Cryotherapy or LEEP for High-Grade Cervical Lesions in Women with HIV Infection?

Women with HIV are at high risk for progression of human papillomavirus-related cervical disease to high-grade intraepithelial lesions that may advance to malignancy and recurrence, even after cervical treatment. To test which treatment yields the lowest risk for recurrence, investigators randomized 400 Kenyan women with HIV to receive cryotherapy or loop electrosurgical excision procedure (LEEP).

At 2 years' follow-up, 30% of women in the cryotherapy group versus 19% of those in the LEEP group had recurrent high-grade intraepithelial neoplasia (relative risk, 1.7). This benefit of LEEP was more pronounced among women with low CD4 counts, detectable plasma HIV, and shorter duration (<2 years) of antiretroviral therapy. Both procedures were w…