6 ms·

Effectiveness of Photodynamic Therapy in Elimination of HPV in Mexican Women [pdf]

238 points by new_guy 8y ago

Pharmakon 8y ago
Amazing results using a proven therapy, wretched article. Here’s the actual study: https://twin.sci-hub.tw/6319/73863883d6bd8895505fcc8581dfc0e0/maldonadoalvarado2017.pdf https://twin.sci-hub.tw/6319/73863883d6bd8895505fcc8581dfc0e... Abstract: This study aimed to determine the effectiveness of photodynamic therapy (PDT), using δ‐aminolevulinic acid (5‐ALA), in the elimination of premalignant cervical lesions in Mexican patients with human papillomavirus (HPV) infection and/or cervical intraepithelial neoplasia (CIN). Thirty women diagnosed with CIN I and/or positive for HPV participated in the study. Topical 6% 5‐ALA in gel form was applied to the uterine cervix; after 4 h, the lesion area was irradiated with a light dose of 200 J cm−2 at 635 nm. This procedure was performed three times at 48‐h intervals. Clinical follow‐up was performed at 3, 6, and 12 months after the initial PDT administration, by colposcopy, cervical cytology, histopathological analysis, polymerase chain reaction, and hybrid capture. Of HPV‐infected patients without evidence of CIN I, 80% cleared the infection, while HPV associated with CIN I was eliminated in 83% of patients (P < 0.05). At 12 months, CIN I had regressed in 57% of patients, although this response was not statistically significant. PDT using 6% 5‐ALA is concluded to be effective in eliminating HPV infection associated or not with CIN I.
- FabHK 8y ago
  > wretched article. Indeed. This doesn't make any sense: > she was able to eradicate HPV in [...] 57.2% in women who had lesions but don't have HPV.
  - sctb 8y ago
    OK, in that case we've updated the link from https://www.eluniversal.com.mx/english/mexican-scientist-cures-human-papilloma-virus https://www.eluniversal.com.mx/english/mexican-scientist-cur.... If someone can suggest a better article we could use that.
- ericpauley 8y ago
  Disappointingly, there is no mention in the paper of how the Hypothesis testing is performed, including no mention of randomized control group. Are these details described elsewhere? Are they assuming a null Hypothesis of no remission with no control group?
- arkades 8y ago
  > Of HPV‐infected patients without evidence of CIN I, 80% cleared the infection, Over 50 percent of new HPV infections are cleared in 6 to 18 months, and 80 to 90 percent will have resolved within two to five years. > while HPV associated with CIN I was eliminated in 83% of patients (P < 0.05). At 12 months, CIN I had regressed in 57% of patients, although this response was not statistically significant. CIN 1 lesions will regress in most women. As an example, a retrospective study of 680 women with biopsy-proven CIN 1 found the following cytology and/or histology results: (1) at six months, 49 percent regressed to negative, 35 percent had persistent CIN 1, and 7 percent had high-grade lesions; (2) at 12 months, among the patients with negative results at six months: 80 percent were negative, 17 percent had low-grade lesions, and 4 percent had high-grade lesions; and (3) at 12 months, among patients with persistent CIN 1 at six months: 50 percent were negative, 46 percent had low-grade lesions, and 4 percent had high-grade lesions (Bansal 2008.) > PDT using 6% 5‐ALA is concluded to be effective in eliminating HPV infection associated or not with CIN I. Doesn’t seem to be much better than the natural course of the untreated disease.
- crusty 8y ago
  This is an awkward study poorly described in the journal paper. They are studying two groups, one that is CIN+ and HPV+ and the other that is CIN- but HPV+. They are applying the same treatment. It's essentially two studies. They provide no treatment control groups but seem to rely on control statistics from a previous, similar study, and only mention it in passing in the discussion. The control that should be covered is for CIN that naturally regresses, which is clearly a significant case as they exclude women under 25 because they "easily regress." They note that their final regression rate with treatment is the same as previously reported natural regression after two years (57% vs. 58%), but indicate their rate of regression to that point is faster (6 vs. 24 months), but not statistically significantly so - they only had 12 CIN+ HPV+ subjects. They also seem to rely on, but make no mention of, natural HPV viral clearance by the immune system. They similarly indicate that the treatment group's clearance rate of HPV is similar to previously reported, but