{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T11:28:26Z","timestamp":1793359706384,"version":"4.5.0"},"reference-count":46,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The role of multiple high\u2010risk human papillomavirus (HR\u2010HPV) infections on the occurrence of persistence\/recurrence of high\u2010grade squamous intraepithelial lesion (HSIL) after conization\/surgery for cervical intraepithelial neoplasia was evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>A systematic search of Pubmed\/Medine, Scopus, Cochrane databases from inception to June 30, 2023 was performed. Three reviewers independently screened the abstracts of the selected studies and extracted data from full\u2010text articles. The data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the OSQE method. PROSPERO registration number CRD42023433022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 1606 records screened, 22 full text articles met the inclusion criteria. A total of 8321 subjects treated (loop electrosurgical excision, laser or surgery) because of HSIL were followed\u2010up and included in the meta\u2010analysis. The pooled prevalence of overall persistence and\/or recurrence was 17.6 (95% CI: 12.3\u201323.5) in multiple and 14.3 (95% CI:\u200910.1\u201319.2) in single HR\u2010HPV infections detected shortly before or at surgery. The pooled rate of multiple HR\u2010HPV infections was 25% (95% CI:\u200920.4\u201330). The odds ratio of histologically confirmed HSIL persistence and\/or recurrence was significantly higher (OR:\u20091.38, 95% CI:1.08\u20131.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01, heterogeneity\u2009=\u200939%) among multiple than single HR\u2010HPV infections. Increased risk of HSIL persistence\/recurrence was more marked among studies with multiple HR\u2010HPVs prevalence \u226525% (12 studies,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20093476) (OR:\u20091.47, 95% CI:\u20091.18\u20131.84, heterogeneity\u2009=\u20090%) and in those evaluating true histologically confirmed recurrence after at least 6\u2009months of negative follow\u2010up (9 studies,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20095073) (OR:\u20091.67, 95% CI:\u20091.17\u20132.37, heterogeneity\u2009=\u200937%). Multiple HR\u2010HPVs infection detected during follow\u2010up visits had no effect on the risk of recurrence although the number of included studies was small (4 studies,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091248) (OR:\u20090.98, 95% CI:\u20090.68\u20131.39, heterogeneity\u2009=\u20090%). The risk of bias was rated as high in 10 and low\u2010moderate in 12 studies, respectively. In subgroup analysis, the risk of bias of the included studies (low\/moderate vs. high), had a small, although not significant effect on the odds ratios of persistence\/recurrence of HSIL (OR:\u20091.57, 95% CI:\u20091.23\u20132 for low\u2010moderate risk of bias and OR:\u20091.06, 95% CI:\u20090.65\u20131.75 for high risk of bias;\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value for subgroup differences\u2009=\u20090.17).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multiple HR\u2010HPVs infections at the time of standard treatment of HSIL entail a small but significant increased risk of persistence\/recurrence of HSIL and should be taken into account in the follow\u2010up plan.<\/jats:p>\n                  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