Risk factors for HPV persistence and cytology anomalies at follow-up after treatment for cervical dysplasia

ObjectiveTo evaluate predictor factors of persistent cytologic dysplasia and/or high-risk human papillomavirus (hrHPV) infection at 6-month follow-up and at 3-5years during routine cervical smear testing. MethodsThe present retrospective study included data from women treated for cervical dysplasia by large loop excision of the transformation zone (LLETZ) at Ipswich Hospital, UK, between January 1 and December 31, 2012. Age, parity, smoking, status of resection margins, and previous LLETZ treatment were evaluated by multivariate analyses. ResultsThere were 192 patients included in the study. There was no association between age (relative risk [RR] 1.0, 95% confidence interval [CI] 0.80-1.23; P>0.99), smoking (RR 1.12, 95% CI 0.79-1.59; P=0.516), or parity (RR 1.10, 95% CI 0.88-1.38; P=0.382) and abnormal cytology and/or persistent hrHPV infection at 6months. There was an association between positive margins (RR 1.64, 95% CI 1.20-2.24; P=0.003), previous LLETZ (RR 3.48, 95% CI 1.69-7.15; P<0.001), and dyskaryosis and/or hrHPV infection at 6months. Only previous LLETZ treatment remained associated with abnormal cytology and persistent hrHPV infection at 3-5years (RR 6.37, 95% CI 3.56-11.3; P<0.001). ConclusionClinical factors, including age, smoking, treatment history, and status of surgical margins, could help to determine the risk of dysplasia recurrence and facilitate patient follow-up based on risk stratification. Positive margins and previous large loop excision of the transformation zone were associated with dyskaryosis and/or high-risk HPV infection at 6-month follow-up.