Cervical Intraepithelial Neoplasia in a Cohort of HIV-positive Women at the University Hospital of the West Indies: Management and Outcome

Liu

et al. 2020

Intl Journal of Cancer

Thermal ablation is a point‐of‐care ablative treatment technique for cervical intraepithelial neoplasia (CIN). However, limited information is available about its efficacy in low‐ and middle‐income countries. We evaluated the efficacy of thermal ablation in treatment of CIN detected through high‐risk human papillomavirus (HPV) screening in China. Women positive on high‐risk HPV and having colposcopically suspected lesions eligible for ablation underwent colposcopy, biopsy and thermal ablation in one visit. Women ineligible were recalled for large loop excision of transformation zone (LLETZ) when histopathology results were high‐grade CIN. Posttreatment follow‐up at 6 months or more was with HPV test and cytology followed by colposcopy and biopsy for HPV and/or cytology‐positive women. Cure was defined as either negative cytology and HPV test or absence of histopathology proved CIN in any positive women. Of total 218 HPV‐positive women treated with thermal ablation (n = 170) or LLETZ (n = 48), 196 reported for follow‐up evaluation. For women with histologically confirmed CIN at baseline (thermal ablation‐104; LLETZ‐38), cure rates were 84.6% for thermal ablation and 86.8% for LLETZ. Cure rates after thermal ablation were 90.3% for CIN grade one (CIN1) and 76.2% for CIN grade two or worse (CIN2+). HPV clearance rate was 80.4% in women undergoing thermal ablation, which was lower for HPV16/18 compared to other oncogenic types (67.6% vs 85.7%). HPV test had a negative predictive value (NPV) of 98.7% to detect CIN2+ at follow‐up and the positive predictive value (PPV) was 40.4%. Thermal ablation is effective to treat CIN as well as to clear the high‐risk HPV infection. HPV test has high PPV and NPV in following up patients posttreatment.

Section: Discussionmentioning

confidence: 99%

Section: Adverse Effects and Complicationsmentioning

confidence: 99%

Efficacy of point‐of‐care thermal ablation among high‐risk human papillomavirus positive women in China

Liu

et al. 2020

Intl Journal of Cancer

“…Fruchter et al [ 38 ] found recurrence to occur in 62.0 % of HIV-positive women compared to 18.0 % of HIV-negative women 36 months after treatment by either ablation or excision. Bambury et al [ 39 ] reported a recurrence rate of 66.2 cases per 100 person-years in HIV-positive women compared to 3.0 per 100 person-years in HIV-negative women following treatment by thermo-coagulation or LLETZ. The main attraction of ablative or excisional treatment after VIA/VILI is the opportunity to reduce or eliminate repeated clinic visits.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of cervical intraepithelial lesions after thermo-coagulation in HIV-positive and HIV-negative Nigerian women

Oga

Brown

et al. 2016

BMC Women's Health

BackgroundThe burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. Effectiveness of screening, rates of recurrence following treatment and factors driving these in Africans have not been sufficiently studied. The purpose of this study therefore was to investigate factors associated with recurrence of cervical intraepithelial lesions following thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugol’s Iodine (VILI) for diagnosis.MethodsA retrospective cohort study was conducted, recruiting participants from the cervical cancer “see and treat” program of IHVN. Data from 6 sites collected over a 4-year period was used. Inclusion criteria were: age ≥18 years, baseline HIV status known, VIA or VILI positive and thermo-coagulation done. Logistic regression was performed to examine the proportion of women with recurrence and to examine factors associated with recurrence.ResultsOut of 177 women included in study, 67.8 % (120/177) were HIV-positive and 32.2 % (57/177) were HIV-negative. Recurrence occurred in 16.4 % (29/177) of participants; this was 18.3 % (22/120) in HIV-positive women compared to 12.3 % (7/57) in HIV-negative women but this difference was not statistically significant (p-value 0.31). Women aged ≥30 years were much less likely to develop recurrence, adjusted OR = 0.34 (95 % CI = 0.13, 0.92). Among HIV-positive women, CD4 count <200cells/mm3 was associated with recurrence, adjusted OR = 5.47 (95 % CI = 1.24, 24.18).ConclusionRecurrence of VIA or VILI positive lesions after thermo-coagulation occurs in a significant proportion of women. HIV-positive women with low CD4 counts are at increased risk of recurrent lesions and may be related to immunosuppression.

“…This is essential among WLWH, given the higher prevalence of CIN 11,13 and the worse treatment outcomes among this population compared with HIV-negative women. 45-47 …”

Section: Discussionmentioning

confidence: 99%

Cervical Abnormalities in South African Women Living With HIV With High Screening and Referral Rates

Katz

Butler

Crankshaw

et al. 2016

JGO

PurposeTo determine the prevalence of screening, cervical dysplasia, and malignancy on the basis of histologic diagnoses from colposcopy and large loop excision of the transformation zone among women living with HIV (WLWH) who attended an urban antiretroviral treatment (ART) clinic in KwaZulu-Natal, South Africa.Materials and MethodsWe performed a retrospective cohort study to examine a random sample of 462 WLWH during a 5-year period from 2004 to 2009. Women on ART for < 3 months were excluded. Data were abstracted from electronic records and paper charts to assess rates of cervical abnormalities detected on Pap smears as well as time to colposcopy.ResultsDuring the study period, 432 women (93.5%) had at least one evaluable Papanicolau test. At baseline, 237 women (54.9%) had an abnormal Papanicolau test, and of these patients, 181 (76.3%) had a Papanicolau test that qualified for further colposcopic evaluation. In addition, 115 women (63.5%) received colposcopy within a median of 39 days from referral. This yielded 74 evaluable histologic samples (64.3%), of which 21.6%, 27.0%, 27.0%, and 1.4% had cervical intraepithelial neoplasia (CIN) 1, CIN2, CIN3, and invasive cervical cancer, respectively.ConclusionIn a large sample of WLWH who received ART in KwaZulu-Natal, South Africa, where Papanicolau test coverage and rates of referral for colposcopy and large loop excision of the transformation zone were high, > 75% of women with evaluable histologic samples had evidence of cervical dysplasia or malignancy. These findings underscore the importance of routine cervical screening upon entry into HIV care to optimize survival.