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Objective We sought to examine the impact of the loop electrosurgical excision procedure ( LEEP) on the rate and magnitude of HIV-1 genital shedding among women undergoing treatment for cervical intraepithelial neoplasia 2/3 ( CIN2/3). Design Prospective cohort study. Population Women infected with HIV-1 undergoing LEEP for CIN2/3 in Kisumu, Kenya. Methods Participants underwent specimen collection for HIV-1 RNA prior to LEEP and at 1, 2, 4, 6, 10, and 14 weeks post- LEEP. HIV-1 viral load was measured in cervical and plasma specimens using commercial real-time polymerase chain reaction ( PCR) assays, to a lower limit of detection of 40 copies per specimen. Main outcome measures Presence and magnitude of HIV-1 RNA (copies per specimen or cps) in post- LEEP specimens, compared with baseline. Results Among women on highly active antiretroviral therapy ( HAART), we found a statistically significant increase in cervical HIV-1 RNA concentration at week 2, with a mean increase of 0.43 log10 cps (95% CI 0.03-0.82) from baseline. Similarly, among women not receiving HAART, we found a statistically significant increase in HIV-1 shedding at week 2 (1.26 log10 cps, 95% CI 0.79-1.74). No other statistically significant increase in concentration or detection of cervical HIV-1 RNA at any of the remaining study visits were noted. Conclusions In women infected with HIV undergoing LEEP, an increase in genital HIV shedding was observed at 2 but not at 4 weeks post-procedure. The current recommendation for women to abstain from vaginal intercourse for 4 weeks seems adequate to reduce the theoretical increased risk of HIV transmission following LEEP. [ABSTRACT FROM AUTHOR]

A reply by the authors to a letter to the editor on their article about the impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on HIV-1 genital shedding is presented.

In resource-limited settings, detection of sexually transmitted infections (STIs) often relies on self-reported symptoms to initiate management. We found self-report demonstrated poor sensitivity for STI detection. Adding clinician-initiated questions about symptoms improved detection rates. Vaginal examination further increased sensitivity. Including clinician-initiated screening in resource-limited settings would improve management of treatable STIs. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the safety, tolerability, and acceptability of loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN 2 or 3) in human immunodeficiency virus (HIV)-positive women performed by nonphysician health care providers in an HIV care and treatment clinic.Methods: We performed a prospective cohort study among women undergoing LEEP for biopsy-confirmed CIN 2 or 3 at the Family Acquired Immunodeficiency Syndrome Care and Education Services Clinic in Kisumu, Kenya. Women were followed-up 4 weeks after the procedure and questioned for abstinence as well as presence and severity of side effects after the procedure. The results were analyzed using descriptive statistics and univariable and multivariable analysis.Results: Among the 180 (91%) women who returned for a 4-week follow up after LEEP, 52% reported at least one postprocedure symptom, including bleeding, discharge, or pain. Using a Likert scale for severity of symptoms, 179 (99%) reported very mild to mild symptoms, whereas one (1%) participant described the symptoms as moderate. No participants reported severe symptoms. Mean CD4 count was significantly higher among women who reported any symptoms compared with women who reported no symptoms after LEEP (419 cells/mm compared with 349 cells/mm, P<.05), an association that remained significant after adjustment for antiretroviral treatment. The presence or severity of postprocedure symptoms did not differ among women who reported sexual activity (16%) less than 4 weeks after the procedure.Conclusion: LEEP performed by clinical officers was well-accepted by HIV-positive women and appears safe, resulting in minimal side effects, even among women with early resumption of intercourse.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]