Long‐term risk and predictors of high‐risk human papillomavirus persistence after thermal ablation amongst women living with <scp>HIV</scp> in West Africa

Abstract

Abstract Introduction Mounting evidence supports the use of thermal ablation in women positively screened with high‐risk Human Papillomaviruses ( hrHPV ) but limited data are available on the long‐term post‐treatment outcomes in women living with HIV ( WLHIV ). We aimed to estimate the persistence of hrHPV infection amongst WLHIV ≥24 months post treatment in West Africa. Methods From October 2019 to October 2024, a cohort study was conducted amongst WLHIV in two HIV clinics in Burkina Faso and Cote d'Ivoire. All WLHIV with a positive hrHPV test who received thermal ablation were followed up ≥24 months. During follow‐up visits, DNA HPV testing, visual inspection and biopsy were systematically performed. Factors associated with ≥24 months hrHPV positivity were assessed through a logistic regression model. Results A total of 200 WLHIV , aged 42 years [Interquartile range ( IQR ): 38–45], with a nadir CD4 of 365 [ IQR : 168–616] cell/mm 3 received thermal ablation and were followed for a median time of 42 [ IQR : 29–48] months. A positive hrHPV was detected in 40.5% of women ≥24 months post treatment. WLHIV who had a nadir CD4 count ≤200 cell/mm 3 ( aOR = 3.06 [95% CI : 1.23–7.59]) or had no or a primary school level ( aOR = 2.25 [95% CI : 1.13–4.49]) were more likely to present at ≥24 months with hrHPV infection. Conclusion Post‐therapeutic hrHPV infection remains high beyond 2 years in WLHIV stressing the need for long‐term follow‐up, especially when diagnosed with advanced HIV disease. Future implementation research should focus on the contribution of additional tools to better track those in need of additional treatment.