P16 expression and recurrent cervical intraepithelial neoplasia after cryotherapy among women living with HIV

Frontiers in Medicine

Medicine

Elizabeth R. Unger¹  Samah Sakr²  Christine J. McGrath³  Sharon A. Greene³  Shahin Sayed⁴  Marleen Temmerman⁴  Daniel Maina⁴  Zahir Moloo⁴  Jonathan Wawire⁴  Michael H. Chung⁵  Nelly Mugo⁶ 

[1] Centers for Disease Control and Prevention, Atlanta, GA, United States;Coptic Hospital, Nairobi, Kenya;Department of Global Health, University of Washington, Seattle, WA, United States;Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Nairobi, Kenya;Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, United States;Sexual Reproductive and Adolescent Child Health Research Program, Kenya Medical Research Institute, Nairobi, Kenya;

关键词: CIN2+;    p16;    recurrence;    cryotherapy;    HIV;    cervical cancer;    cervical lesions;   

DOI  :  10.3389/fmed.2023.1277480

 received in 2023-08-14, accepted in 2023-09-27,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThe expression of p16 protein, a surrogate marker for high-risk human papillomavirus (hrHPV), is associated with cervical dysplasia. We evaluated correlates of p16 expression at treatment for high-grade cervical lesions and its utility in predicting the recurrence of cervical intraepithelial lesions grade 2 or higher (CIN2+) following cryotherapy among women with HIV.MethodsThis is a subgroup analysis of women with HIV in Kenya with baseline cervical biopsy-confirmed CIN2+ who were randomized to receive cryotherapy and followed every six-months for two-years for biopsy-confirmed recurrence of CIN2+. P16 immunohistochemistry was performed on the baseline cervical biopsy with a positive result defined as strong abnormal nuclear expression in a continuous block segment of cells (at least 10–20 cells).ResultsAmong the 200 women with CIN2+ randomized to cryotherapy, 160 (80%) had a baseline cervical biopsy specimen available, of whom 94 (59%) were p16-positive. p16 expression at baseline was associated with presence of any one of 14 hrHPV genotypes [Odds Ratio (OR) = 3.2; 95% Confidence Interval (CI), 1.03–9.78], multiple lifetime sexual partners (OR = 1.6; 95% CI, 1.03–2.54) and detectable plasma HIV viral load (>1,000 copies/mL; OR = 1.43; 95% CI, 1.01–2.03). Longer antiretroviral therapy duration (≥2 years) at baseline had lower odds of p16 expression (OR = 0.46; 95% CI, 0.24–0.87) than <2 years of antiretroviral therapy. Fifty-one women had CIN2+ recurrence over 2-years, of whom 33 (65%) were p16-positive at baseline. p16 was not associated with CIN2+ recurrence (Hazard Ratio = 1.35; 95% CI, 0.76–2.40).ConclusionIn this population of women with HIV and CIN2+, 41% of lesions were p16 negative and baseline p16 expression did not predict recurrence of cervical neoplasia during two-year follow up.

【 授权许可】

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Copyright © 2023 Maina, Chung, Temmerman, Moloo, Wawire, Greene, Unger, Mugo, Sakr, Sayed and McGrath.