title: The Effect of Cryotherapy on Human Papillomavirus Clearance Among HIV-Positive Women in Lusaka, Zambia.
abstract: OBJECTIVE
  We sought to investigate the progression of human papillomaviruses (HPV) infection in HIV-positive women after cryotherapy.
  
  
  METHODS
  We examined changes in detection of high-risk HPV (hrHPV) cervical infections among HIV-infected women over a 12-week period after cryotherapy using stored specimens from a cohort study conducted between June 2009 and March 2011 in Lusaka, Zambia. Samples from visits at baseline and weeks 4, 8, and 12 were tested using the Roche Linear Array assay.
  
  
  RESULTS
  A total of 89 women were included in the analysis. The median age was 32 years (interquartile range [IQR], 28-36 years). The median CD4+ cell count was 350 cells/μL (IQR, 214-470 cells/μL), and 66% of women were receiving antiretroviral therapy. At baseline, the prevalence of hrHPV was 91% (95% confidence interval [CI], 83%-95%). HPV45 was the most common HPV type, present in (30%) women, followed by HPV16 (27%), HPV18 (27%), HPV51 (20%), and HPV58 (22%). Among women with valid results both at baseline and 12 weeks, 25% (17/67) cleared their initial hrHPV infection within 12 weeks of treatment, although 65% (11/17) had new hrHPV types detected.
  
  
  CONCLUSIONS
  Cryotherapy led to clearance of 25% of hrHPV infections within 12 weeks of treatment. However, hrHPV infection remained persistent in most women, and new hrHPV types were detected often, explaining the high rate of persistence and recurrence of cervical disease in this population. Continued efforts to scale up HPV vaccination and cervical screening should remain a priority in high HIV burden settings such as Zambia.
authors.affiliation: 1Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; 2University of North Carolina at Chapel Hill, Chapel Hill, NC; 3University of California, Irvine, Orange, CA; 4University of Zambia, Lusaka, Zambia; 5Vanderbilt University Institute for Global Health, Nashville, TN; 6Cancer Diseases Hospital, Lusaka, Zambia.
authors.forename: Katundu
authors.initials: K
authors.lastname: Katundu
authors.forename: Allen C
authors.initials: AC
authors.lastname: Bateman
authors.forename: Krista S
authors.initials: KS
authors.lastname: Pfaendler
authors.forename: Mulindi H
authors.initials: MH
authors.lastname: Mwanahamuntu
authors.forename: Sharon
authors.initials: S
authors.lastname: Kapambwe
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Vikrant V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.forename: Susan C
authors.initials: SC
authors.lastname: Msadabwe
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
authors.forename: Groesbeck P
authors.initials: GP
authors.lastname: Parham
authors.forename: Carla J
authors.initials: CJ
authors.lastname: Chibwesha
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D052162:Human papillomavirus 16; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D002577:Uterine Cervical Diseases / Q000628:therapy*; D055815:Young Adult; D015024:Zambia