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- Title
Residual or Recurrent Precancerous Lesions After Treatment of Cervical Lesions in Human Immunodeficiency Virus–infected Women: A Systematic Review and Meta-analysis of Treatment Failure.
- Authors
Debeaudrap, Pierre; Sobngwi, Joelle; Tebeu, Pierre-Marie; Clifford, Gary M
- Abstract
Background Screening and treating premalignant cervical lesions (cervical intraepithelial neoplasia 2+ [CIN2+]) is an effective way to prevent cervical cancer, and recommendations exist for the monitoring of treatment success. Yet, there is no specific recommendation for human immunodeficiency virus (HIV)-infected women, who are at a known, increased risk of cervical cancer. Methods A systematic review was performed by searching MEDLINE, EMBASE, and Web of Science for studies published from January 1980 through May 2018. Eligible studies described the prevalence of histologically- and/or cytologically-defined lesions in HIV-infected women at least 6 months post-treatment. The primary endpoint was treatment failure, defined as the presence of residual and/or recurrent high-grade CIN2+/high-grade squamous intraepithelial lesions post-treatment. The pooled prevalence in HIV-infected women and the odds ratios (ORs) for HIV-infected compared to HIV-uninfected women were estimated using random-effects models. Results Among 40 eligible studies, the pooled prevalence of treatment failure in HIV-infected women was 21.4% (95% confidence interval [CI] 15.8–27.0). There was no significant difference in the treatment failure prevalence for cryotherapy (13.9%, 95% CI 6.1–21.6) versus loop electrosurgical excision procedure (13.8%, 95% CI 8.9–18.7; P =.9), but the treatment failure prevalence was significantly higher in women with positive (47.2%, 95% CI 22.0–74.0) than with negative (19.4%, 95% CI 11.8–30.2) excision margin (OR 3.4, 95% CI 1.5–7.7). Treatment failure was significantly increased in HIV-infected versus HIV-uninfected women, both overall (OR 2.7, 95% CI 2.0–3.5) and in all sub-group analyses. Conclusions There is strong evidence for an increased risk of treatment failure in HIV-infected women, in comparison to their HIV-negative counterparts. The only significant predictor of treatment failure in HIV-infected women was a positive margin status, but further data is needed on long-term outcomes after ablative treatment in HIV-infected women.
- Subjects
CANCER relapse; CERVIX uteri surgery; HIV infection complications; COLD therapy; CONFIDENCE intervals; MEDICAL information storage &; retrieval systems; MEDLINE; META-analysis; PRECANCEROUS conditions; RISK assessment; WOMEN'S health; SYSTEMATIC reviews; TREATMENT effectiveness; DISEASE prevalence; ABLATION techniques; CERVICAL intraepithelial neoplasia; ODDS ratio; TUMOR grading; DISEASE risk factors; EVALUATION; CANCER risk factors
- Publication
Clinical Infectious Diseases, 2019, Vol 69, Issue 9, p1555
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy1123