Informative HPV testing after conization and its impact on time-varying estimates: a GAMM-based cohort study

Area of Science:

• Gynecology
• Oncology
• Infectious Diseases

Background:

• Cervical cancer screening relies on human papillomavirus (HPV) testing.
• Conization is a procedure to remove abnormal cervical tissue, but HPV positivity can persist post-procedure.
• Real-world HPV testing follow-up is often irregular, complicating interpretation of positivity rates.

Purpose of the Study:

• To characterize time-varying HPV positivity after conization in a real-world setting.
• To assess if baseline infection multiplicity (single vs. multiple HPV types) impacts postoperative HPV positivity.
• To determine if this association is robust to irregular follow-up and testing intensity.

Main Methods:

• Retrospective cohort study of 872 women undergoing conization with at least one postoperative HPV test.
• Generalized additive mixed models used to analyze time-varying HPV positivity.
• Sensitivity analyses performed to address irregular follow-up and testing intensity.

Main Results:

• Postoperative HPV positivity decreased over time in both single and multiple infection groups.
• Women with multiple baseline infections showed persistently higher HPV positivity trajectories post-conization.
• This association remained consistent even when accounting for testing intensity and irregular follow-up.

Conclusions:

• The association between multiple baseline HPV infections and less favorable postoperative trajectories is robust.
• Risk-stratified surveillance is supported by these findings.
• Accurate estimation of postoperative HPV dynamics requires explicit consideration of follow-up patterns.