HPV DNA testing and pap smear cytology co-testing as a‘test of cure’ in patients previously treated for cervical lesions by leep at Kenyatta National Hospital

Abstract

Background: HPV infection is a pre-requisite for the development of the majority (99.7%) of precancerous cervical lesions. Treatment of cervical precancerous lesions reduces the risk of invasive cervical cancer by 90%; however, treated women still have five times risk of invasive cancer compared to women who have  always had a normal Pap smear, thus special follow-up measures are critical to reduce these risks.

Objective: To determine the utility of co-testing by conventional Pap smear and HPV testing as a ‘test of cure’ in patients previously treated for cervical lesions by LEEP at KNH.

Design: Cross sectional descriptive study.

Setting: Kenyatta National Hospital and KAVI molecular laboratory.

Subjects: Women on follow for cervical lesions post LEEP treatment.

Results: Out of the 25 participants, 22(88%) had a report of NILM while 3(12%) had a report of ≥ASCUS). 16 (64%) were positive for HPV. HPV 56 was the commonest HPV subtype detected in 11 patients (41%). The Cohen’s Kappa correlation between Pap smear and HPV DNA test not statistically significant = 0.143, 95% CI: -0.17 to 0.46, p=0. 166.There was no statistically significant association between HIV status and pap smear findings post LEEP, X²=0.711, p=0.399

Conclusions: Co-testing with HPV DNA testing and Pap smear is a useful approach to stratify women with no cytological abnormalities according to their risk of residual disease