5-Aminolevulinic Acid Photodynamic Therapy for Non-Lesional Persistent High-Risk HPV Infection: A Comparative Cohort...

Area of Science:

• Gynecologic Oncology
• Infectious Diseases
• Photomedicine

Background:

• Persistent high-risk human papillomavirus (HR-HPV) infection is a primary driver of cervical cancer.
• Current treatment options for HR-HPV in patients without visible cervical lesions are limited.
• Five-aminolevulinic acid photodynamic therapy (ALA-PDT) shows promise but its efficacy for HR-HPV clearance in non-lesional cases needs evaluation.

Purpose of the Study:

• To compare the efficacy of ALA-PDT versus interferon (IFN) in clearing persistent HR-HPV infections in patients lacking cervical lesions.
• To identify factors influencing treatment outcomes for persistent HR-HPV infections.

Main Methods:

• A real-world cohort study comparing 157 patients treated with three ALA-PDT sessions against 114 patients receiving three IFN courses.
• Primary outcome: HR-HPV complete clearance assessed at 6 and 12 months post-treatment.
• Generalized estimating equations (GEE) analysis was used to evaluate treatment efficacy and identify risk factors.

Main Results:

• ALA-PDT achieved significantly higher HR-HPV clearance rates: 56.9% at 6 months and 67.0% at 12 months, compared to 15.3% and 28.3% for IFN, respectively (p < 0.001).
• GEE analysis confirmed ALA-PDT's superiority (adjusted odds ratio [aOR] = 0.114, p < 0.001).
• Older age (per year, aOR = 1.025, p = 0.027) and longer infection duration (≥24 months, aOR = 2.334, p = 0.002) were associated with increased persistence risk. Adverse events were mild and infrequent (5.1%).

Conclusions:

• ALA-PDT demonstrates superior and sustained efficacy over IFN for clearing persistent HR-HPV infections in patients without cervical lesions.
• ALA-PDT is a safe treatment option with minimal adverse events.
• Older age and longer infection duration are significant risk factors for treatment failure in persistent HR-HPV infections.