Topical imiquimod treatment for human papillomavirus infection in patients with and without cervical/vaginal intraepithelial neoplasia

Autor: Chyong-Huey Lai, Cheng-Tao Lin, Yun Hsin Tang, Mei Shan Jao, Chin Jung Wang, Shuenn Dyh Chang, Chu Chun Huang, Pei Ju Wu, Jian Tai Qiu, Hung Hsueh Chou, Shih-Ming Jung
Rok vydání: 2012
Předmět:
Adult
medicine.medical_specialty
Vaginal Neoplasms
Administration
Topical
Uterine Cervical Neoplasms
Imiquimod
cervical intraepithelial neoplasia
Cervical intraepithelial neoplasia
lcsh:Gynecology and obstetrics
Gastroenterology
Adjuvants
Immunologic
Internal medicine
Cytology
Obstetrics and Gynaecology
Humans
Medicine
Pap test
Papillomaviridae
human papillomavirus
lcsh:RG1-991
Aged
Retrospective Studies
Aged
80 and over
vaginal intraepithelial neoplasia
Colposcopy
Gynecology
Vaginal intraepithelial neoplasia
medicine.diagnostic_test
biology
business.industry
Papillomavirus Infections
HPV infection
Obstetrics and Gynecology
Middle Aged
medicine.disease
biology.organism_classification
female genital diseases and pregnancy complications
imiquimod
DNA
Viral
Aminoquinolines
Female
business
Carcinoma in Situ
medicine.drug
Zdroj: Taiwanese Journal of Obstetrics & Gynecology, Vol 51, Iss 4, Pp 533-538 (2012)
ISSN: 1028-4559
DOI: 10.1016/j.tjog.2012.09.006
Popis: Objective To evaluate the efficacy and toxicity of topical imiquimod for the treatment of persistent human papillomavirus (HPV) infection in patients with or without cervical/vaginal intraepithelial neoplasia (CIN/VAIN). Methods Patients with persistent HPV infection (≥1 year) after a history of treatment for cervical or vaginal neoplasm but normal histology and cytology, abnormal Papanicolaou (Pap) smears without abnormal histology, and untreated histology-documented CIN/VAIN Grade 1/2/3 with HPV-positive testing were recruited. Patients were instructed to apply 250 mg of 5% imiquimod cream intravaginally on consecutive days or at least twice weekly on an outpatient basis for a minimum of 12 doses. A group of age- and previous diagnosis-matched, imiquimod-untreated historical controls ( n = 20) were selected. The main outcome measures included HPV DNA detection, cytology, and colposcopy/histology at 6 months after treatment. Results A total of 72 patients were eligible for analysis. At a median follow-up of 33.6 months, 37 patients (51.4%) had cytological/histological regression and tested HPV-negative. Six patients (8.3%) had progressive cytology/histology with persistent HPV infections. Of the 72 treated patients, 26 patients who had a normal Pap test but were persistently HPV-positive for at least 1 year had a complete regression rate of 65.4%, which was significantly different from the rate (30%) observed in the untreated historical control ( p = 0.036). Six patients with histologically proven CIN2/3 or VAIN2/3 had a complete regression rate of 66.6% (4/6). Conclusions The tolerability of intravaginal self-administered imiquimod is confirmed. Its efficacy in the treatment of women with persistent HPV infection and normal cytology warrants further randomized, controlled trials to determine appropriate dosages and scheduling.
Databáze: OpenAIRE
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