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

Abstract

Objective To systematically review the published literature in order to estimate the incidence and describe the variability of human papillomavirus (HPV) infection in women following treatment for cervical neoplasia. Methods Several scientific literature databases (e.g. PubMed, ISI Web of Science) were searched through January 31, 2012. Eligible articles provided data on (i) baseline HPV infection status within 6 months prior to or at time of treatment (pre-treatment); and (ii) HPV test results for women's first visit after treatment occurring within 36 months (post-treatment). We abstracted and summarized the post-treatment incidence of newly detected HPV genotypes that were not present at pre-treatment, overall and stratified by study and other population characteristics. Results A total of 25 studies were included, reporting post-treatment HPV incidence in nearly 2000 women. Mean patient age ranged from 31 to 43 years (median 36). Most studies used cervical exfoliated cell specimens to test for HPV DNA (n = 20; 80%), using polymerase chain reaction (n = 21; 84%). Cervical neoplasia treatment included loop electrical excision procedure (n = 11; 44%); laser conization (n = 2; 8%); laser ablation, surgical conization, cryotherapy, alpha-interferon (n = 1; 4% each); or multiple treatment regimens (n = 8; 32%). Follow-up times post-treatment ranged from 1.5 to 36 months (median 6). More than half of studies (n = 17; 68%) estimated the incidence of any HPV type following treatment, while 7 (28%) focused specifically on high-risk (HR) HPV. HPV incidence after treatment varied widely, ranging from 0 to 47% (interquartile range: 0%-15%) in up to 3 years of follow-up after treatment. Lower HPV incidence was observed among studies that included relatively younger women, used laser conization, focused on HR-HPV rather than overall HPV infection, and had a lower proportion of recurrent cervical disease. Conclusions These modest summary incidence estimates from the published literature can guide clinicians, epidemiologists and health economists in developing best practices for post-treatment cervical cancer prevention.

Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review

“…It should be noted that estimates of HPV persistence after treatment may represent either truly persistent infections ( i.e ., infections persisting from before treatment), recurrent HPV infections ( i.e ., reinfection after treatment), or newly acquired HPV infections ( i.e ., infections acquired after treatment). In light of our previous systematic review in women post‐treatment, a notable proportion of these “persistent” HPV infections may have been infections acquired after treatment. This is likely of particular concern for studies with long time intervals ( i.e ., 12 and 24 months) between HPV tests in which sexual activity and subsequent HPV exposure are likely to occur.…”

“…To date, there has been no summary of the literature that examines the estimates of and definitions for HPV persistence after CIN treatment. In 2014, we published a systematic review of HPV incidence after treatment for CIN . In contrast to persistent HPV infections, which are infections that are present at or before treatment and remain present after treatment, incident HPV infections are defined as the detection of a new HPV genotype after treatment for CIN that was not present before or at the time of treatment .…”

“…In 2014, we published a systematic review of HPV incidence after treatment for CIN . In contrast to persistent HPV infections, which are infections that are present at or before treatment and remain present after treatment, incident HPV infections are defined as the detection of a new HPV genotype after treatment for CIN that was not present before or at the time of treatment . To better understand the proportion of HPV‐positive women who remain HPV‐positive following treatment for cervical disease, we performed a systematic review to describe the persistence of HPV infection following treatment for CIN in the published literature.…”

Risk factors for HPV persistence and cytology anomalies at follow‐up after treatment for cervical dysplasia

“…The incidence of persistent hrHPV after treatment for cervical dysplasia has been variously reported as 33% at 6 months, 13% at 12 months, and 9.9% at 36 months, depending on the method used to detect HPV DNA and the type of treatment . In the present study population, the frequency of persistent hrHPV infection was 20% at 6 months.…”

Can HPV vaccine have other health benefits more than cancer prevention? A systematic review of association between cervical HPV infection and preterm birth

“…Mounting evidence suggested that HPV infection, especially high-risk (HR)-HPV, was one of the most critical independent risk factors for cervical dysplasia and cervical cancer [3,4]. Since the highest prevalence of HPV infection has been observed in women during their reproductive age [5,6] and pregnancy is considered to be an independent risk factor for HR-HPV infection [7,8].…”