Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review

IntroductionEighty per cent of the sexually active population will get human papillomavirus (HPV) infection, which is the most prevalent sexually transmitted disease worldwide. Persistence of high-grade HPV infection may evolve to a cervical intraepithelial neoplasia (CIN), and these lesions may be precursors of cervical cancer. However, this progression can be prevented by the administration of therapeutic vaccines which use the main oncoproteins responsible for cancer development in an attempt to trigger a more specific and effective immunological response against this disorder. We aim to evaluate the safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade CIN 2/3 associated with HPV.Methods and analysisA systematic review of clinical trials will be undertaken. Medline, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online and Scopus will be searched, with no restriction regarding publication date. Primary outcomes will include measures related to safety, efficacy and the immunogenicity of the therapeutic vaccines used in these patients. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for randomised controlled trials, and the quality evidence of the risk of bias in single studies will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. A narrative synthesis will be done for all included studies. Outcomes will be analysed according to the subgroups of HPV type, CIN grade, route of vaccine administration and vaccine type. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges’ g score for both fixed and random effect models. I2statistics will be used to assess heterogeneity and identify their potential sources.Ethics and disseminationEthical approval is not required as primary data will not be collected. Findings will be disseminated widely via peer-reviewed publication and in different media, for example, conferences, congresses or symposia.PROSPERO registration numberCRD42017077428.

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Cervicovaginal Microbiome after Cervical Intraepithelial Neoplasia Treatment. A Protocol for Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179050 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9050

Author(s):

Marta Janicka-Kośnik ◽

Beata Sarecka-Hujar ◽

Grzegorz Jakiel ◽

Aneta Słabuszewska-Jóźwiak

Keyword(s):

Systematic Review ◽

Cervical Intraepithelial Neoplasia ◽

Meta Analysis ◽

Chemical Properties ◽

Intraepithelial Neoplasia ◽

Hpv Infection ◽

Adverse Outcomes ◽

Lactobacillus Species ◽

Treatment Change ◽

Randomized Controlled Studies

(1) Background: The microbiome consists of microorganisms from various kingdoms with numerous physical and chemical properties Lactobacillus species constitute the highest percentage of healthy cervical and vaginal microbiota. Dysbiosis may cause adverse outcomes, e.g., bacterial vaginosis, pelvic inflammatory disease and pregnancy complications. The cervicovaginal microbiome might contribute to the development of a persistent HPV infection—the main risk factor of cervical cancer—and influence progression to malignancy The aim is to perform a systematic review of current literature and a meta-analysis regarding microbiome changes after cervical intraepithelial neoplasia treatment. (2) Methods: We will search PubMed, Scopus, Google Scholar and Embase Database and trace citations in the reference sections. Randomized and non-randomized controlled studies, case–control and cohort studies published between January 2000 and May 2021 will be included in the study protocol. The following keywords will be used: ‘microbiome’, ‘vaginal microbiome’, ‘cervical microbiome’, ‘cervical neoplasia treatment’, ’conization’, ‘electroconization’, and ‘electrosurgical treatment’. Statistical analyses will be performed using RevMan 5.4. (3) Results: The results will be published as a peer-reviewed article. (4) Conclusions: The study will show which forms of intraepithelial neoplasia treatment change the cervicovaginal microbiome. Finding the best form of treatment by studying the cervicovaginal microbiome after various forms of treatment is essential. Patients would benefit not only from the treatment of the initial disease but also the management of dysbiosis, which might underlie other pathologies.

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Comments on “Cumulative risk of cervical intraepithelial neoplasia for women with normal cytology but positive for human papillomavirus: Systematic review and meta‐analysis”

International Journal of Cancer ◽

10.1002/ijc.33511 ◽

2021 ◽

Author(s):

Rama Jayaraj ◽

Peter Shaw ◽

Chellan Kumarasamy ◽

Sameep S. Shetty

Keyword(s):

Systematic Review ◽

Human Papillomavirus ◽

Cervical Intraepithelial Neoplasia ◽

Meta Analysis ◽

Cumulative Risk ◽

Intraepithelial Neoplasia ◽

Normal Cytology

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Association of cervicovaginal dysbiosis mediated HPV infection with cervical intraepithelial neoplasia

Microbial Pathogenesis ◽

10.1016/j.micpath.2021.104780 ◽

2021 ◽

Vol 152 ◽

pp. 104780

Author(s):

Seema Kumari ◽

Vikrant M. Bhor

Keyword(s):

Cervical Intraepithelial Neoplasia ◽

Intraepithelial Neoplasia ◽

Hpv Infection

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Photodynamic Therapy for Low-grade Cervical Intraepithelial Neoplasia (CIN1): A Case Report

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i6.1612 ◽

2020 ◽

Vol 4 (6) ◽

Author(s):

Yinyin Zhang ◽

Hong Lin ◽

Huizhen Fan

Keyword(s):

Photodynamic Therapy ◽

Cervical Intraepithelial Neoplasia ◽

Persistent Infection ◽

Precancerous Lesions ◽

Irradiation Time ◽

Intraepithelial Neoplasia ◽

Hpv Infection ◽

Cervical Canal ◽

Low Grade ◽

Oxygen Inhalation

As a drug-mechanical combination technology, photodynamic (PDT) can achieve accurate and targeted therapy for malignant tumors and benign diseases through the production of reactive oxygen species, oxygen free radicals or singlet oxygen by photosensitizers at specific wavelengths. Compared with traditional surgery, it has the advantages of selective killing, repeatable treatment, preserving target organ function and so on. The purpose of this study was to explore the clinical value of photodynamic therapy in cervical precancerous lesions by taking the patients with low-grade cervical intraepithelial neoplasia (CIN1) with high-risk human papillomavirus (HR-HPV) persistent infection diagnosed by "three-step diagnosis and treatment procedure" as an example. Using HiPorfin as a photosensitizer, photodynamic therapy was performed 48 hours after intravenous drip. Set laser wavelength 630nm, light dose density 137.58J/cm2, transmission efficiency 1.42, output power 2w. 3cm columnar optical fiber was placed around the 2cm in the cervical canal to cover all the lesions, and the irradiation time was 900s (600s in the cervical canal and 300s outside the cervical canal). The patients were given oxygen inhalation for 6 hours after operation, and the patients were observed for itching and other discomfort, and paid attention to avoid light. Photodynamic therapy was performed again in the same way on the second day. After two months of treatment, pathological biopsy showed chronic cervicitis, indicating that the disease had been effectively controlled. Theoretically, although the patient is not the absolute indication of photodynamic therapy (that is, meeting CIN ? or CIN ?, having fertility requirements and not undergoing surgery), this therapy can remove not only the superficial lesions inside and outside the cervix, but also the potential lesions not found under colposcopy. It can also block the persistent infection of HPV by inhibiting the expression of HPV18, E6 and E7mRNA in Hela cells. In combination with Baofukang suppository, it can block HPV infection. Increase the negative conversion rate of cervical HPV and reduce the probability of recurrence after CIN1 cure. For young female patients with persistent HR-HPV infection and fertility requirements, photodynamic therapy is an effective choice for clinical treatment of CIN1.

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