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HPV 16 is related to progression of cervical intraepithelial grade 2: a case series

Abstract

Objective: To describe the acquisition, persistence and clearance of HPV infection in women with CIN 2 confirmed by biopsy followed for 12 months under expectant management. Study Design: Thirty seven women with CIN 2 biopsy proven, referral cervical smear showing low-grade squamous intraepithelial lesions or atypical squamous cells of undetermined significance and tested for HPV were included. They were followed up for one year with cervical smear, colposcopy and HPV test every three months. HPV DNA was detected by the polymerase chain reaction (PCR), and genotyping was performed by reverse line blot hybridization assay. The associatioTo describe the acquisition, persistence and clearance of HPV infection in women with CIN 2 confirmed by biopsy followed for 12 months under expectant management. Thirty seven women with CIN 2 biopsy proven, referral cervical smear showing low-grade squamous intraepithelial lesions or atypical squamous cells of undetermined significance and tested for HPV were included. They were followed up for one year with cervical smear, colposcopy and HPV test every three months. HPV DNA was detected by the polymerase chain reaction (PCR), and genotyping was performed by reverse line blot hybridization assay. The association between HPV 16 with CIN 2 clinical outcome was tested using Fisher's Exact Test. At the end of twelve months follow-up, the CIN 2 regression rate was 49% (18/37), persistence as CIN 1 or CIN 2 was 22% (8/37), and progression to CIN 3 was 29% (11/37). Multiple HPV types were observed at admission in 41% (15/37) of cases. During follow-up, 54% (20/37) of the women had one or more new HPV type detected, resulting in eight more women with multiple HPV type detected. HPV 16 was detected at admission in 58% (11/19) of the cases that persisted/progressed, in 39% (7/18) of those that regressed. HPV 16 was considered possibly causal in 67% (10/15) of the cases that persisted or progressed and in 10% (1/10) that regressed (p=0.01). Multiple HPV infections were frequently detected among women with CIN 2 at admission and during the follow up. The CIN 2 associated with HPV 16 were more likely to persist or to progress to CIN 3. (AU)n between HPV 16 with CIN 2 clinical outcome was tested using Fisher's Exact Test. Results: At the end of twelve months follow-up, the CIN 2 regression rate was 49% (18/37), persistence as CIN 1 or CIN 2 was 22% (8/37), and progression to CIN 3 was 29% (11/37). Multiple HPV types were observed at admission in 41% (15/37) of cases. During follow-up, 54% (20/37) of the women had one or more new HPV type detected, resulting in eight more women with multiple HPV type detected. HPV 16 was detected at admission in 58% (11/19) of the cases that persisted/progressed, in 39% (7/18) of those that regressed. HPV 16 was considered possibly causal in 67% (10/15) of the cases that persisted or progressed and in 10% (1/10) that regressed (p=0.01). Conclusion: Multiple HPV infections were frequently detected among women with CIN 2 at admission and during the follow up. The CIN 2 associated with HPV 16 were more likely to persist or to progress to CIN 3. (AU)