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. Issue 2 (9th August 2022)

• Record Type: Journal Article
• Authors: Joshi, Smita; Muwonge, Richard; Kulkarni, Vinay; Mandolkar, Mahesh; Lucas, Eric; Pujari, Sanjay; Sankaranarayanan, Rengaswamy; Basu, Partha
• Is Part Of: International journal of cancer. Volume 152:Issue 2(2023)
• Page Start: 249
• Page End: 258
• Publication Date: 2022-08-09
• Subjects: cervical cancer -- CIN -- HIV -- HPV -- posttreatment CIN; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.34221
• Languages: English
• ISSNs: 0020-7136

Abstract

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. Abstract : What's new? Women living with HIV (WHIV) are at disproportionately high risk of human papillomavirus (HPV) infection and subsequent cervical cancer. The extent to which cervical intraepithelial neoplasia (CIN) affects WHIV and outcomes among those treated for CIN are not fully known. Here, among women in India, WHIV with persistent HPV infection had a 138.18‐fold increase in risk of CIN2 or worse. Two‐thirds of HPV‐positive WHIV treated with thermal ablation for high‐grade CIN experienced complete disease regression. Nonetheless, HPV persisted in nearly 45% of ablation‐treated WHIV. A significant majority of WHIV who were HPV‐negative at baseline remained HPV‐free in subsequent screenings.