Factors associated with the persistence/recurrence of CIN2/3 in women submitted to loop electrosurgical excision procedure in a teaching hospital in northeastern Brazil: a case-control study.

OBJECTIVE: This study aimed to identify risk factors associated with the persistence/recurrence of cervical intraepithelial neoplasia (CIN) 2/3 in women submitted to loop electrosurgical excision procedure (LEEP) in a hospital in northeastern Brazil. MATERIALS AND METHODS: A case-control study included 50 women with and 50 women without persistence/recurrence of CIN2/3 after LEEP at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between 2004 and 2011. Data were collected from June to December 2011. Inclusion criteria were diagnosis of CIN2/3 during follow-up (cases) and women free of CIN2/3 after a follow-up of 2 years or longer (controls). Exclusion criteria (cases/controls) were LEEP performed at another hospital, LEEP performed for persistent CIN1, invasive carcinoma in the cone specimen or at cytology, and/or histopathology within a 2-year follow-up period. Persistence was defined as residual disease detected in the first year after LEEP, and recurrence was defined as the reappearance of a lesion more than 1 year after surgery. Bivariate analysis was performed for biological, sociodemographic, sexual, reproductive, lifestyle, and clinical variables. Odds ratios (ORs) and their 95% confidence intervals (95% CIs) were calculated, and a multiple logistic regression analysis was performed to control for potential confounding factors. The study was approved by IMIP's internal review board. RESULTS: Multiple logistic regression analysis showed a significant association between persistence/recurrence of CIN2/3 and living outside the capital city (OR=3.11, 95% CI=1.14-8.41), smoking (OR=4.22, 95% CI=1.18-15.05), and positive endocervical margins (OR=6.58, 95% CI=2.37-18.28). CONCLUSIONS: Women with persistence/recurrence of CIN2/3 are more likely to live outside the state capital, be smokers, and have positive endocervical margins, so these women should be followed up more closely.

Chlamydia trachomatis infection and human papillomavirus in women with cervical neoplasia in Pernambuco-Brazil.

Chlamydia trachomatis (CT) is the most common bacterial cause of sexually transmitted disease. High-risk human papillomavirus (HR-HPV) is considered the main etiological agent for cervical neoplasia. Evidences showed that the presence of co-infection of CT and HR-HPV plays a central role in the etiology of cervical intraepithelial neoplasia (CIN) and cervical cancer. The goals of this study were: evaluate the human papillomavirus (HPV) and CT prevalence among Brazilian women with abnormal cytology and provide the effect of this association on the severity of cervical neoplasia. The population of this study was composed by 142 women with incident histological incidence of CIN grades I, II, III or cervical cancer from Recife, Northeast of Brazil. The polymerase chain reaction method on a cervical brush specimen was used to detect both agents and the automatic sequencing method was used for HPV genotyping assay. The prevalence of HPV and CT was 100 and 24.65 %, respectively. Thirteen types of HPV were detected; HPV 16, 18, 31 and 33 were the most common. The most prevalent HPV types were HPV 16 and 18. A significant association between CT positive and HPV 16 infection was found (p < 0.0106; OR = 5.31; 95 % IC 1.59-17.67). In the study population, there was diversity of HPV infections, with high-risk types being the most common. Also, the data collected suggest that CT infection may play an important role in the natural history of HPV infection.

IFN-gamma and IL-12B polymorphisms in women with cervical intraepithellial neoplasia caused by human papillomavirus.

The Human Papillomavirus (HPV) is a sexually transmitted organism associated with Cervical Intraepithelial Neoplasia (CIN) and cervical cancer, the second main cause of malignancy in women worldwide. The virus itself, however, is not enough to cause lesions on the cervix. Several studies suggest that some polymorphic sites changes the cytokines levels and influence the cancer development in HPV infected patients. In this study, we evaluated the presence of functional polymorphisms at +874 (T/A) IFNG and +1188 (A/C) IL-12B genes in cervical smears samples from 76 healthy women and 162 women, HPV positive, with CIN lesion--CIN I (45), CIN II (55), CIN III (53) and cervical cancer (9)--in Brazilian population. There was no significant differences in genotype (p = 0.4192) and allele (p = 0.370; OR = 1.20) distributions between CIN patients and control groups on IFNG allelic polymorphism. Moreover, for IL-12B gene, there was a significant difference in genotype (p = 0.015) and allele distribution (p = 0.014; OR = 0.5754) between the groups. When samples were stratified according to grade of cervical lesion, the AA genotype and A allele were less frequent in the group with low-grade cervical lesions than in group with high-grade cervical lesions (p = 0.0036 and p = 0.0010; OR = 0.3819, respectively), suggesting that the C allele (mutant) may protect against the emergence of CIN lesions and its progression.