Residual or recurrent precancerous lesions after treatment of cervical lesions in HIV-infected women: a systematic review and meta-analysis of treatment failure - Debeaudrap, Pierre; Sobngwi, Joelle; Tebeu, Pierre-Marie; Clifford, Gary M (Clinical Infectious Diseases, 2019)
Background Screening and treating premalignant cervical lesions (CIN2+) is an effective way to prevent cervical cancer, and recommendations exist for monitoring of treatment success. Yet, there is no specific recommendation for HIV-infected women, who are at known increased risk of cervical cancer. Methods A systematic review was performed by searching MEDLINE, EMBASE and Web of Science from January 1980 through May 2018. Eligible studies described prevalence of histologically and/or cytologically-defined lesions in HIV-infected women, at least 6 months post-treatment. Primary endpoint was treatment failure, defined as the presence of residual and/or recurrent high-grade CIN2+/HSIL+ lesions post-treatment. Pooled prevalence in HIV-infected women, and odds ratios (OR) for HIV-infected compared to HIV-uninfected women were estimated using random-effects models. Results Among 40 eligible studies, pooled prevalence of treatment failure in HIV-infected women was 21.4% (95%CI 15.8–27.0). There was no significant difference in treatment failure for cryotherapy (13.9%, 95%CI 6.1–21.6) versus LEEP (13.8%, 95%CI 8.9–18.7,p=0.9), but it 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) margins (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. Conclusion There is strong evidence for 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 positive margin status, but further data is needed on long-term outcomes after ablative treatment in HIV-infected women.
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