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

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

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19 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)533-538
Number of pages6
JournalTaiwanese Journal of Obstetrics and Gynecology
Volume51
Issue number4
DOIs
Publication statusPublished - Dec 2012
Externally publishedYes

Keywords

  • Cervical intraepithelial neoplasia
  • Human papillomavirus
  • Imiquimod
  • Vaginal intraepithelial neoplasia

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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    Lin, C. T., Qiu, J. T., Wang, C. J., Chang, S. D., Tang, Y. H., Wu, P. J., Jung, S. M., Huang, C. C., Chou, H. H., Jao, M. S., & Lai, C. H. (2012). Topical imiquimod treatment for human papillomavirus infection in patients with and without cervical/vaginal intraepithelial neoplasia. Taiwanese Journal of Obstetrics and Gynecology, 51(4), 533-538. https://doi.org/10.1016/j.tjog.2012.09.006