Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear

Nobbenhuis, Mariëlle; Helmerhorst, Theo J.M.; Brule, Adriaan J. C. van den; Rozendaal, Lawrence; Voorhorst, Feja J.; Bezemer, P.D.; Verheijen, René H.M.; Meijer, Chris J.L.M.

doi:10.1016/s0140-6736(01)06809-x

Cited by 210 publications

(173 citation statements)

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“…For contrasts we used the log-rank test. The time-point of HPV clearance was taken at the mid-point between positive and negative test results for high-risk HPV (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001. We included 179 non-pregnant women with a high-risk HPV positive test at baseline (Figure 1; group A) and 38 women with a high-risk HPV positive test at their first visit during pregnancy (Figure 1; groups B and C).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in a study in which postpartum regression rates of cervical lesions were Molecular and Cellular Pathology compared in women who delivered vaginally or by caesarean section, a higher postpartum regression was seen in women with vaginal deliveries probably due to stimulation of local immune factors (Ahdoot et al, 1998). From recent studies we know that HPV clearance is associated with and precedes on average 3 months regression of cervical lesions (Nobbenhuis et al, 2001;Zielinski et al, 2001). Thus, following clearance an increased regression rate of cervical lesions could be expected postpartum.…”

Section: Discussionmentioning

confidence: 99%

“…The characteristics of this cohort have been described previously (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001. Briefly, the inclusion criteria were: referral because of an abnormal cervical smear (i.e.…”

Section: Womenmentioning

confidence: 99%

“…Women were monitored every 3 to 4 months by cytology, colposcopy and HPV testing (Remmink et al, 1995;Nobbenhuis et al, 1999Nobbenhuis et al, , 2001. Clinicians and laboratory staff were blinded for HPV test results and clinical findings, respectively.…”

Section: Womenmentioning

confidence: 99%

“…Women were considered to be clear of infection when no high-risk HPV type from the previous visit was detected at the next visit (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001). …”

Section: Definition Of Hpv Clearancementioning

confidence: 99%

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High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

et al. 2002

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We followed 353 women referred with abnormal cervical cytology in a non-intervention cohort study. In 91 pregnant women we compared high-risk human papilloma virus rates in the subsequent trimesters and postpartum in comparison to 262 nonpregnant women. High-risk human papilloma virus clearance was compared with 179 high-risk human papilloma virus positive non-pregnant women. Our main questions were: (1) do high-risk human papilloma virus rates change during pregnancy?; and (2) is there any difference between high-risk human papilloma virus clearance in pregnant and non-pregnant women? Women were monitored 3 -4 monthly by cytology, colposcopy, and high-risk human papilloma virus testing. The median follow-up time was 33 months (range 3 -74). Non-pregnant women showed prevalence rates of high-risk human papilloma virus of 64, 57, 53, and 50%, respectively, in four subsequent 3-months periods since the start of the study. These high-risk human papilloma virus rates were higher than in the three trimesters of pregnancy, and during the first 3 months postpartum, i.e. 50, 44, 45, and 31%, respectively. Postpartum only, this difference was statistically significant (P=0.004). Paired comparisons of high-risk human papilloma virus prevalence rates of the different trimesters with the postpartum rate showed (McNemar test) decreased rates: first trimester: 18% (P=0.02), second trimester: 13% (P=0.02) and third trimester: 23% (P50.005). Such a phenomenon was not found in non-pregnant women. Pregnant women showed a trend for increased high-risk human papilloma virus clearance during the third trimester and postpartum compared to non-pregnant women (hazard ratios 3.3 (0.8 -13.7) and 4.6 (1.6 -12.8), respectively). These results suggest a lowered immune-response against human papilloma virus during the first two trimesters of pregnancy with a catch-up postpartum. Keywords: human papillomavirus; pregnancy; follow-up study; natural history; prevalence Several epidemiological and biological studies have established the important role of infection with high-risk types of human papilloma virus (HPV) for development of cervical cancer and its precursor lesions. In women with or without abnormal cervical smears a positive high-risk HPV test result indicates an increased risk for development of high grade cervical lesions (Ho et al, 1995;Remmink et al, 1995;Rozendaal et al, 1996Rozendaal et al, , 2000Nobbenhuis et al, 1999). Moreover, in nearly all cervical cancers high-risk HPV types have been detected .The increased prevalence of high grade cervical lesions and cervical cancer in immunocompromised patients, such as AIDS patients and transplant recipients, indicates that persistence of high-risk HPV and consequently HPV-mediated carcinogenesis is related to compromised immunosurveillance (IARC, 1995;Petry et al, 1996;Sun et al, 1997). Pregnancy is believed to alter immune-response in women (Schneider et al, 1987;Sethi et al, 1998). Some authors concluded pregnancy has no effect on CIN (Jain et al, 1997). Others reported high regress...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Womenmentioning

confidence: 99%

Section: Womenmentioning

confidence: 99%

“…Women were considered to be clear of infection when no high-risk HPV type from the previous visit was detected at the next visit (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001). …”

Section: Definition Of Hpv Clearancementioning

confidence: 99%

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High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

et al. 2002

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Dysplasia, HPV and Cervical Cancer

Dunleavey

2008

Cervical Cancer

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Comparison of the accuracy of Hybrid Capture II and polymerase chain reaction in detecting clinically important cervical dysplasia: a systematic review and meta‐analysis

et al. 2013

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The effectiveness of screening programs for cervical cancer has benefited from the inclusion of Human papillomavirus (HPV) DNA assays; which assay to choose, however, is not clear based on previous reviews. Our review addressed test accuracy of Hybrid Capture II (HCII) and polymerase chain reaction (PCR) assays based on studies with stronger designs and with more clinically relevant outcomes. We searched OvidMedline, PubMed, and the Cochrane Library for English language studies comparing both tests, published 1985–2012, with cervical dysplasia defined by the Bethesda classification. Meta-analysis provided pooled sensitivity, specificity, and 95% confidence intervals (CIs); meta-regression identified sources of heterogeneity. From 29 reports, we found that the pooled sensitivity and specificity to detect high-grade squamous intraepithelial lesion (HSIL) was higher for HCII than PCR (0.89 [CI: 0.89–0.90] and 0.85 [CI: 0.84–0.86] vs. 0.73 [CI: 0.73–0.74] and 0.62 [CI: 0.62–0.64]). Both assays had higher accuracy to detect cervical dysplasia in Europe than in Asia-Pacific or North America (diagnostic odd ratio – dOR = 4.08 [CI: 1.39–11.91] and 4.56 [CI: 1.86–11.17] for HCII vs. 2.66 [CI: 1.16–6.53] and 3.78 [CI: 1.50–9.51] for PCR) and accuracy to detect HSIL than atypical squamous cells of undetermined significance (ASCUS)/ low-grade squamous intraepithelial lesion (LSIL) (HCII-dOR = 9.04 [CI: 4.12–19.86] and PCR-dOR = 5.60 [CI: 2.87–10.94]). For HCII, using histology as a gold standard results in higher accuracy than using cytology (dOR = 2.87 [CI: 1.31–6.29]). Based on higher test accuracy, our results support the use of HCII in cervical cancer screening programs. The role of HPV type distribution should be explored to determine the worldwide comparability of HPV test accuracy.

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Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear

Cited by 210 publications

References 6 publications

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

Dysplasia, HPV and Cervical Cancer

Comparison of the accuracy of Hybrid Capture II and polymerase chain reaction in detecting clinically important cervical dysplasia: a systematic review and meta‐analysis

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