title: Reduced acquisition and reactivation of human papillomavirus infections among older women treated with cryotherapy: results from a randomized trial in South Africa.
abstract: BACKGROUND
  Treatment of women for high-grade cervical cancer precursors frequently results in clearance of the associated high-risk human papillomavirus (hrHPV) infection but the role of treatment among women without hrHPV is unknown. We investigated whether cervical cryotherapy reduces newly detected hrHPV infections among HIV-positive and HIV-negative women who were hrHPV negative when treated.
  
  
  METHODS
  The impact of cryotherapy on newly detected hrHPV infections was examined among 612 women of known HIV serostatus, aged 35 to 65 years, who were negative for hrHPV DNA, and randomized to either undergo cryotherapy (n = 309) or not (n = 303). All women underwent repeat hrHPV DNA testing 6, 12, 24, and 36 months later.
  
  
  RESULTS
  Among 540 HIV-negative women, cryotherapy was associated with a significant reduction in newly detected hrHPV infections. Women in the cryotherapy group were 55% less likely to have newly detected hrHPV than women in the control group (95% CI 0.28 to 0.71). This association was independent of the influence of changes in sexual behaviors following therapy (adjusted hazards ratio (HR) = 0.49, 95% CI 0.29 to 0.81). Among 72 HIV-positive women, similar reductions were not observed (HR = 1.10, 95% CI 0.53 to 2.29).
  
  
  CONCLUSIONS
  Cervical cryotherapy significantly reduced newly detected hrHPV infections among HIV-negative, but not HIV-positive women. These results raise intriguing questions about immunological responses and biological mechanisms underlying the apparent prophylactic benefits of cryotherapy.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Taylor
authors.forename: Chunhui
authors.initials: C
authors.lastname: Wang
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wright
authors.forename: Lynette
authors.initials: L
authors.lastname: Denny
authors.forename: Wei-Yann
authors.initials: WY
authors.lastname: Tsai
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
mesh_terms: D000328:Adult; D000368:Aged; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control*; D013019:South Africa; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*