HPV persistence and association with recurrent cervical intraepithelial neoplasia (CIN) after cryotherapy vs. LEEP among HIV-positive women

Among women living with HIV, treatment of cervical intraepithelial neoplasia of grade 2 or higher (CIN2+) with the loop electrosurgical excision procedure (LEEP) is more likely to clear infection with high-risk, oncogenic types of human papillomavirus (hrHPV) than treatment with cryotherapy, according to the results of a new study conducted by scientists from the International Agency for Research on Cancer (IARC) and partner institutions.

The researchers conducted a secondary analysis of a randomized clinical trial that followed up almost 400 HIV-positive women in Nairobi, Kenya, for 24 months. They found that LEEP was 40% more likely to clear hrHPV infection compared with cryotherapy. They also found that women with persistent hrHPV detection were 5 times more likely to have recurrent CIN2+ compared with women without hrHPV.

Because HIV infection appears to reduce clearance of hrHPV infection after both LEEP and cryotherapy, the benefits of LEEP in reducing the risk of recurrent CIN2+ may be related in part to its ability to clear hrHPV infection more efficiently. Among HIV-positive women, screening for hrHPV after treatment may be used to rule out recurrent CIN2+, given the high sensitivity and high negative predictive value of hrHPV testing in detecting recurrent CIN2+.

Chung MH, De Vuyst H, Greene SA, Mugo NR, Querec TD, Nyongesa-Malava E, et al.
Human papillomavirus persistence and association with recurrent cervical intraepithelial neoplasia after cryotherapy vs loop electrosurgical excision procedure among HIV-positive women: a secondary analysis of a randomized clinical trial
JAMA Oncol, Published online 05 August 2021;
https://doi.org/10.1001/jamaoncol.2021.2683

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