The significance of nonsurgical therapies for cervical infection of high‐risk human papilloma virus: A systematic review and meta‐analysis

Abstract

ObjectiveTo assess whether nonsurgical therapies were related with clearance of cervical infection of high‐risk human papilloma virus (hr‐HPV) or regression of mild abnormal cytology related with hr‐HPV.MethodsUntil March 2023, we identified a total of 10 424 women with cervical infection of hr‐HPV and 1966 women with mild abnormal cytology related with hr‐HPV from 44 studies that met the inclusion criteria.ResultsAfter systematically retrieving literature, we identified 2317 citations and 44 randomized controlled studies (RCT) were enrolled. Cumulative results suggested women with cervical infection of hr‐HPV might benefit from nonsurgical therapies. Both the clearance of hr‐HPV (OR: 3.83, I2 = 99%, p < 0.00001) and regression of mild abnormal cytology related with hr‐HPV (OR: 3.12, I2 = 63%, p < 0.00001) were significantly higher than control group. Subgroup analysis stratified by systematic therapy, topical therapy, traditional Chinese medicines (TCMs), and presistent hr‐HPV got consistent results. There was substantial heterogeneity between trials (I2 = 87% for clearance of hr‐HPV and 63% for regression of cytology), sensitivity analysis was performed by excluding single study one by one, and found the cumulative results were stable and dependable. Both the funnel plots for clearance of hr‐HPV and regression of abnormal cytology were asymmetrical, significant publication bias might exist.ConclusionNonsurgical therapies might benefit women who had a cervical infection of hr‐HPV with/without mild abnormal cytology related with hr‐HPV. Both the clearance of hr‐HPV and regression of abnormal cytology were significantly higher than control group. More studies with less heterogeneity were needed urgently to draw concrete conclusion.

The impact of herbal treatments on cervicovaginal human papillomavirus infection: a systematic review and meta-analysis

“…A literature search identified meta-analysis studies evaluating the efficacy of non-surgical treatments on HPV. The results, similar to this study, indicated a significant effect on clearing HPV: Xiong et al 10 (p<0.00001), Huang et al 5 (p <0.0001), and Zhuang and Yang 11 (p<0.01). While these studies are up-to-date, providing a comprehensive assessment of non-surgical treatment methods, this study is crucial for focusing exclusively on the impact of herbal treatments and obtaining more specific data.…”

“…In this study, herbal treatments were determined to be effective in clearing HPV infection (p=0.05). Although there is no meta-analysis specifically evaluating the effectiveness of herbal treatments in HPV treatment in the literature, a meta-analysis found a significant impact of biological and herbal studies on HPV clearance in a subgroup analysis similar to this study (p=0.01) 11 .…”

“…This systematic review and meta-analysis encompass five studies involving a total of 662 women, aiming to examine the impact of herbal treatments on cervicovaginal HPV infection. The studies were conducted in India 10 , the United States 11 , Iran 7 , Congo 12 , and Italy 13 . The study design for all included studies was RCTs.…”

“…Therefore, we assessed the risk of bias as low in this domain for these studies. Except for Aragona et al, 1 all studies reported sufficient allocation concealment for randomization and were evaluated as having a low risk of bias, except for one study 11 where dropouts were balanced between intervention and control groups or were considered to have a low risk of bias due to the small number of dropouts that would not significantly impact the study. In three studies included in the meta-analysis 10 - 12 , we considered a high risk of bias because they discussed significant results, including adverse outcomes, and matched the reports in their records.…”