Screening and management of high-risk human papillomavirus infections: lessons from pandemic

• Autor(a) principal: Santos,Fernanda
• Data de Publicação: 2023
• Outros Autores: Sousa,Rita
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302023009000187
• topic: Human papillomavirus DNA tests; Atypical squamous cells of the cervix; Squamous intraepithelial lesions

Abstract Introduction: At the beginning of COVID-19 pandemic, the Central Regional Health Administration recommended that all women with a positive HPV test for types non 16 or 18 (HR-HPV) and reflex cytology ASC-US/LSIL, should repeat screening after 12 months, in primary healthcare. Objective: Our main goal was to evaluate the impact of this orientation, searching for persistence or elimination of HPV infection, related risk factors, and secondarily, assessing the development of dysplasia. Design: A nested case-control was performed (cases: HPV persistence; control: HPV elimination). Setting and Participants: The initial cohort, included 215 women (HR-HPV/ASCUS or LSIL), referred to the Gynecologic department of Portuguese Institute of Oncology of Coimbra. They were screened from 27 of March 2019 to 30 March of 2020. The data were collected through medical records, in March 2022. Main outcome measures: This sample was evaluated through two rounds. In the first round, 189 were sent back to primary healthcare and 26 older women remained at the department. At the second round, 51 were readmitted, based on a second positive HPV test. For analysis purposes, we divided our sample in three groups: the first with 97 women that repeated the HPV test at primary healthcare (92 missed the retest), the second with 77 women evaluated at the department (26 at first round and 51 at second round) and the third, by 111 that repeated a second HPV test. Results: About 47% of those who repeated the HPV test at primary healthcare, cleared the infection. From the 77 evaluated at the department, only five cases had HSIL/CIN2. After 24 months of follow-up, about 50% have HR-HPV infection. Smoking habits and menopause were related with higher persistence. Conclusion: For women with HR-HPV and ASCUS or LSIL reflex cytology, repeating HPV testing at 12 months, seems to be a safety measure.