Premalignant cervical lesion treatment failure is more prevalent in women with HIV compared with women who do not have HIV, and the only significant predictor of this kind of treatment failure in women with HIV was positive margin status, according to a systematic review published in Clinical Infectious Diseases.
Successful screening and treatment of premalignant cervical lesions (CIN2+) are tools which aid in the prevention of cervical cancer. Although there are recommendations for monitoring treatment success in the general population of women, there are no specific recommendations for women with HIV, who have an increased risk of cervical cancer.
Researchers performed a systematic review using data from EMBASE, MEDLINE, Web of Science, databases of large conferences, and the Cochrane Database of Systematic Reviews. Eligible studies were published between January 1980 and May 2018 and described the prevalence of cytologically and/or histologically defined precancerous lesions in women with HIV at least 6 months post-treatment. The primary end point was treatment failure, defined as the presence of post-treatment residual and/or recurrent high-grade CIN2+/high grade squamous intraepithelial lesions. Random-effects models were used to estimate pooled prevalence in women with HIV and odds ratios (OR) for women with HIV vs women without HIV.
In the 40 eligible studies, which included 3975 women with HIV and 3638 women without the infection; the pooled treatment failure prevalence in women with HIV was 21.4% (95% CI, 15.8-27.0). No significant treatment failure difference was observed for cryotherapy (13.9%; 95% CI, 6.1-21.6) vs loop electrosurgical excision procedure (13.8%; 95% CI, 8.9-18.7, P=.9). Treatment failure was significantly higher among women with positive margins (47.2%; 95% CI, 22.0-74.0) vs negative margins (19.4%; 95% CI, 11.8-30.2; OR 3.4; 95% CI, 1.5-7.7). Prevalence of treatment failure significantly increased for women with HIV compared with those without HIV (23.4%; 95% CI, 14.0-32.7 vs 9.5%; 95% CI, 5.8-13.2), indicating a 2-fold higher risk of treatment failure for those with HIV (OR 2.7, 95% CI, 2.0-3.5).
Researchers concluded that the study “provides evidence for an increased risk of high cervical lesions post-treatment in HIV-infected women in comparison to their HIV-uninfected counterparts. Thus, there is a need to reflect upon appropriate follow-up strategies for these women, particularly in limited-resource contexts where the HIV epidemic is known to concentrate.”
Debeaudrap P, Sobngwi J, Tebeu P, Clifford GM. Residual or recurrent precancerous lesions after treatment of cervical lesions in HIV-infected women: a systematic review and meta-analysis of treatment failure [published online January 2, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciy1123