{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T06:41:32Z","timestamp":1740120092353,"version":"3.37.3"},"reference-count":18,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,5,7]],"date-time":"2013-05-07T00:00:00Z","timestamp":1367884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University of California, San Francisco-Gladstone Institute of Virology and Immunology Center","award":["P30-AI027763"],"award-info":[{"award-number":["P30-AI027763"]}]},{"name":"NIH\/NCRR\/OD UCSF-CTSI","award":["KL2 RR024130"],"award-info":[{"award-number":["KL2 RR024130"]}]},{"name":"International Clinical Research"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We sought to examine the impact of the loop electrosurgical excision procedure (<jats:styled-content style=\"fixed-case\">LEEP<\/jats:styled-content>) on the rate and magnitude of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 genital shedding among women undergoing treatment for cervical intraepithelial neoplasia 2\/3 (<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content>2\/3).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women infected with <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 undergoing <jats:styled-content style=\"fixed-case\">LEEP<\/jats:styled-content> for <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content>2\/3 in Kisumu, Kenya.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants underwent specimen collection for <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 <jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content> prior to <jats:styled-content style=\"fixed-case\">LEEP<\/jats:styled-content> and at 1, 2, 4, 6, 10, and 14\u00a0weeks post\u2010<jats:styled-content style=\"fixed-case\">LEEP<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 viral load was measured in cervical and plasma specimens using commercial real\u2010time polymerase chain reaction (<jats:styled-content style=\"fixed-case\">PCR<\/jats:styled-content>) assays, to a lower limit of detection of 40 copies per specimen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Presence and magnitude of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 <jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content> (copies per specimen or cps) in post\u2010<jats:styled-content style=\"fixed-case\">LEEP<\/jats:styled-content> specimens, compared with baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among women on highly active antiretroviral therapy (<jats:styled-content style=\"fixed-case\">HAART<\/jats:styled-content>), we found a statistically significant increase in cervical <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 <jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content> concentration at week 2, with a mean increase of 0.43 log<jats:sub>10<\/jats:sub> cps (95% CI 0.03\u20130.82) from baseline. Similarly, among women not receiving <jats:styled-content style=\"fixed-case\">HAART<\/jats:styled-content>, we found a statistically significant increase in <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 shedding at week 2 (1.26 log<jats:sub>10<\/jats:sub> cps, 95% CI 0.79\u20131.74). No other statistically significant increase in concentration or detection of cervical <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 <jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content> at any of the remaining study visits were noted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In women infected with HIV undergoing <jats:styled-content style=\"fixed-case\">LEEP<\/jats:styled-content>, an increase in genital <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> shedding was observed at 2 but not at 4\u00a0weeks post\u2010procedure. The current recommendation for women to abstain from vaginal intercourse for 4\u00a0weeks seems adequate to reduce the theoretical increased risk of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> transmission following <jats:styled-content style=\"fixed-case\">LEEP<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12258","type":"journal-article","created":{"date-parts":[[2013,5,7]],"date-time":"2013-05-07T09:24:27Z","timestamp":1367918667000},"page":"1233-1239","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of loop electrosurgical excision procedure for cervical intraepithelial neoplasia on <scp>HIV<\/scp>\u20101 genital shedding: a prospective cohort study"],"prefix":"10.1111","volume":"120","author":[{"given":"MJ","family":"Huchko","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"VG","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Liegler","sequence":"additional","affiliation":[{"name":"Department of Medicine ARI\u2010Lab of Clinical Virology University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Leslie","sequence":"additional","affiliation":[{"name":"Division of Epidemiology University of California Berkeley CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Smith\u2010McCune","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"GF","family":"Sawaya","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EA","family":"Bukusi","sequence":"additional","affiliation":[{"name":"Center for Microbiology Research Kenya Medical Research Institute Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CR","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,5,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3001888"},{"volume-title":"Kenya Demographic and Health Survey 2008\u201309","year":"2010","author":"Kenya National Bureau of Statistics (KNBS) and ICF Macro","key":"e_1_2_6_3_1"},{"volume-title":"Kenya AIDS Indicator Survey 2007","year":"2008","author":"National AIDS and STI Control Programme","key":"e_1_2_6_4_1"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/00224499.2011.554918"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1462-5822.2006.00768.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2003.005157"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.1998.5250"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2303.2008.00567.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.108999"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32834a3654"},{"volume-title":"ART for HIV Infection in Adults and Adolescents in Poor Settings: Towards Universal Access. 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