Risk of high grade precancerous lesions and invasive cancers in high risk HPV positive women with normal cervix or CIN 1 at baseline – a population based cohort study

Abstract

Infection with High-risk Human Papillomavirus (HR-HPV) is transient and clears on its own in majority of the women. Only a few women who have persistent infection may finally develop Cervical Intraepithelial Neoplasia (CIN) or cervical cancer in later years. The risk of progression in the HR-HPV positive women with normal cervix or low grade lesion on colposcopy and histopathology at baseline is less studied. We performed a longitudinal study on 650 HR-HPV positive women with colposcopy and/or histopathology proved normal or CIN1 diagnosis at baselineto assess the cumulative risk of development of high-grade CIN. After a mean follow up of 2.1 PYO (range 0.1-5.1) the cumulative incidence of CIN2+ (6.4%; 3.0/100 PYO) was significantly higher in women who had persistent HR-HPV infection compared to those who cleared the infection (adjusted HR 6.28; 95%C.I. 2.87-13.73). The risk of viral persistence in women aged 50-60 years was 2 times higher compared to women aged 40-49 years,and 3 times higher compared to women aged 30-39 years. The probability of having persistent infection increased progressively with higher viral load at baseline (adjusted HR 3.29, 95%C.I. 2.21-4.90 for RLU ≥100; adjusted HR 2.69, 95%C.I. 1.71-4.22 for RLU 10-100). Women with increasing viral load at follow up had four times higher risk of developing CIN2 or worse lesions as compared to those with decreasing load (20.9% vs. 4.8%; p<0.001). In the context of developing countries where cytology or genotyping triaging is not feasible, colposcopy referral of HR-HPV positive women with advancing age, viral persistence andincreasingviral load may be considered. This article is protected by copyright. All rights reserved.

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