Human Papillomavirus (HPV) 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

Human Papilloma Virus infection is a pre-requisite for the development of the majority (99.7%) of precancerous cervical lesions. Treated women have five times risks of invasive cervical cancer compared to women who have always had a normal Pap smear, thus special follow-up measures are critical to reduce these risks. The main objective was to determine the utility of co-testing by conventional Pap smear cytology and HPV genotyping as a „test of cure‟ in patients previously treated for cervical lesions by LEEP at KNH.This study was a cross sectional descriptive study. The study site and was clinic 66, KNH, for duration of 4 months. Twenty five women with prior history of cervical lesion treatment by LEEP were recruited into the study. The Papanicolaou staining protocol was used to stain the slides. Pap smears were reported using the Bethesda system 2014 by a Pathologist. HPV testing was done using the HPV Genotypes 14 Real-TM Quant test kit in KAVI laboratory. SPSS version 21 was used to analyze the data. In all tests, a p-value below 0.005 was regarded as statistically significant. Mean age of the study participants was 43.3 ±12.3 years. The average age at first intercourse was 21.4±3.9. Out of 25 participants, 22 (88%) had a report of NILM while 3 (12%) had a report of ≥ASCUS). 16 (64%) were positive for HPV with HPV 56 being the commonest subtype 11 (41%).The Cohen‟s Kappa correlation between Pap smear and HPV DNA test was statistically insignificant, k=0.143, 95% Confidence Interval: -0.17 to 0.46, p=0.166.The association between HIV status and Pap smear findings post LEEP was statistically insignificant, X²=0.711, p=0.399. The association between HIV status and HPV positivity post LEEP was statistically insignificant, X²=0.001, p =0.973. Approximately 10% of women have residual or recurrent cervical lesion post LEEP treatment at KNH. The majority of women were positive for high risk HPV post LEEP treatment. HPV 56 was the commonest HPV in post LEEP patients at KNH. HPV genotyping should be introduced in the monitoring of women post LEEP treatment as this helps to stratify women according to their risk of recurrent cervical lesions. HPV positivity did not correlate with clinical disease, a larger study which incorporate HPV-mRNA transcript which is more specific should be don