MODERN APPROACHES TO TREATMENT AND POST-TREATMENT MONITORING OF HPV-POSITIVE WOMEN WITH CERVICAL PATHOLOGY
DOI:
https://doi.org/10.31149/ijnps.v4i4.2860Keywords:
Human Papillomavirus, HPV, Cervical Pathology, CIN2+, HSIL, LEEP, LLETZ, Conization, Ablation, Post-Treatment Follow-Up, hrHPV, Risk Stratification, Overtreatment, Reproductive OutcomesAbstract
Cervical pathology in HPV-positive women remains a key problem in modern gynecology and gynecologic oncology, as it is in this group that the transition from virus carriage to clinically significant precancerous lesions and invasive cervical cancer occurs. In recent years, primary HPV screening, molecular triage, and risk stratification have significantly changed early diagnosis. However, the selection of optimal treatment strategies and the development of effective post-treatment monitoring remain the subject of active clinical debate. The main difficulty stems from the heterogeneity of the HPV-positive population: some patients have transient infection and lesions with a high probability of regression, while others develop HSIL/CIN2+ lesions, requiring timely and oncologically adequate intervention. The aim of this review article is to analyze current literature on the treatment of cervical pathology in HPV-positive women and the organization of post-treatment follow-up. This review focuses on the individualization of treatment strategies, the problem of overtreatment, the reproductive consequences of excisional procedures, the importance of follow-up hrHPV testing, and prospects for further personalization of the patient's care pathway. This paper examines current approaches to choosing between surveillance, ablative methods, LEEP/LLETZ, and conization, highlighting their advantages and limitations, and emphasizing the need to balance oncological safety with reproductive preservation. Special attention is paid to post-treatment surveillance, where follow-up hrHPV testing plays a key role as the most informative tool for the early detection of treatment failure. Factors predicting an unfavorable prognosis are discussed, including persistent hrHPV positivity, resection margin status, age, and initial lesion severity. The final section presents promising areas related to artificial intelligence, therapeutic HPV vaccines, and molecular personalization of treatment algorithms. It is concluded that treatment and follow-up of HPV-positive women should not be based on a one-size-fits-all approach, but on a step-by-step, individualized risk assessment. This allows for a simultaneous reduction in the likelihood of missing clinically significant lesions, a reduction in overtreatment, and an improvement in oncologic and reproductive outcomes.
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