (CROI).
“Overall, cryotherapy was associated with a 52% to 64% higher risk of recurrence of cervical precancer,” the study’s lead author, Sharon A. Greene, MPH, a graduate student in epidemiology at the University of Washington School of Public Health, said during a news conference.
“So the results from this randomized trial provide compelling evidence for WHO and ministries of health to develop screening and treatment algorithms based on HIV status.”
The study included 400 HIV–infected women, enrolled at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya, who underwent cervical screening from June 2011 to July 2014.
The median patient age was 37, with a range of 31 to 43, and 89% were receiving antiretroviral therapy. The median CD4 T-lymphocyte count was 380 cells/µl, with a range of 215 to 524 cells/µl.
Of the 200 patients randomized to undergo cryotherapy, 71 (35.5%) had moderate cervical intraepithelial neoplasia (CIN 2) at baseline, 107 (53.5%) had CIN 3 (severe), 11 (5.5%) carcoma in situ (CIS) and 11 had no dysplasia or CIN 1 (mild).
Of the 200 receiving LEEP treatment, 59 (29.5%) had CIN 2, 116 (58%) had CIN 3, 10 (5%) had CIS and 15 (7.5%) had no dysplasia or CIN 1.
Follow-ups were conducted at 6, 12, 18 and 24 months postoperatively, and 85% of the patients completed all four. At 24 months, recurrence of precancerous lesions had occurred in 37% of those receiving cryotherapy versus 26% of patients who had undergone LEEP.
“There are four main things we should do with these findings,” Greene concluded. “First, the time has come to leverage the infrastructure of HIV care facilities to offer cervical cancer screening and treatment using LEEP as a key component to comprehensive care.
“Second, in high-burden settings, a screen-and-treat approach should be coupled with HIV testing,” she said, adding that women unaware of their HIV status could undergo simultaneous cervical cancer and HIV screening.
“Third, it’s important to acknowledge that the availability and implementation of LEEP over cryotherapy will depend on resources,” Greene continued.
“In settings where LEEP is not available, or the likelihood of loss to follow-up is high, cryotherapy should still be a treatment option.
“And finally, WHO recommends post-treatment follow-up at 12 months, regardless of HIV status,” she said. “But our findings indicate that women should be screened at more frequent intervals, particularly following cryotherapy. If there is recurrent disease, detection and retreatment must be done before precancer spreads and becomes invasive.” – by Joe Green
Reference:
Greene SA, et al. Randomized Trial of LEEP vs Cryotherapy to Treat CIN 2/3 in HIV-Infected Women. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 13-16, 2017; Seattle.
Disclosure: The authors reported no relevant financial disclosures.