Lucia Li

Influence of Pre‐Vaccination HPV Status on Vaccine Effectiveness Among Chinese Women: A Multicenter Cross‐Sectional Study

ABSTRACTBackground and AimsHuman papillomavirus (HPV) vaccines have been available in China for only 8 years, and routine HPV testing is not recommended prior to vaccination. Therefore, evaluation of HPV vaccine effectiveness and the impact of pre‐vaccination HPV infection status on vaccine protective effect in Chinese women is warranted.MethodsFrom June 2022 to June 2023, women aged 18 to 50 years without a history of cervical or uterine excision were recruited from three medical institutions. Baseline characteristics were compared between vaccinated and unvaccinated participants, with inverse probability treatment weighting (IPTW) applied to adjust for confounding factors. HPV infection rates and vaccine effectiveness (VE) were calculated. Additionally, a sub‐group analysis was conducted among vaccinated women to explore the impact of pre‐vaccination HPV infection status.ResultsAfter adjusting for group differences, the vaccine effectiveness against new HPV16/18 infections was 76.1% (95% CI: 58.7%–86.2%) among 2285 participants. Older age and possession of a master's degree or higher were identified as protective factors, whereas increased parity and exclusive use of oral contraceptives were determined to be risk factors for HPV16/18 infection. Women with unknown pre‐vaccination HPV status exhibited significantly higher post‐vaccination rates of high‐risk HPV infections (RR 4.278, 95% CI: 2.537–7.215) compared to those who were HPV‐negative prior to vaccination. However, no significant difference in new high‐risk HPV infection rates was observed between pre‐vaccination HPV‐negative and HPV‐positive women.ConclusionIn addition to HPV vaccination, factors such as age, parity, exclusive use of oral contraceptives, and higher education attainment were independently associated with HPV16/18 infection rates. Pre‐vaccination HPV infection status did not significantly influence the protective efficacy of the HPV vaccine against previously unencountered HPV types.

Optimizing the Follow‐Up Interval After Successful Cold Knife Conization of CIN3: A 10‐Year Retrospective Cohort Study

ABSTRACTBackgroundThis study was conducted to identify the risk of residual or recurrent high‐grade squamous intraepithelial lesions or worse (HSIL+) in patients with successful conization and to develop a customized management strategy.MethodsThis retrospective study included 939 patients who underwent cold knife conization (CKC) for cervical intraepithelial neoplasia 3 at a hospital in China between January 1, 2013 and December 31, 2020. Demographic characteristics and test results were obtained before and 6, 12, and 24 months after CKC and annually thereafter. Human papillomavirus (HPV) persistence was defined as HPV positive at both 6 and 12 months after CKC, and the primary endpoint was residual or recurrent HSIL+ after CKC.ResultsThe mean follow‐up period was 68.8 months. In total, 61 (6.5%) patients had HPV persistence, and 19 (2.0%) had residual or recurrent HSIL+. The risk of residual or recurrent HSIL+ was increased in patients with HPV infection at 6 months (hazard ratio [HR], 84.6; 95% confidence interval [CI], 11.2–641) and 12 months (HR, 214; 95% CI, 28.1–1625) after CKC, and HPV persistence after CKC (HR, 244; 95% CI, 32.2–1854). Comparing two different colposcopic referral criteria for HPV persistence and HPV positive 6 months post‐CKC, substantially fewer colposcopies were performed per case of residual or recurrent HSIL+ detected in patients with HPV persistence after CKC (3.39 vs. 8.28).ConclusionsThe risk of residual or recurrent HSIL+ was higher in patients with HPV persistence after CKC. In patients with negative margins, extending the follow‐up interval to 12 months may reduce the number of HPV tests and colposcopy referral rates while maintaining HSIL+ detection.