Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ).
OBJECTIVE
Human Papillomavirus (HPV) persistence after high-grade cervical intra-epithelial neoplasia (CIN) removal may be associated with residual lesions or risk of disease recurrence. Knowledge regarding the factors associated with HPV persistence following CIN treatment is still limited. The main purpose of this longitudinal study was to assess the association between characteristics of the patients and their cervical lesions with high-risk HPV-type persistence, detected by commercially available Hybrid Capture II (HC II), after CIN 2 and 3 treatment with large loop excision of the transformation zone (LLETZ).


METHODS
For this cohort study, a total of 94 women submitted to LLETZ between March 2001 and September 2002 were included. Only women with at least one follow-up visit at 6 or 12 months and confirmed CIN 2 or 3 in the cone specimen were considered. In each visit women answered to a questionnaire and undertook Pap smear and HC II specimens collection. McNemar's, chi-square and Fisher tests were used for univariate analysis. Generalized Estimating Equations (GEE) were used for multivariate analysis. All calculations were performed within 95% confidence intervals (95% CI).


RESULTS
Histological evaluation showed 12 (13%) women with CIN, 2 and 82 (87%) with CIN 3 and conization margins were compromised in 27 (29%) cases. Eighty-seven (92%) women showed positive HC II tests prior to LLETZ. Of women initially HPV negative, none had a positive HC II during follow-up. The proportion of positive HPV tests was reduced from 92% to 20%(P < 0.01) at the first visit and to 22% (P < 0.01) at the second visit after LLETZ. Multivariate analysis showed that smoking and age above 35 years (irrespective of margin status) were strongly associated with positive HPV during follow-up.


CONCLUSIONS
HPV persistence following LLETZ was associated with smoking and with the interaction between age and conization margins.
Sarian
Luís Otávio Zanatta
LO
Obstetrics and Gynecology Department, Universidade Estadual de Campinas, UNICAMP, Campinas, Brazil.
Derchain
Sophie Françoise Mauricette
SF
Pitta
Denise da Rocha
Dda R
Morais
Sirlei Siani
SS
Rabelo-Santos
Silvia Helena
SH
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002584:Cervix Uteri / Q000601:surgery / Q000821:virology; D015331:Cohort Studies; D003127:Colposcopy; D019092:Conization; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D027383:Papillomaviridae / Q000235:genetics / Q000502:physiology*; D030361:Papillomavirus Infections / Q000601:surgery / Q000821:virology*; D012907:Smoking; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000601:surgery / Q000821:virology*
D004279:DNA, Viral