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

Background: Cervical cancer is a major public health problem in Bangladesh. Persistence of high riskhuman papillomavirus (HRHPV) influences the progression of the disease, with an important role in followupfor cervical intraepithelial neoplasia (CIN).
Objective: To establish application of high risk HPV DNA testin the follow-up of women after treatment of CIN. Materials and
Methods: This cross-sectional and hospitalbased study was carried out among 145 CIN treated women during the previous six months to three years at thecolposcopy clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka, between January 2011 and June2012. Pap smear and HPV samples were collected and colposcopy was performed to find out the persistence ofthe disease. Cervical samples obtained were tested for HPV DNA using the Hybrid Capture II (HC-II) test. Acervical biopsy was collected whenever necessary. The results were compared to assess the efficacy of differentmethods during follow up such as Pap smear, HPV test and colposcopy.
Results: Mean age of the recruitedwomen (n=145) was 33.6 (± 7.6), mean age of marriage was 16.8 (±2.9) and mean age of 1st delivery was 18.8(±3.5) years. More than half had high grade CIN before treatment and 115 (79.3%) women were managed byLEEP and 20.7% were managed by cold coagulation. Among the 145 treated women, 139 were negative forHPV 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 DNAtest can be an effective method of identifying residual disease. It can be added to colposcopy and this should beapplied to all treated women attending for their first or second post-treatment follow-up visit at 6 months to oneyear, irrespective of the grade of treated CIN.