ArticleWomen's health (London, England)
Persistent human papillomavirus after thermal ablation in Malawian women with and without HIV: Implications for risk-based cervical cancer prevention in low- and middle-income countries.
Article in Women's health (London, England). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPersistent high-risk human papillomavirus (hrHPV) infection can lead to cervical precancer, with women living with HIV (WLWH) at increased risk due to impaired immune clearance. Thermal ablation (TA) is a low-cost treatment for precancerous lesions, but data on hrHPV persistence after TA among WLWH are limited.
objectivesTo evaluate overall and channel-specific hrHPV persistence 12 months after TA among women in Lilongwe, Malawi.
designCross-sectional analysis of Malawian women who received TA during and after the PEER trial (prevention of cervical cancer through two HPV-based screen-and-treat implementation models in Malawi).
methodsWe analyzed 495 hrHPV-positive women (113 WLWH, 382 without HIV) treated with TA. Self-collected cervicovaginal samples were obtained before treatment and at 12 months post-treatment and tested with the GeneXpert HPV assay, which detects hrHPV across five high-risk genotype channels (P1-P5). Channels P3-P5 were grouped as non-16/18/45 hrHPV types (HPV 31, 33, 35, 39, 51, 52, 56, 58, 59, 66, 68). Persistence was defined as the detection of the same channel at both time points. Differences in persistence rates were assessed using Fisher's exact and Welch's
resultsAt 12 months post-TA, 35.6% of women were persistently hrHPV-positive. Persistence was higher among WLWH (46.0%) than women without HIV (32.0%,
conclusionsOver one-third of women had persistent hrHPV 12 months after TA, with higher rates among WLWH, primarily for non-16/18/45 genotypes. Findings highlight the need for enhanced follow-up and adjunct therapies to improve post-treatment clearance and advance cervical cancer prevention in low-resource settings.
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