A meta-analysis of photodynamic therapy in the treatment of cervical intraepithelial neoplasia: Based on randomized controlled trials.

Analysis of factors affecting lesion or HPV clearance rate after photodynamic therapy of persistent cervical intraepithelial neoplasia grade 1.

Cold knife conization (CKC) and the loop electrosurgical excision procedure (LEEP) are standard treatments for cervical intraepithelial neoplasia and carcinoma in situ. However, the comparative long-term effectiveness of these procedures in promoting human papillomavirus (HPV) clearance and preventing recurrent cervical lesions remains uncertain. To compare the long-term incidence of HPV clearance and recurrence of cervical lesions after CKC or LEEP. This cohort study comprised 2 cohorts: a nationwide cohort from Sweden (cohort 1) and a multicenter hospital-based cohort from Fujian Province, China (cohort 2). The study dates were January 1, 1997, to December 31, 2013, for cohort 1 and from October 1, 2013, to October 1, 2022, for cohort 2. A target trial emulation framework was applied to evaluate the effectiveness of CKC vs LEEP, using inverse probability of censoring weighting to balance baseline covariates and address censoring. Women with cervical intraepithelial neoplasia or carcinoma in situ were included. Data were analyzed from October 1, 2024, to August 31, 2025. Cold knife conization or the loop electrosurgical excision procedure. The primary outcome was recurrence of cervical lesions. Secondary outcomes included HPV clearance at 3, 6, and 12 months (cohort 2). Weighted Cox models with hazard ratios (HRs) and 95% CIs were used to compare the recurrence of cervical lesions between CKC and LEEP, adjusting for clinical and demographic factors. The total sample size was 77 001 women who underwent cervical conization in Sweden between 1997 and 2013. In cohort 1, after 22 years of follow-up, 16 017 of 75 497 (21.2%) women who underwent LEEP had recurrence, and 319 of 1504 (21.2%) women who underwent CKC had recurrence. In cohort 2, 65 of 3710 (1.8%) women who were treated with LEEP had recurrent cervical lesions compared with 11 (0.8%) recurrent cervical lesions among the 1340 women who were treated with CKC after 9 years of follow-up. In the hypothetical target trial, women who underwent CKC had a significantly lower risk of recurrence compared with those who underwent LEEP, with HR of 0.67 (95% CI, 0.65-0.68) in cohort 1 and 0.41 (95% CI, 0.21-0.79) in cohort 2. In addition, the HPV clearance rate after CKC was higher than that of LEEP at 3, 6, and 12 months in cohort 2. These findings suggest that among women with cervical intraepithelial neoplasia or carcinoma in situ, CKC was associated with a lower risk of recurrent cervical lesions and higher HPV clearance rates compared with LEEP.

A randomized study of hexaminolevulinate photodynamic therapy in patients with cervical intraepithelial neoplasia 1/2

4553 An investigation into the use of curcumin, a topical herbal agent, for the treatment of cervical intraepithelial neoplasia

BackgroundThe primary objective was to determine human papilloma virus (HPV) clearance rate after cervical biopsy among women with persistent high-risk HPV infection compared with spontaneous HPV clearance rate in the absence of biopsy.MethodsWe collected data from a dedicated screening program of women aged 30–70 years old. Inclusion criteria for the baseline non-interventional cohort were a positive HPV test (hybrid capture 2, HC2) and normal cytology. In the baseline cohort women were followed with approximately yearly HPV-tests and cytology until HPV regressed (one negative HPV test) or interventions in the form of diagnostic biopsies or therapy. Women who had a diagnostic biopsy were included in the biopsy cohort and followed until HPV regression or therapy. Observed HPV regression rates and time to HPV regression were compared between baseline and biopsy cohorts. For the comparison, we used Fisher’s exact test for the HPV regression rates and interval-censored, accelerated failure time model for time to HPV regression.ResultsAmong the 1079 women included in the baseline cohort, 499 (46.3%) had HPV clearance and 475 were referred for colposcopy with biopsy. The biopsy cohort comprised all women who were not treated and had at least one HC2 test after biopsy (201/475; 42.3%). Of those, 138 (68.7%) experienced HPV regression. In the biopsy cohort, time to clearance of HPV infection was approximately halved (0.46, 95% CI 0.38–0.56) compared with the baseline cohort. This result was robust in a wide range of sensitivity analyses.ConclusionsA higher proportion of women cleared their HPV infection, and time to HPV clearance was shorter in the biopsy cohort than in the baseline cohort. It is reassuring for clinicians to know that conservative management of patients with HPV persistency is successful when colposcopy with biopsies excludes high-grade disease.

Alternatives to surgical therapy are needed for the treatment of high-grade cervical intraepithelial neoplasia (CIN 2-3). We aimed to estimate the efficacy of a treatment with imiquimod, a topical immune-response modulator, in patients with CIN 2-3. Fifty-nine patients with untreated CIN 2-3 were randomly allocated to a 16-week treatment with self-applied vaginal suppositories containing either imiquimod or placebo. The main outcome was efficacy, defined as histologic regression to CIN 1 or less after treatment. Secondary outcomes were complete histologic remission, human papillomavirus (HPV) clearance, and tolerability. Assuming a two-sided 5% significance level and a power of 80%, a sample size of 24 patients per group was calculated to detect a 35% absolute increase in CIN 2-3 regression. Histologic regression was observed in 73% of patients in the imiquimod group compared with 39% in the placebo group (P=.009). Complete histologic remission was higher in the imiquimod group (47%) compared with the placebo group (14%) (P=.008). At baseline, all patients tested positive for high-risk HPV. Human papillomavirus clearance rates were increased in the imiquimod group (60%) compared with the placebo group (14%) (P<.001). In patients with HPV-16 infection, complete remission rates were 47% in the imiquimod group compared with 0% in the placebo group (P=.003). Microinvasive cancer was observed in three of 59 (5% [1-14%]) patients, all within the placebo group. Topical imiquimod treatment was well tolerated, and no high-grade side effects were observed. Topical imiquimod is an efficacious and feasible treatment for patients with CIN 2-3.

