Cervical intraepithelial neoplasia recurrence after conization in HIV infected and no infected women
C. Lodi1, M. Michelin2, M.I. Lima3, N. Teixeira4, S. Adad2, E.D. Murta5, A. Lucena4, M. Guimarães4, E. Murta2, V. Melo5, Women and HIV Research Group, Belo Horizonte, Brazil
1Medical Science School of Minas Gerais, Belo Horizonte, Brazil, 2Research Institute of Federal University of Triângulo Mineiro, Uberaba, Brazil, 3Reference Service in Cervical Pathology, PAM Sagrada Família, Belo Horizonte, Brazil, 4Reference and Training Center on Infectious and Parasitic Diseases (CTR-DIP) Orestes Diniz, Belo Horizonte, Brazil, 5Federal University of Minas Gerais, Belo Horizonte, Brazil
Background: Cervical intraepithelial neoplasia (CIN) is a precursor of invasive squamous cell carcinoma; untreated high-grade CIN significantly increase the risk of invasive cancer. CIN lesions are usually adequately excised by loop electrosurgical excision procedures (LEEP), which typically preserves cervix anatomy and function. However, women treated for pre-invasive cancer are at risk for recurrence (5% to 30%), and a strict follow-up after LEEP is essential. There are several factors associated with CIN recurrence: margin involvement; histopathologic CIN grade; glandular involvement; persistent HPV infection; and immunosuppression associated to HIV infection. We aimed to identify risk factors associated with recurrence of CIN following LEEP in women with and without HIV.
Methods: This is a case-control study. Cervical samples were colected between 1999 and 2004. Recurrence/residual diagnosis was established after conization, and tissues were fixed in formalin and embedded in paraffin by ten years. Polymerase chain reaction (PCR) was used to detect the human papillomavirus genome (HPV DNA), types 6,11,16,18,31,33,35. Statistical analysis was performed using X2 test with Yates correction and the Fisher´s exact test for comparison of categorical variables. Multivariate analysis was carried out using logistic regression models.
Results: A total of 33 patients with recurrent CIN and 105 without recurrence were enrolled. HIV-infection (p=0.001), glandular involvement (p=0.000), and compromised margins (p=0.02) were significantly associated to CIN recurrence. HPV DNA was positive in 57.6% of patients with CIN recurrence. High-risk HPV subtypes were detected in most cases but were not associated with recurrence (p=0.27). In multivariate analysis, HIV infection (OR-4.29; 95%CI: 1.62-11.34) and glandular involvement (OR-11.78; 95%CI: 3.48-39.9) were independently associated with CIN recurrence.
Conclusions: Human immunodeficiency virus infection and glandular involvement were independently associated with increased risk of recurrence of cervical intraepithelial neoplasia.
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