High-risk HPV positivity is a long-term risk factor for recurrence after cervical excision procedure in women living with HIV.

OBJECTIVE To evaluate the risk factors for recurrence of high-grade disease after cervical excision in women living with HIV, with a specific interest in the role of HR-HPV positivity. METHODS Multicentric retrospective study conducted on WLWH who underwent cervical excision between January 1987 and June 2017 in six Italian institutions. The rate of high-grade recurrence was determined. Risk factors for recurrence and HR-HPV positivity were determined with the Log-rank test and Cox proportional-hazards regression models. RESULTS A total of 271 WLWH were included in the final analysis. A high-grade recurrence was found in 58 (21.4%) patients. Age ≥41 years at inclusion and HR-HPV positivity during follow-up were independently associated with a higher risk of disease recurrence with an RR of 4.15 (95% CI 2.01-8.58, p < 0.001) and 5.18 (95% CI 2.12-12.67, p < 0.01), respectively. Age ≥41 years (RR of 1.75 (95% CI 1.01-3.04, p = 0.047) resulted as a risk factor for HR-HPV positivity during follow-up. CONCLUSION HR-HPV positivity is a risk factor for recurrence after cervical excision in WLWH. Women older than 41 years may benefit from a long-term yearly follow-up. Future studies regarding HPV vaccination after treatment in WLWH may be useful, considering the protective role of the higher probability of HPV negativity in vaccinated women.