un-cited, rates of natural clearance, but with a sharper slope to the clearance rate among the treated patients. They offer that this might be due to coincidentally specific immune response to the treatment that corresponds to the necessary immune response for effective natural HPV clearance. In many respects, this is a report of negative results, and they don't really hide that. They just wait until the discussion to explicitly mention any of the key information. But respect for publishing negative results. EDIT: changed "article" to "journal paper" to avoid confusing the published research paper with the news report of it that was originally linked and which I didn't bother wasting time reading.
mlacks 8y ago
This is good to see. I don't usually see a lot in the press about Mexico accept for the cartel-related news. Hard to believe I forget that Mexico is more or less a normal country, not some dystopian war zone.
- Insanity 8y ago
  Maybe you should head over there to see for yourself what it's like. This summer, I'll be heading to Mexico (Monterrey) and San Antonio again, and I'm looking forward to Monterrey a lot more than San Antonio. Mexico, apart from certain regions (like almost everywhere) is pretty great.
  - Waterluvian 8y ago
    I agree with the sentiment but the "(like almost everywhere)" part frustrates me. Where are the armed guards at gas stations in Canada? Where are the mass graves in Sweden? Where's the bribery-is-business-as-usual in England? Don't pretend like everywhere has these kinds of problems. It really undercuts the valid point you have that there's a lot of great places in Mexico and it's generally populated by good people.
    - modzu 8y ago
      how is op saying "almost anywhere" has the same issues? canada and sweden have issues too. talk to many aboriginals?
      - loeg 8y ago
        The countries of the American continents have a ton of historical baggage with regards to treatment of first nations / indigenous / aboriginal / native american people and plenty of current baggage. And I don't doubt Sweden does too. However, the current status is not in remotely the same league as the violence, corruption, and warfare raging throughout Mexico. This is quantifiably worse.
        8y ago
painful 8y ago
https://en.wikipedia.org/wiki/Photodynamic_therapy https://en.wikipedia.org/wiki/Photodynamic_therapy
deleted 8y ago
[deleted]
yonatron 8y ago
This sounds like nonsense. Unlikely and highly improbable. I sincerely hope im wrong...
dannykwells 8y ago
Has anyone read the study? Severe side effects in almost every patient, and a 50% cure rate of CIN. Existing treatments for CIN have side effects in about 1% of patients and with a 90% cure rate: https://my.clevelandclinic.org/health/diseases/15678-cervical-intraepithelial-neoplasia-cin/management-and-treatment https://my.clevelandclinic.org/health/diseases/15678-cervica... Moreover, as the above makes clear, curing HPV is not necessary (especially with such an invasive technique) - only 1% of low grade CIN (which itself is a subset of all HPV) progress to cervical cancer.
- rinchik 8y ago
  Thank you for readying the actual study. News outlets are political and have their narratives. If there is no hard boiled source, it impossible to tell from one source what the actual facts are. Almost no one will compare different sources to filter the truth, most just stick with the outlets they used to.
- bicubic 8y ago
  > Moreover, as the above makes clear, curing HPV is not necessary There's a body of evidence that HPV might be a factor of Alzheimer's and other neurodegenerative conditions. If that turns out to be true, curing HPV will be very much necessary. https://www.cell.com/neuron/fulltext/S0896-6273(18)30421-5 https://www.cell.com/neuron/fulltext/S0896-6273(18)30421-5
  - atomical 8y ago
    That article doesn't reference HPV.
    - bicubic 8y ago
      My bad. HHV != HPV. I have been misreading the OP article. I'd delete the above if it was within time limit.
loeg 8y ago
> The results of her investigation show that she was able to eradicate HPV in … 57.2% in women who had lesions but don't have HPV. How do you eradicate HPV in a population that does not have HPV?
- TaylorAlexander 8y ago
  With a mere snap of the fingers!
- kaikai 8y ago
  Presumably they eradicated the lesions, which were potentially precancerous.
entwife 8y ago
No control group. Very small treatment group. Low power study. Possibly of interest to researchers for discussion, no value to clinician or general public. Nice that they reported side effects of treatment including pain.

