Persistence and clearance of high-risk human papillomavirus and cervical dysplasia at one year in women living with human immunodeficiency virus: a prospective cohort study.

OBJECTIVE Evaluate one-year outcomes of cervical cancer screening and treatment using primary high-risk human papillomavirus (HPV) testing in women living with human immunodeficiency virus (HIV). DESIGN Prospective cohort study SETTING: HIV treatment center in Botswana POPULATION: Women living with HIV METHODS: Participants underwent cervical cancer screening with high-risk HPV testing and triage evaluation at baseline and one-year follow-up. Excisional treatment was offered as indicated. Histopathology was the gold standard. MAIN OUTCOME MEASURES Persistence, clearance and incidence of high-risk HPV infection; and persistence, progression, regression, cure and incidence of cervical dysplasia. RESULTS Among 300 women screened at baseline, 237 attended follow-up (79%). High-risk HPV positivity significantly reduced from 28% at baseline to 20% at one year (p=0.02). High-risk HPV persistence was 46% and clearance 54%; incidence was high at 9%. Prevalence of cervical intraepithelial neoplasia grade (CIN) 2 or higher was most common in participants with incident high-risk HPV (53%). CIN2 or higher was also common in those with persistent high-risk HPV (32%) and even in those who cleared high-risk HPV (30%). 40% of high-risk HPV positive participants at baseline with

Keywords:

• Incidence (epidemiology)
• Internal medicine
• Prospective cohort study
• Gold standard
• Dysplasia
• Population
• Cervical intraepithelial neoplasia
• HPV infection
• Medicine
• Histopathology

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