Longitudinal study of patients after surgical treatment for cervical lesions: detection of HPV DNA and prevalence of HPV-specific antibodies

Abstract

The principal aims of this study were to test whether persistence of human papillomavirus (HPV) DNA is predictive of recurrent disease in women after surgical treatment for cervical lesions, to distinguish between persistent and newly acquired HPV infection, and to observe the effect of surgical treatment on levels of HPV-specific antibodies. A group of 198 patients surgically treated for low-grade and high-grade squamous intraepithelial lesions and 35 age-matched controls were monitored for 18 months at 6-month intervals. The presence of HPV DNA in cervical smears was detected by means of consensus polymerase chain reaction, and serum levels of HPV-specific antibodies to HPV types 16, 18, 31, 33, and 45 were measured. In ten patients positive for HPV type 16 in consecutive samples, the HPV 16 variants were identified using a polymerase chain reaction specific for the long control region. Data regarding demographics, risk factors for cervical cancer, and risks related to HPV exposure were collected through a patient questionnaire. Subjects persistently positive for HPV DNA were more likely to present with cytological and/or colposcopical abnormalities. A higher reactivity to HPV-specific antibodies was observed in these women at the 18-month follow-up visit. All ten patients with HPV 16 infection detected in consecutive samples showed persistence of either the same prototype or the same variant during the follow-up period. Risky sexual behavior and smoking were more common in patients than in controls. Persistent HPV infection as demonstrated by both HPV DNA detection and antibody detection appears to be a risk factor for the recurrence of pathological findings in women after surgery. An individually based approach to surgical treatment is an important factor in the outcome of disease at follow-up.

The incidence of human papillomavirus infection following treatment for cervical neoplasia: A systematic review

“…Recurrent CIN may result from the inadequate treatment of precancerous cervical lesions or treatment failure, re-infection with an HR-HPV type, incomplete removal of latent HPV infections or long-term persistence of HR-HPV infections not associated with the previously treated cervical lesion [9–11]. Therefore, continued monitoring of women following cervical treatment is currently recommended.…”

Recommandations pour la surveillance des patientes traitées pour des lésions de haut grade du col utérin

“…Le tabagisme semble être un autre facteur de risque de réci-dive, il est significativement associé au développement du cancer invasif du col. L'HPV semble disparaître plus difficilement chez les femmes fumeuses [36,41] (NP3).…”

“…En effet, la prévalence d'HPV diminue de façon progressive, particulièrement pendant les 12 premiers mois de suivi [11,36,69] (NP2). Tableau 1 Données publiées sur le risque d'invasion à long terme après traitement conservateur des CIN.…”

Quel suivi après traitement chirurgical d’une lésion de haut grade du col utérin ?

“…La persistance d'une infection virale après conisation représente donc un excellent marqueur de risque de récidive [32][33][34][35][36]. Une preuve indirecte du rôle de l'infection à hr-HPV est apportée par le fait que les récidives postthérapeutiques sont plus fréquentes chez les fumeuses [37] en se souvenant que le tabagisme nuit à la clairance virale [38]. Rappelons enfin que les conisations lors de la grossesse ne doivent pas être considérées comme thérapeutiques en raison principalement du fort pourcentage de résections non in sano [39,40].…”

“…Comparée au suivi cytologique, la sensibilité relative du test HPV est de 1,16 % (IC 95 % : 1,02-1,33) pour une spécificité identique 0,96 % (IC 95 % : 0,91-1,01) [71]. La diminution du portage d'HPV après conisation est due à l'exérèse elle-même associée à la réaction immunitaire induite : ainsi la diminution est progressive dans les 12 premiers mois [35,37,72] et 32,4 % (23,6-41,2) des patientes seulement sont porteuses d'hr-HPVà six mois [71]. Il semble donc logique de proposer les étapes suivantes ( Fig.…”