Persistent HPV infection after conization in patients with negative margins.

Objectives: To investigate the rate of clearance of high-risk HPV after conization with negative margins and to identify the factors that may predict high-risk HPV clearance/persistence after conization with negative margins.

Methods: We performed a retrospective review of 69 patients (mean age 39.5 years, range 25-60 years) with histologically verified CIN 2 or CIN 3 who underwent electroknife conization with negative margins between March 2002 and December 2003. High-risk HPV testing was performed on cervical cytology prior to and 6 months after conization. Hybrid Capture II testing was used to detect HPV DNA.

Results: High-risk HPVs were detected in the primary cervical lesions of 67 of 69 patients (97.1%) prior to conization. Follow-up at 6 months revealed that high-risk HPVs were eradicated by conization in 82.1%. Univariate analysis showed that persistent HPV infection after conization with negative margins was more likely to occur when the pretreatment viral load was high (RLU/PC > 500) (P = 0.005). HPV infection after conization with negative margins was persistent in 43.8% (7/16) of patients with high viral load (RLU/PC > 500) and in 9.8% (5/51) of patients with low viral load (RLU/PC < or = 500). Multiple regression analysis showed that high viral load (RLU/PC > 500) was the only significant independent predictor of HPV persistence (P = 0.0027).

Conclusions: High-risk HPV infections were effectively eliminated by conization with negative margins in most cases. Because high viral loads are significantly associated with high-risk HPV persistence after conization with negative margins, patients with high viral loads prior to conization should be closely followed.