Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra, India

Abstract

We are reporting (a) updated incidence of cervical intraepithelial neoplasia (CIN) among women who did not have colposcopic or histopathological disease at baseline and (b) disease outcomes among women treated for CIN and their follow‐up HPV status; in a cohort of women living with HIV (WHIV). The median overall follow‐up was 3.5 years (IQR 2.8‐4.3). The incidence of any CIN and that of CIN 2 or worse disease was 16.7 and 7.0 per 1000 person‐years of observation (PYO), respectively. Compared with women who were HPV negative at baseline, women who cleared HPV infection had 23.95 times increased risk of incident CIN 2 or worse lesions (95% CI 2.40‐661.07). Women with persistent HPV infection had 138.18 times increased risk of CIN 2 or worse lesions (95% CI 20.30‐3300.22). Complete disease regression was observed in 65.6% of the HPV positive women with high‐grade CIN and were treated with thermal ablation but HPV persistence was seen in 44.8% of those with high‐grade disease. Among those who did not have any disease at baseline and were also HPV negative, about 87% (95% CI 83.79‐89.48) women remained HPV negative during consecutive HPV test/s with the median interval of 3.5 years. Long‐term surveillance of WHIV treated for any CIN is necessary for the prevention of cervical cancer among them. Our study provides an early indication that the currently recommended screening interval of 3 to 5 years among WHIV may be extended to at least 5 years among HPV negative women. Increasing the screening interval can be cost saving and improve scalability among WHIV to support WHO's cervical cancer elimination initiative.

Efficacy of thermal ablation for treatment of biopsy‐confirmed high‐grade cervical precancer among women living with HIV in Kenya

“…Our findings of high CIN2/3 treatment failure rates align with recent TA efficacy studies using hand‐held devices, which also assessed disease status in WLWH through histology or other objective criteria 15‐17 . In a 2023 study reporting 3.5‐year treatment outcomes from a cohort of WLWH in India, among 32 HPV+ WLWH with biopsy‐confirmed CIN2/3 who received TA and had follow‐up, 9 (28%) had persistent CIN2+ at follow‐up 15 .…”

“…[15][16][17] In a 2023 study reporting 3.5-year treatment outcomes from a cohort of WLWH in India, among 32 HPV+ WLWH with biopsy-confirmed CIN2/3 who received TA and had follow-up, 9 (28%) had persistent CIN2+ at follow-up. 15 Although data on the impact of HIV control on CIN treatment outcome was not reported, persistent HPV infection following TA was significantly associated with recurrent CIN2/3 (OR 138.2, 95% CI 20.3-3300.2). In a 2020 study reporting pilot results of an ongoing randomized trial in Zambia, treatment success following TA, defined as type-specific HPV clearance at 6 months was 44% in WLWH, compared to 83% in HIVnegative women.…”

“…Our findings of high CIN2/3 treatment failure rates align with recent TA efficacy studies using hand-held devices, which also assessed disease status in WLWH through histology or other objective criteria. [15][16][17] In a 2023 study reporting 3.5-year treatment outcomes from a cohort of WLWH in India, among 32 HPV+ WLWH with biopsy-confirmed CIN2/3 who received TA and had follow-up, 9 (28%) had persistent CIN2+ at follow-up. 15 Although data on the impact of HIV control on CIN treatment outcome was not reported, persistent HPV infection following TA was significantly associated with recurrent CIN2/3 (OR 138.2, 95% CI 20.3-3300.2).…”

Safety and adherence to self-administered intravaginal 5-fluorouracil cream following cervical intraepithelial neoplasia (CIN) 2/3 treatment among HIV-positive women in Kenya: A phase 1 clinical trial

“…Randomized trials in South Africa and Kenya demonstrate 18–19% and 27–30% CIN2/3 recurrence following excision and cryotherapy among WLWH, respectively. 4 , 5 Rates of CIN2/3 recurrence among WLWH following thermal ablation are 28% 6 - 39.9% 6 , 7 at 1–3 years after treatment. This calls for studies on innovative yet feasible and accessible strategies to improve outcomes in this population, including topical therapies, immunotherapy, or therapeutic vaccinations.…”