NEW YORK (Reuters Health) – A cervical cancer prevention trial conducted in South Africa shows that a single test for human papillomavirus (HPV) infection followed by cryotherapy in positive cases reduces the subsequent occurrence of cervical intraepithelial neoplasia grade 2 or higher in women infected with HIV.

Dr. Louise Kuhn with the College of Physicians and Surgeons, Columbia University, New York, and colleagues explain in their report in AIDS issued online August 11 that conventional cytology-based screening is difficult in resource-poor settings, and that confirmation of diagnosis creates another barrier to cervical cancer prevention.

The researchers conducted a trial of two screen-and-treat strategies in 6555 women in Cape Town, of whom 956 had HIV. The participants were assigned to screening with HPV DNA testing or visual inspection with acetic acid (VIA) or to a control group in which evaluation and treatment was delayed 6 months. Women with positive results in the HPV and VIA arms underwent cryotherapy on a follow-up visit 2-6 days later.

Colposcopy to assess lesion status was performed at 6 months and at 1, 2 and 3 years. Dr. Kuhn and her associates found that about two-thirds of the women remained in the study at 36 months.

“Screen-and-treat utilizing HPV DNA testing was highly effective in reducing the risk of CIN2+ by 36 months among both HIV-positive [relative risk (RR) = 0.20] and HIV-negative women (RR =0.31),” they report. The benefit of VIA-based screening was only apparent in HIV-positive women.

Because HIV-positive women have a greater risk of cervical cancer, the impact of the protocol was greater for them. Specifically, “For every 100 women screened, HPV-and-treat program could prevent 11.9 CIN2+ cases in HIV-positive women and 3.1 CIN2+ cases in HIV-negative women, whereas VIA-and-treat program could prevent 7.4 cases in HIV-positive women and 1.1 cases in HIV-negative women,” according to the report.

Although not specifically designed to address efficacy in HIV-positive women, the screen-and-treat strategy could substantially reduce CIN2+ in this population, the team concludes.

Reference:

Efficacy of human papillomavirus-based screen-and-treat for cervical cancer prevention among HIV-infected women

AIDS 2010;24.