Impact of HPV vaccination after a diagnosis of cervical HSIL - a case-control study

This study aimed to evaluate the impact of HPV vaccination at the time of treatment of cervical intraepithelial neoplasia (CIN) 2 or 3 on recurrence/persistence.

Unvaccinated women with genital high-grade lesion(s) were offered vaccination (Gardasil 9®) at the time of treatment. Those with CIN2 or 3 were compared with a historical control group of unvaccinated women.

Vaccination was accepted by 99.6% of women (267/268); 170 satisfied the inclusion criteria. CIN2+ recurrence/persistence rate up to 24 months in the vaccine group was 3.0% (5/164) vs. 7.1% (21/295) in the control group, p = 0.091. There were no differences in the time until diagnosis.Positive margins (HR [hazard ratio] 8.28; 95% CI 4.08 to 16.77, p < 0.001) and age > 45 years (HR 2.99; 95% IC 1.56 to 5.74, p < 0.001) were associated with increased risk of persistence/recurrence.There was no reduction in HPV detection at 6 months, but vaccinated women were more likely to become HPV negative (HR 0.689; CI 95% 0.54 to 0.89; p = 0.003) and earlier.

There was a non-significant trend toward lower risk of recurrence/persistence of CIN2+ after treatment in vaccinated women; vaccination did not impact the short-term HPV detection but increased the likelihood of becoming undetectable.