The role of HPV genotypes and persistence in follow-up of cervical intraepithelial neoplasia after treatment.

Abstract

1561 Background: HPV testing is considered as an acceptable strategy for surveillance after treatment of cervical intraepithelial neoplasia (CIN). The role of high risk HPV (HR-HPV) genotypes and persistent infection in follow-up remains unclear. Methods: A prospective observational study was conducted on 249 patients with CIN (CIN1=11, CIN2=34, CIN3==204) after conization. Besides traditional follow-up with cytology and colposcopy, HPV genotyping test identifying 13 HR-HPVs (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68) was performed every 6 months after treatment. Endpoint of this study was a histological confirmed CIN during follow-up. Results: 17 recurrences occurred during a median follow-up of 28 months. HR-HPV positive rate decreased over time (29.3% (73/249) for 6 months, 20.1% (50/249) for 12 months, and 15.3% (38/249) after 12 months, respectively). HR-HPV positive results predicted 88.2% (15/17) of recurrences. The most common HR-HPV genotypes appeared post-treatment were HPV 16 (19.3%), HPV 58 (12.0%), HPV 52 (8.0%), HPV18 (4.4%) and HPV33(4.0%). HPV 16, HPV 58 and HPV52 remained as the top three most frequent genotypes in type specific persistent infection. There was no correlation between recurrence and individual HR-HPV infections such as HPV 16, HPV 52 or HPV58 (P>0.05). Recurrent disease was more likely to occur in patients with multiple HR-HPV infection than with single infection (11/27 vs. 4/72, P<0.001). Persistent HR-HPV infection had a higher risk of recurrence than transient infection as compared to negative (hazard ratio [95%CI]: 28.8 [6.35-103.96] for persistence, 1.40 [0.12-14.35] for transition, P<0.0001). Type specific HPV infection had an elevated risk of recurrence (hazard ratio [95%CI]: 40.86 [9.01-185.36]). Conclusions: HPV genotyping test is useful in follow-up. Multiple HR-HPV infection and persistent especially type specific persistent HR-HPV infection indicates a higher risk of recurrence, unlike appearance of the most common HR-HPV genotypes (HPV16, 58, 52) post-treatment.