• M J Huchko, V G Woo, T Liegler, H Leslie, K Smith-McCune, G F Sawaya, E A Bukusi, and C R Cohen.
• Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, CA 94105, USA. megan.huchko@ucsf.edu
• BJOG. 2013 Sep 1; 120 (10): 1233-9.

ObjectiveWe 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).DesignProspective cohort study.PopulationWomen infected with HIV-1 undergoing LEEP for CIN2/3 in Kisumu, Kenya.MethodsParticipants 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 MeasuresPresence and magnitude of HIV-1 RNA (copies per specimen or cps) in post-LEEP specimens, compared with baseline.ResultsAmong 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.ConclusionsIn 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.© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

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