238 points by new_guy 8y ago

Amazing results using a proven therapy, wretched article. Here’s the actual study: https://twin.sci-hub.tw/6319/73863883d6bd8895505fcc8581dfc0e0/maldonadoalvarado2017.pdf https://twin.sci-hub.tw/6319/73863883d6bd8895505fcc8581dfc0e... Abstract: This study aimed to determine the effectiveness of photodynamic therapy (PDT), using δ‐aminolevulinic acid (5‐ALA), in the elimination of premalignant cervical lesions in Mexican patients with human papillomavirus (HPV) infection and/or cervical intraepithelial neoplasia (CIN). Thirty women diagnosed with CIN I and/or positive for HPV participated in the study. Topical 6% 5‐ALA in gel form was applied to the uterine cervix; after 4 h, the lesion area was irradiated with a light dose of 200 J cm−2 at 635 nm. This procedure was performed three times at 48‐h intervals. Clinical follow‐up was performed at 3, 6, and 12 months after the initial PDT administration, by colposcopy, cervical cytology, histopathological analysis, polymerase chain reaction, and hybrid capture. Of HPV‐infected patients without evidence of CIN I, 80% cleared the infection, while HPV associated with CIN I was eliminated in 83% of patients (P < 0.05). At 12 months, CIN I had regressed in 57% of patients, although this response was not statistically significant. PDT using 6% 5‐ALA is concluded to be effective in eliminating HPV infection associated or not with CIN I.

FabHK 8y ago
> wretched article. Indeed. This doesn't make any sense: > she was able to eradicate HPV in [...] 57.2% in women who had lesions but don't have HPV.
- sctb 8y ago
  OK, in that case we've updated the link from https://www.eluniversal.com.mx/english/mexican-scientist-cures-human-papilloma-virus https://www.eluniversal.com.mx/english/mexican-scientist-cur.... If someone can suggest a better article we could use that.
ericpauley 8y ago
Disappointingly, there is no mention in the paper of how the Hypothesis testing is performed, including no mention of randomized control group. Are these details described elsewhere? Are they assuming a null Hypothesis of no remission with no control group?
arkades 8y ago
> Of HPV‐infected patients without evidence of CIN I, 80% cleared the infection, Over 50 percent of new HPV infections are cleared in 6 to 18 months, and 80 to 90 percent will have resolved within two to five years. > while HPV associated with CIN I was eliminated in 83% of patients (P < 0.05). At 12 months, CIN I had regressed in 57% of patients, although this response was not statistically significant. CIN 1 lesions will regress in most women. As an example, a retrospective study of 680 women with biopsy-proven CIN 1 found the following cytology and/or histology results: (1) at six months, 49 percent regressed to negative, 35 percent had persistent CIN 1, and 7 percent had high-grade lesions; (2) at 12 months, among the patients with negative results at six months: 80 percent were negative, 17 percent had low-grade lesions, and 4 percent had high-grade lesions; and (3) at 12 months, among patients with persistent CIN 1 at six months: 50 percent were negative, 46 percent had low-grade lesions, and 4 percent had high-grade lesions (Bansal 2008.) > PDT using 6% 5‐ALA is concluded to be effective in eliminating HPV infection associated or not with CIN I. Doesn’t seem to be much better than the natural course of the untreated disease.
crusty 8y ago
This is an awkward study poorly described in the journal paper. They are studying two groups, one that is CIN+ and HPV+ and the other that is CIN- but HPV+. They are applying the same treatment. It's essentially two studies. They provide no treatment control groups but seem to rely on control statistics from a previous, similar study, and only mention it in passing in the discussion. The control that should be covered is for CIN that naturally regresses, which is clearly a significant case as they exclude women under 25 because they "easily regress." They note that their final regression rate with treatment is the same as previously reported natural regression after two years (57% vs. 58%), but indicate their rate of regression to that point is faster (6 vs. 24 months), but not statistically significantly so - they only had 12 CIN+ HPV+ subjects. They also seem to rely on, but make no mention of, natural HPV viral clearance by the immune system. They similarly indicate that the treatment group's clearance rate of HPV is similar to previously reported, but un-cited, rates of natural clearance, but with a sharper slope to the clearance rate among the treated patients. They offer that this might be due to coincidentally specific immune response to the treatment that corresponds to the necessary immune response for effective natural HPV clearance. In many respects, this is a report of negative results, and they don't really hide that. They just wait until the discussion to explicitly mention any of the key information. But respect for publishing negative results. EDIT: changed "article" to "journal paper" to avoid confusing the published research paper with the news report of it that was originally linked and which I didn't bother wasting time reading.

