Validation of Implementation of Cervical Dysplasia Treatment Modalities in HIV-Seropositive Women
Validation of Implementation of Cervical Dysplasia Treatment Modalities in HIV-Seropositive Women
To compare the efficacy of cryotherapy and large loop excision of the transformation zone
 (LLETZ) procedures for the treatment of high-grade cervical intra-epithelial neoplasia
 (CIN2/3) among HIV-seropositive women by follow-up VIA, cytology and Human Papillomavirus.

 Hypothesis: LEEP will be more effective than cryotherapy in removing CIN 2/3 lesions in HIV
 positive women in South Africa
Cervical cancer is the most common cancer in HIV positive women. This is due to
 immunosuppression and lack of organized and effective screening and treatment programs in
 Africa. Other screening and treatment modalities need to be evaluated in resource limited
 countries as there is not capacity in most of these countries to implement a
 cytology/histology based program. The treatment modality of cryotherapy is easy to train and
 perform and can be done by a nurse. LEEP requires significant training usually doctors and
 skills in administering local anaesthetic. This study compares the two modalities of
 cryotherapy vs LEEP in a randomized controlled study in HIV positive women in South Africa.

 A. PRIMARY AIMS (S.A.):

 1. To compare the efficacy of cryotherapy and large loop excision of the transformation
 zone (LLETZ) procedures for the treatment of high-grade cervical intra-epithelial
 neoplasia (CIN2/3) among HIV-seropositive women by follow-up VIA, cytology and HPV.

 2. To determine the utility of subsequent HPV DNA testing as a marker of effective
 treatment following the treatment of CIN 2/3 among HIV-seropositive women.

 3. To compare the safety of cryotherapy versus LLETZ in HIV seropositive women.

 SECONDARY AIMS:

 1. To describe HIV disease status (CD4, HIV viral load), demographics, and sexual behavior in
 each treatment arm (LLETZ and cryotherapy) in HIV seropositive women.

 3. To determine the cervical disease recurrence rates with cryotherapy and LLETZ.

 4. To evaluate the relationship between HIV status, demographics, HPV, and sexual behavior
 with the clearance of cervical disease at the ectocervical and endocervical margins in HIV
 seropositive women.
Inclusion Criteria:

 -  Women 18-65 years of age

 -  Not menstruating (if menstruating, the patient can be screened at another date)

 -  Able to sign consent

 -  Able to follow the study protocol

 -  HIV positive (by two different criteria; either 2 different rapid HPV tests of
 different manufacturers, a HIV viral load ≥5,000,ELISA, Western blot documented in
 VICAR 1)

 -  Participant with histology-proven CIN 2 or 3 disease

 Exclusion Criteria:

 -  Pregnant

 -  Clinically active sexually transmitted disease determined by clinical history and/or
 physical exam (may participate after adequate treatment by syndromic treatment
 management)

 -  Known and previous treatment for high grade squamouse intraepithelial lesion by any
 method (cryotherapy, LLETZ or cone biopsy)

 -  Previous hysterectomy with removal of the cervix

 -  Significant medical illness/mental illness that the investigator feels would prevent
 the participant from complying with the protocol or place the participant at medical
 risk

 -  Cervical dysplastic lesions that are not appropriate for cryotherapy, defined as the
 following:

 1. Lesion is greater than ≥75% cervix

 2. Lesion entering into the cervical canal and the complete lesion cannot be
 visualized

 3. Presence of abnormal vasculature

 4. Lesion bigger that the cryotherapy probe