CERVICAL INTRAEPITHELIAL NEOPLASIA IN WOMEN INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS - OUTCOME AFTER LOOP ELECTROSURGICAL EXCISION

Our clinical experience with loop electrosurgical excision as therapy for cervical intraepithelial neoplasia (CIN) in women infected with hu man immunodeficiency virus is described. Information for this analysis was obtained from a retrospective chart review of all women with biop sy-confirmed CIN treated by loop electrosurgical excision who attended our colposcopy clinic during January 1991 to September 1992. Outcomes in women known to be HIV-seropositive were compared to those in women of unknown HIV serostatus. Patients included in the analysis were fol lowed for at least 6 months or until the documentation of recurrent/pe rsistent: CIN, and all had at least one post-treatment colposcopic exa mination, including endocervical curettage and cervical biopsy of any acetowhite lesions. Recurrent/persistent CIN following loop excision w as documented in 56% (19 of 34) HIV-infected women compared with 13% ( 10 of 80) women of unknown serostatus (OR 8.9, P < 0.001). HIV-infecte d women had a significantly higher rate of recurrent/persistent CIN th an women of unknown serostatus, regardless of grade of CIN. In HIV-inf ected women, recurrent/persistent CIN following loop excision develope d in 20% (1 of 5) with CD4+ T-lymphocyte counts >500 cells/mu l compar ed td 61% (11 of 18) with CD4+ counts less than or equal to 500 cells/ mu l (P = 0.13). Loop electrosurgical excision has a high failure rate in HIV-infected women, and this failure rate may increase as the leve l of immunosuppression increases. (C) 1994 Academic Press, Inc.