Cervical intraepithelial neoplasia grade 2 (CIN2) is an equivocal diagnosis that is associated with a high inter-observer variation. It is well known that excisional treatment for CIN is associated with increased reproductive harm, and recent studies have demonstrated high regression rates of CIN2, up to 60% in women

Join us in the Exhibition for a round table discussion. Cervical intraepithelial neoplasia grade 2 (CIN2) is an equivocal diagnosis that is associated with a high inter-observer variation. It is well known that excisional treatment for CIN is associated with increased reproductive harm, and recent studies have demonstrated high regression rates of CIN2, up to 60% in women.

There is both biologic, clinical and epidemiologic evidence that HPV can exist in a latent phase in the cervix. Other anogenital sites are less studied. Whether there is a truly latent phase (that is, dormant state within a cell in which the virus production ceases but the viral genome continues to exist) that can be reactivated to restart its life cycle remains highly controversial. From an epidemiology point of view, reactivation would be defined as redetection of an identical specific genotype after a period of no detection. Since sexual exposure can result in reinfection, supporting evidence would require redetection during periods of abstinence. Unfortunately, redetection during this time period doesn’t necessarily assure the existence of latency since negative tests can occur for several reasons including sampling error or low copy numbers. There is certainly evidence that HPV can exist in a state of low copy persistence which may reflect one mechanism for immune evasion. In addition, autoinoculation from other sites such as the anus remains another source of reinfection. Whether detection is reactivation or newly acquired, its clinical implication is questionable since data suggest a positive test preceded by a negative test is associated with low risk for CIN 3+. An IPVC working group has been created to examine the basic science, epidemiologic, clinical and modeling evidence for latency. Each of the 4 groups will review observable events, possible explanation, uncertainties, best inference with explicit assumptions and practical implications. This will be followed by panel discussion with the audience.