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HPV vaccination after LEEP. A systematic review and meta-analysis.
  • Ralf van de Laar,
  • Heleen van Beekhuizen,
  • Ward Hofhuis
Ralf van de Laar
Erasmus MC
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Heleen van Beekhuizen
Erasmus MC
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Ward Hofhuis
Franciscus Gasthuis
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Abstract

Background: Prophylactic human papillomavirus (HPV) vaccines are highly effective in reducing premalignant lesions of the cervix. Recurrence is reported up to 17%. Little is known about the effect of HPV vaccines on women with CIN who already are HPV infected and CIN. Objective: Review of the literature addressing the question whether adjuvant vaccination with an HPV-vaccine in addition to LEEP treatment is effective in preventing recurrence of CIN-lesions. Search strategy: Medline search using Mesh terms. Selection criteria: Studies on HPV vaccination in addition to a LEEP procedure. One of the study parameters had to describe the effect of vaccination in addition to a surgical treatment. Data collection and Analysis: All results were assessed by two reviewers and meta-analysis performed. Main result: Six studies met the inclusion and exclusion criteria: one case report, three post-hoc analyses, one case-control study and one retrospective study. In the post-hoc analysis of three community-based clinical trials; the combined recurrence rate of CIN2+ was 1.49% (12/806) in the HPV- vaccinated group versus 3.51% (37/1052) in the non-HPV vaccinated group, with a combined RR of 0.41 (95% CI 0.21-0.78; P<0.01). The retrospective and the case-control study combined, reported an incidence of 2.07% (11/532) versus 6.92% (38/549) in favor for HPV vaccination, resulting in a significant positive vaccination effect in addition to LEEP treatment (RR 0.30 95%CI 0.16-0.58; P<0.01). Funding: None Keywords: HPV, CIN, VACCINACTION, LEEP