Topical imiquimod treatment for human papillomavirus infection in patients with and without cervical/vaginal intraepithelial neoplasia.

Abstract

OBJECTIVE:

To evaluate the efficacy and toxicity of topical imiquimod for the treatment of persistent human papillomavirus (HPV) infection in patients with or without cervical/vaginal intraepithelial neoplasia (CIN/VAIN).

METHODS:

Patients with persistent HPV infection (≥ 1 year) after a history of treatment for cervical or vaginal neoplasm but normal histology and cytology, abnormal Papanicolaou (Pap) smears without abnormal histology, and untreated histology-documented CIN/VAIN Grade 1/2/3 with HPV-positive testing were recruited. Patients were instructed to apply 250 mg of 5% imiquimod cream intravaginally on consecutive days or at least twice weekly on an outpatient basis for a minimum of 12 doses. A group of age- and previous diagnosis-matched, imiquimod-untreated historical controls (n = 20) were selected. The main outcome measures included HPV DNA detection, cytology, and colposcopy/histology at 6 months after treatment.

RESULTS:

A total of 72 patients were eligible for analysis. At a median follow-up of 33.6 months, 37 patients (51.4%) had cytological/histological regression and tested HPV-negative. Six patients (8.3%) had progressive cytology/histology with persistent HPV infections. Of the 72 treated patients, 26 patients who had a normal Pap test but were persistently HPV-positive for at least 1 year had a complete regression rate of 65.4%, which was significantly different from the rate (30%) observed in the untreated historical control (p = 0.036). Six patients with histologically proven CIN2/3 or VAIN2/3 had a complete regression rate of 66.6% (4/6).

CONCLUSIONS:

The tolerability of intravaginal self-administered imiquimod is confirmed. Its efficacy in the treatment of women with persistent HPV infection and normal cytology warrants further randomized, controlled trials to determine appropriate dosages and scheduling.

• Authors: Cheng-Tao Lin, Jian-Tai Qiu, Chin-Jung Wang, Shuenn-Dyh Chang, Yun-Hsin Tang, Pei-Ju Wu, Shih-Ming Jung, Chu-Chun Huang, Hung-Hsueh Chou, Mei-Shan Jao, Chyong-Huey Lai
• Journal: Taiwanese journal of obstetrics & gynecology (Taiwan J Obstet Gynecol) Vol. 51 Issue 4 Pg. 533-8 (Dec 2012) ISSN: 1875-6263 [Electronic] China (Republic : 1949- )
• PMID: 23276555 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012. Published by Elsevier B.V.

Chemical References

• Adjuvants, Immunologic
• Aminoquinolines
• DNA, Viral
• Imiquimod

Topics

• Adjuvants, Immunologic (adverse effects, therapeutic use)
• Administration, Topical
• Adult
• Aged
• Aged, 80 and over
• Aminoquinolines (adverse effects, therapeutic use)
• Carcinoma in Situ (drug therapy, pathology, virology)
• DNA, Viral (blood)
• Female
• Humans
• Imiquimod
• Middle Aged
• Papillomaviridae
• Papillomavirus Infections (blood, drug therapy, pathology)
• Retrospective Studies
• Uterine Cervical Neoplasms (drug therapy, pathology, virology)
• Vaginal Neoplasms (drug therapy, pathology, virology)