Alternatives to surveillance for persistent human papillomavirus after a positive cervical screen: A systematic review and meta-analysis

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 302; pp. 332 - 338
• Main Authors: McGee, A.E., Hawco, S., Bhattacharya, S., Hanley, S.J.B., Cruickshank, M.E.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.11.2024
• Subjects: Cervical screening; Early Detection of Cancer - methods; Female; Human papillomavirus; Human Papillomavirus Viruses; Humans; Obstetrics and Gynecology; Papillomaviridae; Papillomavirus Infections - complications; Papillomavirus Infections - diagnosis; Persistent human papillomavirus infection; Surveillance; Treatments; Uterine Cervical Dysplasia - diagnosis; Uterine Cervical Dysplasia - therapy; Uterine Cervical Dysplasia - virology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - virology; RCT; ROB-2; Persistent human papillomavirus infection; OR; CI; LEEP; CIN; LSIL; PRISMA; HPV; ROBINS-I; Human papillomavirus; Surveillance; LLETZ; Cervical screening; Treatments; HR-HPV; WHO; World Health Organisation; Preferred Reporting Items for Systematic Reviews and Meta-Analyses; Risk Of Bias 2; Cervical intraepithelial neoplasia; Risk Of Bias In Non-randomised Studies − of Interventions; large local excision of the transformation zone; High-risk human papillomavirus; loop electrosurgical excision procedure; Low-grade intraepithelial lesion; Confidence interval; Randomised controlled trial; Odds ratio
• ISSN: 0301-2115; 1872-7654; 1872-7654
• DOI: 10.1016/j.ejogrb.2024.09.019

•This review can better inform discussions with HR-HPV+ women and answer their questions about alternatives to surveillance.•This paper is the first of its kind to compile treatment options for women with HPV persistence and low-grade changes only.•Meta-analysis showed some therapies may lead to earlier HR-HPV resolution and CIN regression compared with natural clearance. In 2021, the World Health Organisation (WHO) updated its guidelines for cervical screening from cytology testing to primary high-risk human papillomavirus (HR-HPV) testing. This change in testing has effectively led to a ‘new disease’ as women are now aware of having a virus that induces changes that can cause cancer, which they would have been unaware of previously. While current management involves a ‘watch and wait’ approach and no active treatment, the anxiety associated with having HR-HPV may prompt some women to seek ‘treatments’ outside the screening programme. ● to identify potential treatment options available for women with persistent HR-HPV and/or low-grade cervical intraepithelial neoplasia (CIN), i.e. ≤CIN 1. ● to determine the clinical effectiveness of these treatments, namely by: ◦ HR-HPV clearance rate, and/or: ◦ CIN regression. We searched MEDLINE, PubMed, EMBASE, Web of Science and the Cochrane Library. We included cohort studies and randomised controlled trials (RCTs) only. Records (n = 2135) were screened in Rayyan by two independent reviewers. Quality assessment was conducted using the ROBINS-I tool and the ROB-2 tool. 12 studies (four cohort studies and eight RCTs) were included: six oral medications, two topical medications, one vaccination, and three non-surgical device treatments. Meta-analysis revealed that some therapeutic interventions, including vaginal gels, photodynamic therapy, and some oral medications, may lead to earlier resolution of persistent HR-HPV and regression of low-grade CIN when compared with natural clearance. This review can better inform discussions with HR-HPV+ women and answer their questions about alternatives to surveillance.