Recurrence of cervical intraepithelial neoplasia at six months post cryotherapy or loop electro-surgical excision procedure at Mbabane Government Hospital Swaziland

Abstract

Introduction Cervical cancer is the most common female cancer in sub-Sahara Africa. In 2018, Swaziland was rated with the highest burden globally. In 2014, 21% female deaths in Swaziland were due to cancer and almost half (40%) were due to cervical cancer. Although, the World Health Organization guidelines for cervical intraepithelial neoplasia (CIN) screening and treating were adapted in 2011, the recurrence of CIN post treatment is noted in practice, but the burden remains unknown. The study assessed the prevalence and factors associated with CIN recurrence among women treated with cryotherapy or loop electrosurgical excision procedure (LEEP) at 6-months treatment follow-up. Methods A retrospective cohort analysis of women screened for CIN between January 2014 and December 2016 at Mbabane government hospital, was conducted. The study participants included all women treated with either cryotherapy or LEEP and reviewed at six months post treatment. The statistical methods used included descriptive statistics and logistic regression. Permission for the study was obtained from the relevant authorities. Results The 602 study participants enrolled for the study had a mean age of 30.9 years (SD: 5.7). Few (39/602; 6.5%) had recurrence of CIN. The adjusted OR for recurrence for positive HIV status was 2.47 (95%CI 1.01-6.02; p=0.022) and 2.46 (95%CI 1.01-6.03; p=0.048) for low CD4 cell count. Anti-retroviral therapy (ART) reduced the odds for CIN recurrence by 70% (AOR 0.31; 95%CI 0.13-0.71; p=0.006). Conclusion: A positive HIV status and low CD4 count increased the odds of recurrence, while ART was found to be protective. The treatment modality had no effect. HIV infected individuals need ART which significantly improves CIN treatment outcomes. Recommendation: HIV infected individuals need ART which significantly improves CIN treatment outcomes