Follow-Up and Outcomes After Thermal Ablation Treatment Among HIV-Infected Women From Resource-Limited Countries With Positive HPV-Based Screening: Results of the AIMA-CC Cohort (ANRS 12375).

Primary screening for human papillomavirus (HPV) followed by treatment with thermal ablation (TA) is an important component of the global strategy to eliminate cervical cancer. However, evidence on post-TA outcomes in women living with HIV (WLWH) remains limited. The aim of this study is to evaluate the risk and determinants of post-TA CIN2+. As part of the AIMA-CC study, WLWH from Côte d'Ivoire, Burkina Faso and Cambodia were screened using HPV testing (GeneXpert). All HPV-positive women were biopsied and those with positive triage (positive visual inspection and/or HPV-161845) were treated with TA using a flat probe and followed for 12 months with HPV testing and biopsies. Among the 456 WLWH (age: 30-59 years) treated with TA and with valid histology, 396 (86%) attended the 12-month follow-up visit. HPV persistence (HPV of same GeneXpert channel at baseline and 12-month post-treatment) was 40% and was associated with baseline HPV16 positivity (p = 0.007), age ≥ 40 years (p = 0.03) and CD4 ≤ 500 cells/mm3 (p = 0.02). CIN2+ was detected at 12 months in 12 (4%) of the 318 WLWH with valid histology and was associated with 12-month HPV positivity (OR: 5.29 [1.46-28.46]). The risk of CIN2+ was particularly high among women with HPV-16 at 12 months (OR: 15.53 [3.49-91.17]). HPV positivity at 12 months had a sensitivity for detecting CIN2+ of 83% but a specificity of 54%. HPV-16 positivity had lower sensitivity (42%) but high specificity (> 90%). In conclusion, there is an urgent need to improve TA management in WLWH who are at high risk of CIN2+ re-occurrence post-treatment.