mlacks 8y ago

This is good to see. I don't usually see a lot in the press about Mexico accept for the cartel-related news. Hard to believe I forget that Mexico is more or less a normal country, not some dystopian war zone.

Insanity 8y ago
Maybe you should head over there to see for yourself what it's like. This summer, I'll be heading to Mexico (Monterrey) and San Antonio again, and I'm looking forward to Monterrey a lot more than San Antonio. Mexico, apart from certain regions (like almost everywhere) is pretty great.
- Waterluvian 8y ago
  I agree with the sentiment but the "(like almost everywhere)" part frustrates me. Where are the armed guards at gas stations in Canada? Where are the mass graves in Sweden? Where's the bribery-is-business-as-usual in England? Don't pretend like everywhere has these kinds of problems. It really undercuts the valid point you have that there's a lot of great places in Mexico and it's generally populated by good people.
  - modzu 8y ago
    how is op saying "almost anywhere" has the same issues? canada and sweden have issues too. talk to many aboriginals?
    - loeg 8y ago
      The countries of the American continents have a ton of historical baggage with regards to treatment of first nations / indigenous / aboriginal / native american people and plenty of current baggage. And I don't doubt Sweden does too. However, the current status is not in remotely the same league as the violence, corruption, and warfare raging throughout Mexico. This is quantifiably worse.
      - 8y ago

painful 8y ago

https://en.wikipedia.org/wiki/Photodynamic_therapy https://en.wikipedia.org/wiki/Photodynamic_therapy

deleted 8y ago

[deleted]

yonatron 8y ago

This sounds like nonsense. Unlikely and highly improbable. I sincerely hope im wrong...

dannykwells 8y ago

Has anyone read the study? Severe side effects in almost every patient, and a 50% cure rate of CIN. Existing treatments for CIN have side effects in about 1% of patients and with a 90% cure rate: https://my.clevelandclinic.org/health/diseases/15678-cervical-intraepithelial-neoplasia-cin/management-and-treatment https://my.clevelandclinic.org/health/diseases/15678-cervica... Moreover, as the above makes clear, curing HPV is not necessary (especially with such an invasive technique) - only 1% of low grade CIN (which itself is a subset of all HPV) progress to cervical cancer.

rinchik 8y ago
Thank you for readying the actual study. News outlets are political and have their narratives. If there is no hard boiled source, it impossible to tell from one source what the actual facts are. Almost no one will compare different sources to filter the truth, most just stick with the outlets they used to.
bicubic 8y ago
> Moreover, as the above makes clear, curing HPV is not necessary There's a body of evidence that HPV might be a factor of Alzheimer's and other neurodegenerative conditions. If that turns out to be true, curing HPV will be very much necessary. https://www.cell.com/neuron/fulltext/S0896-6273(18)30421-5 https://www.cell.com/neuron/fulltext/S0896-6273(18)30421-5
- atomical 8y ago
  That article doesn't reference HPV.
  - bicubic 8y ago
    My bad. HHV != HPV. I have been misreading the OP article. I'd delete the above if it was within time limit.

loeg 8y ago

> The results of her investigation show that she was able to eradicate HPV in … 57.2% in women who had lesions but don't have HPV. How do you eradicate HPV in a population that does not have HPV?

TaylorAlexander 8y ago
With a mere snap of the fingers!
kaikai 8y ago
Presumably they eradicated the lesions, which were potentially precancerous.

entwife 8y ago

No control group. Very small treatment group. Low power study. Possibly of interest to researchers for discussion, no value to clinician or general public. Nice that they reported side effects of treatment including pain.