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Role of the HPV DNA Test in Follow-up of Treated Cervical Intraepithelial Neoplasia in Bangladesh

  • Nessa, Ashrafun (Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University) ;
  • Rashid, Mohammad Harun Ur (Planning and Research Unit, Directorate General of Health Services) ;
  • Jahan, Munira (Department of Virology, Bangabandhu Sheikh Mujib Medical University) ;
  • Ferdous, Noor-E (Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University) ;
  • Nahar, Pervin Akhter Shamsun (Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University) ;
  • Chowdhury, Afroza (Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University)
  • Published : 2014.10.23

Abstract

Background: Cervical cancer is a major public health problem in Bangladesh. Persistence of high risk human papillomavirus (HRHPV) influences the progression of the disease, with an important role in followup for cervical intraepithelial neoplasia (CIN). Objective: To establish application of high risk HPV DNA test in the follow-up of women after treatment of CIN. Materials and Methods: This cross-sectional and hospital based study was carried out among 145 CIN treated women during the previous six months to three years at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka, between January 2011 and June 2012. Pap smear and HPV samples were collected and colposcopy was performed to find out the persistence of the disease. Cervical samples obtained were tested for HPV DNA using the Hybrid Capture II (HC-II) test. A cervical biopsy was collected whenever necessary. The results were compared to assess the efficacy of different methods during follow up such as Pap smear, HPV test and colposcopy. Results: Mean age of the recruited women (n=145) was 33.6 (${\pm}7.6$), mean age of marriage was 16.8 (${\pm}2.9$) and mean age of 1st delivery was 18.8 (${\pm}3.5$) years. More than half had high grade CIN before treatment and 115 (79.3%) women were managed by LEEP and 20.7% were managed by cold coagulation. Among the 145 treated women, 139 were negative for HPV DNA and six of them (4.1%) were HPV positive. Sensitivity of Pap smear (40.0) and HPV DNA test (40.0) was poor, but specificity was quite satisfactory (>93.0) for all the tests. Conclusions: The high risk HPV DNA test can be an effective method of identifying residual disease. It can be added to colposcopy and this should be applied to all treated women attending for their first or second post-treatment follow-up visit at 6 months to one year, irrespective of the grade of treated CIN.

Keywords

HPV DNA test;follow-up;treated CIN;Bangladesh

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