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A Comparison of Loop Electrosurgical Excision Procedures Between Human Immunodeficiency Virus-Seropositive and -Seronegative Women

Cejtin, Helen E. MD; Malapati, Radha MD; Chaparala, Sushma MD

Journal of Lower Genital Tract Disease: January 2011 - Volume 15 - Issue 1 - pp 37-41
doi: 10.1097/LGT.0b013e3181eb3115
Original Articles

Objective. The purpose of this study was to compare preoperative and postoperative factors between human immunodeficiency virus (HIV)-seropositive and -seronegative women having a loop electrosurgical excision procedure (LEEP). Our hypothesis is that cervical intraepithelial neoplasia (CIN) presents differently in immunocompromised women.

Materials and Methods. A database of LEEPs performed from October 2004 to November 2009 at John H. Stroger Jr. Hospital, Cook County, Illinois, was created. Patients were considered to have persistent/recurrent disease if they had a cytological diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, or worse with no histology or a histological diagnosis of CIN 1 or worse at any time after their LEEP. χ2 Analysis was performed to evaluate differences between HIV-seropositive and -seronegative women.

Results. There were 886 LEEPs performed during the study period, 92 among HIV-seropositive and 794 among HIV-seronegative women. Overall, 64.7% had any cytology or histology performed after their procedure, and seropositive women were more likely to follow up (p = .004). Preoperative cytological and cervical histological diagnoses were not different between seropositive and negative women; however, a preoperative endocervical curettage, which was positive, was more common among seropositive women (p < .0001). Human immunodeficiency virus-seropositive women were more likely to have CIN on LEEP histology (p = .04), and more likely to have positive margins (p < .0001) and recurrent/persistent disease (p < .0001).

Conclusions. The spectrum of cervical disease was very different between HIV-seropositive and -negative women having LEEPs in our study. Practitioners managing HIV-infected women should be aware of these differences and counsel and follow up appropriately.

Human immunodeficiency virus-seropositive women have more endocervical disease, higher-grade lesions and more positive margins on LEEP, and more frequent recurrent/persistent disease than seronegative women.

Department of Obstetrics and Gynecology, John H. Stroger Jr. Hospital of Cook County, Chicago, IL

Reprint requests to: Helen E. Cejtin, MD, 1969 W Ogden Ave, Chicago, IL 60612. E-mail: hcejtin@gmail.com

©2011The American Society for Colposcopy and Cervical Pathology