Journal Article

Residual or Recurrent Precancerous Lesions After Treatment of Cervical Lesions in Human Immunodeficiency Virus–infected Women

Sobngwi, Joelle, Debeaudrap, Pierre, Tebeu, Pierre-Marie, Clifford, Gary M.

2019

Overview

Abstract Background Screening and treating premalignant cervical lesions (cervical intraepithelial neoplasia 2+ [CIN2+]) is an effective way to prevent cervical cancer, and recommendations exist for the monitoring of treatment success. Yet, there is no specific recommendation for human immunodeficiency virus (HIV)-infected women, who are at a known, increased risk of cervical cancer. Methods A systematic review was performed by searching MEDLINE, EMBASE, and Web of Science for studies published from January 1980 through May 2018. Eligible studies described the prevalence of histologically- and/or cytologically-defined lesions in HIV-infected women at least 6 months post-treatment. The primary endpoint was treatment failure, defined as the presence of residual and/or recurrent high-grade CIN2+/high-grade squamous intraepithelial lesions post-treatment. The pooled prevalence in HIV-infected women and the odds ratios (ORs) for HIV-infected compared to HIV-uninfected women were estimated using random-effects models. Results Among 40 eligible studies, the pooled prevalence of treatment failure in HIV-infected women was 21.4% (95% confidence interval [CI] 15.8–27.0). There was no significant difference in the treatment failure prevalence for cryotherapy (13.9%, 95% CI 6.1–21.6) versus loop electrosurgical excision procedure (13.8%, 95% CI 8.9–18.7; P = .9), but the treatment failure prevalence was significantly higher in women with positive (47.2%, 95% CI 22.0–74.0) than with negative (19.4%, 95% CI 11.8–30.2) excision margin (OR 3.4, 95% CI 1.5–7.7). Treatment failure was significantly increased in HIV-infected versus HIV-uninfected women, both overall (OR 2.7, 95% CI 2.0–3.5) and in all sub-group analyses. Conclusions There is strong evidence for an increased risk of treatment failure in HIV-infected women, in comparison to their HIV-negative counterparts. The only significant predictor of treatment failure in HIV-infected women was a positive margin status, but further data is needed on long-term outcomes after ablative treatment in HIV-infected women. Residual or recurrent premalignant cervical lesions are detected in around one-fifth of human immunodeficiency virus (HIV)-infected women treated for precancerous cervical lesions, who are twice as likely to suffer treatment failure as HIV-uninfected women, regardless of the treatment method.

• Publisher: Oxford University Press,Oxford University Press (OUP)
• Subject: and Commentaries / ARTICLES AND COMMENTARIES / Female / HIV - pathogenicity / Human health and pathology / Humans / Life Sciences / Odds Ratio / Prevalence / Squamous Intraepithelial Lesions - epidemiology / Squamous Intraepithelial Lesions - pathology / Squamous Intraepithelial Lesions - virology / Uterine Cervical Neoplasms - epidemiology / Uterine Cervical Neoplasms - pathology / Uterine Cervical Neoplasms - virology