Evaluation of 5-aminolevulinic acid-mediated photodynamic therapy in postmenopausal women with persistent HPV infection with or without cervical and vaginal low-grade squamous intraepithelial lesions (CIN1/VaIN1)

Comparative study of topical 5-aminolevulinic acid photodynamic therapy and surgery for recurrent cervical high-grade squamous intraepithelial lesions following surgery

Efficacy and safety of photodynamic therapy mediatied by 5-aminolevulinic acid for the treatment of cervical intraepithelial neoplasia 3(CIN 3): A single-center, prospective, cohort study.

Efficacy and safety of photodynamic therapy for cervical intraepithelial neoplasia: A systemic review

Efficacy of 5-aminolevulinic acid photodynamic therapy versus observation for cervical low-grade squamous intraepithelial lesion with type 3 transformation zone.

Purpose Human papillomavirus (HPV) infection is the primary driver of cervical cancer development and progression. This study aimed to determine the incidence, persistence, and clearance of type-specific HPV infections in Yunnan. Methods A retrospective cohort study was conducted between October 2019 and August 2023 on female gynecological outpatients residing in Yunnan, Southwest China. HPV genotyping was performed using a multiplex polymerase chain reaction and capillary electrophoresis. We investigated the incidence, persistence, and clearance of HPV in women who tested again at various times following the initial test. Results This study included 45,149 participants; overall incidence of HPV infection was 36.84% with HPV 52 having the highest incidence, followed by HPV 51, 81, 58, and 16. The age ranges–30–39 and 40–49 y had the highest incidence rates. The overall persistence rate of the HPV infection was 55.56%, while HPV subtypes 42, 52, 58, 81, and 56 showed the highest rates of persistent infection. The highest rates of persistent infection were found in the &lt; 30 and &gt; 59 y age groups. The overall HPV clearance rate was 74.43%, and it increased with age. The most probable HPV subtypes to be cleared were 26, 83, 11, 82, and 44, least likely HR HPV subtypes were 58, 52, and 35, and least likely LR HPV subtypes were 42, 81, and 43. Conclusions Women in Yunnan had a higher likelihood of incident and persistent infections and a lower likelihood of being cleared of HPV 58, 52, 42, and 81. Older adults are more prone to persistent HPV infection, whereas younger individuals are more likely to recover from infection.

IntroductionObservational studies suggest HIV and human papillomavirus (HPV) infections may have multiple interactions. We reviewed the strength of the evidence for the influence of HIV on HPV acquisition and clearance, and the influence of HPV on HIV acquisition.MethodsWe performed meta‐analytic systematic reviews of longitudinal studies of HPV incidence and clearance rate by HIV status (review 1) and of HIV incidence by HPV status (review 2). We pooled relative risk (RR) estimates across studies using random‐effect models. I 2 statistics and subgroup analyses were used to quantify heterogeneity across estimates and explore the influence of participant and study characteristics including study quality. Publication bias was examined quantitatively with funnel plots and subgroup analysis, as well as qualitatively.Results and DiscussionIn review 1, 37 publications (25 independent studies) were included in the meta‐analysis. HPV incidence (pooled RR = 1.55, 95% CI: 1.29 to 1.88; heterosexual males: pooled RR = 1.95, 95% CI: 1.62, 2.34; females: pooled RR = 1.63, 95% CI: 1.26 to 2.11; men who have sex with men: pooled RR = 1.36, 95% CI: 1.01 to 1.82) and high‐risk HPV incidence (pooled RR = 2.20, 95% CI: 1.90 to 2.54) was approximately doubled among people living with HIV (PLHIV) whereas HPV clearance rate (pooled RR = 0.53, 95% CI: 0.42 to 0.67) was approximately halved. In review 2, 14 publications (11 independent studies) were included in the meta‐analysis. HIV incidence was almost doubled (pooled RR = 1.91, 95% CI 1.38 to 2.65) in the presence of prevalent HPV infection. There was more evidence of publication bias in review 2, and somewhat greater risk of confounding in studies included in review 1. There was some evidence that adjustment for key confounders strengthened the associations for review 2. Misclassification bias by HIV/HPV exposure status could also have biased estimates toward the null.ConclusionsThese results provide evidence for synergistic HIV and HPV interactions of clinical and public health relevance. HPV vaccination may directly benefit PLHIV, and help control both HPV and HIV at the population level in high prevalence settings. Our estimates of association are useful for mathematical modelling. Although observational studies can never perfectly control for residual confounding, the evidence presented here lends further support for the presence of biological interactions between HIV and HPV that have a strong plausibility.

Efficacy of 5-aminolevulinic acid and LED photodynamic therapy in cervical intraepithelial neoplasia: A clinical trial.

Association of Oral Papivir/Pavirona® Supplementation with HPV DNA Clearance.