Endometrial polyps associated with human papillomavirus: A rationale for pathogenetic therapy

Objective. To study the rate of recurrence of endometrial polyps associated with human papillomavirus (HPV) of a high oncogenic risk, and the efficacy of inosine pranobex antiviral therapy for prevention of disease recurrences. Patients and methods. Two groups of patients were singled out 2: group 1 (n = 29) – patients with recurrent glandular, glandular-fibrous endometrial polyps; group 2 (n = 35) – patients with newly diagnosed glandular, glandular-fibrous endometrial polyps. In the process of viral load description, the groups were divided into subgroups 1a and 2b. Cytological/ immunohistochemical examination was based on liquid-based cytology. Molecular-genetic examination consisted in human papillomavirus identification with the use of polymerase chain reaction. Results. In group 1, 79.3% (n = 23) of women were HPV positive; in group 2 viral load was found only in 37.1% (n = 13) (p ≤ 0.001). A positive response to protein р16ink4 was determined in 72.4% (n = 21) of patients of group 1 and in 26.0% (n = 9) of patients of group 2 (p ≤ 0.001). After antiviral therapy with Groprinosin 3 months afterwards the viral load decreased in patients of group 1 as compared with initial data up to complete elimination of virus in 18 patients (presence of virus: 17.2% after therapy vs. 79.3% before therapy). Analysis of р16ink4 immunostaining was indicative of a drop in the number of stained clones (6.9% after therapy vs. 72.4% before therapy). The cumulative logarithm of viral DNA copies showed: of 5 individuals who had HVP after therapy in subgroup 1а (n = 23) a clinically significant cumulative log was preserved in three patients (13%) out of the initially infected persons. Conclusion. HPV can be regarded as one of the predictors of recurrent endometrial polyps. The use of combined treatment (hysteroresectoscopy + antiviral therapy with inosine pranobex) permits to reduce the risks for recurrence of endometrial polyps. © 2019, Dynasty Publishing House. All rights reserved.