Cervical Intraepithelial Neoplasia Recurrence Among HIV Positive and Negative Ethiopian Women after Cryotherapy: A Retrospective Cohort Study

Abstract

Background: Early testing and treatment is among the successful strategies for the prevention and control of cervical pre-cancer and invasive cancer which is costly in low-income countries. In Ethiopia, visual inspection using acetic acid for screening and Cryotherapy treatment is commonly practiced, though the recurrence of the infection has not been well documented. Methods: We conducted a retrospective cohort study from January to April 2021. The objective was to investigate the association of HIV status and the recurrence of cervical pre-cancer after Cryotherapy among Ethiopian women. The time to the incidence of recurrence was compared between HIV positive and HIV negative women. The effect of confounding of pre-specified variables were then adjusted by running the Cox regression model. Variables having a p-value of at most 0.25 in univariate analysis were considered in the multivariate analysis. Findings : A total of 140 eligible patient cards were included in the analysis with the median follow-up of 15.5 months. The overall recurrence was 15.7% and it was significantly higher among HIV positives as compared with HIV negatives (p-value=0.008). In addition, age and corticosteroid use were the predictors of the recurrence of cervical pre-cancer. Interpretation: The recurrence of the infection was higher among women above 39 years of age (hazard ratio (HR) of 11.94 (95% CI, 1.07-133.04; P=0.04), and those women who used corticosteroid (HR=7.82, 95% CI=1.04-58.75; P=0.046) compared with counterparts. The current finding might highlight the performance of Cryotherapy and seek for prospective cohort study including other available treatment modalities to set forth a guideline for clinicians and an input for policy makers. Funding: Seed money was obtained from Addis Ababa University, Aklilu Lemma Institute of Pathobiology Declaration of Interest: All authors declare that, there is no any competing interest Ethical Approval: This study was approved by the Ministry of Science and Higher Education (MoSHE), National Research Ethics (NRERC), Aklilu Lemma Institute of Pathobiology, City Government of Addis Ababa Health Bureau, and St. Paul’s Hospital Millennium Medical College