%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Beaudrap, Pierre de
%A Sobngwi, J.
%A Tebeu, P. M.
%A Clifford, G. M.
%T Residual or recurrent precancerous lesions after treatment of cervical lesions in Human Immunodeficiency Virus-infected women : a systematic review and meta-analysis of treatment failure
%D 2019
%L fdi:010077137
%G ENG
%J Clinical Infectious Diseases
%@ 1058-4838
%K human immunodeficiency virus ; human papillomavirus ; cervical cancer ; treatment failure ; meta-analysis
%M ISI:000491239500014
%N 9
%P 1555-1565
%R 10.1093/cid/ciy1123
%U https://www.documentation.ird.fr/hor/fdi:010077137
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2024-01/010077137.pdf
%V 69
%W Horizon (IRD)
%X Background. Screening and treating premalignant cervical lesions (cervical intraepithelial neoplasia 2+ [CIN2+]) is an effective way to prevent cervical cancer, and recommendations exist for the monitoring of treatment success. Yet, there is no specific recommendation for human immunodeficiency virus (HIV)-infected women, who are at a known, increased risk of cervical cancer. Methods. A systematic review was performed by searching MEDLINE, EMBASE, and Web of Science for studies published from January 1980 through May 2018. Eligible studies described the prevalence of histologically- and/or cytologically-defined lesions in HIV-infected women at least 6 months post-treatment. The primary endpoint was treatment failure, defined as the presence of residual and/or recurrent high-grade CIN2+/high-grade squamous intraepithelial lesions post-treatment. The pooled prevalence in HIV-infected women and the odds ratios (ORs) for HIV-infected compared to HIV-uninfected women were estimated using random-effects models. Results. Among 40 eligible studies, the pooled prevalence of treatment failure in HIV-infected women was 21.4% (95% confidence interval [CI] 15.8-27.0). There was no significant difference in the treatment failure prevalence for cryotherapy (13.9%, 95% CI 6.1-21.6) versus loop electrosurgical excision procedure (13.8%, 95% CI 8.9-18.7; P = .9), but the treatment failure prevalence was significantly higher in women with positive (47.2%, 95% CI 22.0-74.0) than with negative (19.4%, 95% CI 11.8-30.2) excision margin (OR 3.4, 95% CI 1.5-7.7). Treatment failure was significantly increased in HIV-infected versus HIV-uninfected women, both overall (OR 2.7, 95% CI 2.0-3.5) and in all sub-group analyses. Conclusions. There is strong evidence for an increased risk of treatment failure in HIV-infected women, in comparison to their HIV-negative counterparts. The only significant predictor of treatment failure in HIV-infected women was a positive margin status, but further data is needed on long-term outcomes after ablative treatment in HIV-infected women.
%$ 050 ; 052