Margins Status After LLETZ in HIV-Positive Patients at a South African Teaching Hospital: Post Universal HAART Program Review

Abstract

Introduction: Cervical cancer is one of the most preventable diseases, yet it remains a leading cause of death. Despite recent advances, cervical cancer still poses a challenge in South Africa. We saw the need to determine the margin status following large loop excision of the transformational zone in women living with HIV at a South African Tertiary hospital as part of a post-universal HAART program review. Objective: Analysis of margins after LLETZ and Pap-smear results at six months as a test of cure. Methods: This was a unicentric retrospective cohort of patients who were seen at the colposcopy clinic at Charlotte Maxeke Johannesburg Academic Hospital, South Africa, with high-grade squamous intraepithelial lesion on their Pap smear, managed with LLETZ, and followed up after six months for the test of cure. A data collection sheet was used on files sampled between January 1st January 2016 and 31st December 2020 at the colposcopy clinic. Descriptive statistics were used to summarize the data. Chi-square analysis was employed to determine the association between demographic characteristics, clinical factors, and outcomes. Cohen's kappa statistic was used to determine the agreement between margin status after LLETZ in HIV-positive patients. Results: During the period under review, a total of 802 patients had LLETZ; and more than half, 454 (55%), were HIV-positive and on antiretroviral treatment. Of these, 98 (22%) patients were cured. No statistical difference in cure rate between positive and negative margins, but 31.21% of patients with negative margins, and 25.38% of patients with positive margins were cured. xii Conclusion: Patients had positive margins despite antiretroviral drugs, and there was a significant association between margin status following.