Residual Disease and HPV Persistence after Cryotherapy for Cervical Intraepithelial Neoplasia Grade 2/3 in HIV-Positive Women in Kenya

Abstract

ObjectiveTo assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women.DesignFollow-up study.Methods79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells).ResultsAt 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI): 66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at baseline. CD4 count and duration of combination antiretroviral therapy (cART) were not associated with residual CIN2/3. CIN3 instead of CIN2 was the only significant risk factor for residual disease (odds ratio, OR vs CIN2 = 4.3; 95% CI: 1.2–15.0) among hrHPV-positive women after adjustment for age and HPV16 infection. Persistence of hrHPV types previously detected in biopsies was found in 77.5% of women and was associated with residual CIN2/3 (OR = 8.1, 95% CI: 0.9–70). The sensitivity, specificity, and negative predictive value of hrHPV test in detecting residual CIN2/3 were 0.94, 0.36, and 0.96 respectively.ConclusionsNearly one quarter of HIV-positive women had residual CIN2/3 disease at 6 months after cryotherapy, and the majority had persistent hrHPV. CD4 count and cART use were not associated with residual disease or hrHPV persistence. The value of hrHPV testing in the detection of residual CIN2/3 was hampered by a low specificity.

Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening

“…These findings are consistent with a study of HIV-infected women from Kenya, which found 23% of women had residual CIN 2/3 at 6 months after cryotherapy[22]. Neither the use of antiretroviral therapy nor CD4 counts were associated with post-treatment disease in that study nor in the present study.…”

Assessment of the scale‐up of cervical cancer screening in Abidjan stratified by HIV status

“…Follow‐up after cryotherapy is critical for the long‐term effectiveness of a CC screening program because recurrences of cervical intraepithelial neoplasia after treatment are frequent, particularly among women with HIV . In the present study, the reported attendance of the 1‐year follow‐up visit after cryotherapy was 23.1%, which is much lower than that reported in Ethiopia (51.1%) .…”

Methylation Levels of CADM1, MAL, and MIR124-2 in Cervical Scrapes for Triage of HIV-Infected, High-Risk HPV-Positive Women in Kenya

“…We note that persistence of hrHPV was common in this population even after the treatment of CIN2+, and we did not perform any random biopsy to exclude residual disease in women whose cytology was not HSIL+. 26 An important strength of the present study is the systematic collection of baseline biopsies from all women, which increased the accuracy of cervical lesion ascertainment. Cytology and histological diagnoses were centrally reviewed, and hrHPV infection was assessed using a clinically validated assay.…”

“…Women with CIN2 lesions or worse (CIN2+) were offered cryotherapy or more extended treatment if not eligible for cryotherapy. 26 A follow-up visit was planned for all women 6 months after the baseline visit. Cervical cells were collected again to perform conventional cytology, HPV testing, and, among women who were still hrHPV positive at follow-up, a second methylation marker analysis.…”

“…Women who were CIN2+ at the 6-month follow-up visit were treated with cryotherapy if appropriate. 26 If the lesion was too large or the woman had already been treated at the screening round, a loop electrosurgical excision procedure was performed.…”