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| |  HPV DNA Testing Plus Cryotherapy Effective Approach in Reducing Cervical Lesions in Women With HIV: Presented at IPV By Bruce Sylvester MALMO, Sweden -- May 15, 2009 -- Human papillomavirus (HPV) DNA testing followed by treatment is an effective approach for reducing cervical cancer precursor lesions in women with HIV, researchers stated here at the 25th International Papillomavirus (IPV) Conference. "We consider using HPV DNA testing to be an effective means of reducing the risk of cervical cancer among HIV-infected women," said Louise Kuhn, PhD, Mailman School of Public Health, Columbia University, New York, on May 11. For the study, the researchers randomised 6,553 unscreened women, aged 35 to 65 years, from Cape Town, South Africa to (1) cryotherapy when DNA testing (Digene Hybrid Capture II) showed them to be HPV positive (screen to treat), (2) cryotherapy when they were HPV positive on visual inspection with acetic acid, or (3) delayed treatment (control group). At baseline, 956 women (14.6%) were HIV positive. All patients underwent colposcopy/biopsy 6 months after randomisation, and two-thirds were followed at 12, 24, and 36 months. Colposcopy/biopsy was repeated at 36 months. Adjudicated histological diagnosis of cervical intraepithelial neoplasia grade 2/3 (CIN2+) was the endpoint of the study. At baseline 45.9% of women with HIV were coinfected with HPV, versus 17.2% of HIV-negative women (P < .0001). Among patients in the control group, 14.9% of HIV-positive women showed CIN2+ by 36 months, versus 4.6% of HIV-negative women (relative risk [RR] = 3.27; 95% confidence interval [CI], 2.21-4.83). Sensitivity of HPV testing was similar in both HIV-positive (94%) and HIV-negative (87%) women. In intent-to-treat analyses of the screen-and-treat HPV group, CIN2+appeared in 3.05% of HIV-positive women versus 1.43% of HIV-negative women by 36 months. Among the control group, CIN2+ appeared in 14.9% of HIV-positive women versus 4.6% of HIV-negative women by 36 months. Notably, screen-and-treat using HPV testing achieved an 80% reduction in CIN2+ among HIV-positive women (RR = 0.20; 95% CI, 0.06-0.69), which was similar to the reduction observed among HIV-negative women (RR = 0.31; 95% CI, 0.20-0.50). "HIV-infected women are at high risk of being coinfected with HPV, and a third of HIV-HPV coinfected women have biopsy-confirmed CIN2+ within 36 months," the researchers concluded. "Screen and treat using HPV DNA testing is an effective means of reducing cervical cancer precursor lesions and should be considered as part of HIV treatment programs." Funding for this study was provided by the Bill and Melinda Gates Foundation to the Alliance for Cervical Cancer Prevention. [Presentation title: Screen-and-Treat Using HPV Testing Is Highly Effective Among HIV-Infected Women. Abstract O-16.01]
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