Regression, Persistence, and Progression of Cervical Precursor Lesions in Relation to High-Risk Human Papillomavirus Genotypes Over a 2-Year Follow-Up: A Prospective Cohort Study in Iran

Purpose

Cervical cancer remains a significant global health burden, especially in low- and middle-income countries where screening coverage is limited. Persistent infection with high-risk human papillomavirus (HR-HPV) is the primary cause of cervical cancer. This study evaluates the natural history of cervical precursor lesions in women with negative Pap smears but positive HR-HPV results, focusing on risk factors of lesion regression, persistence, and progression. Patients and Methods: A prospective cohort study was conducted between December 2021 and April 2024 in Tehran, Iran. Women aged 30– 65 years with HR-HPV infection and normal Pap smear results were enrolled. Participants underwent colposcopy-guided biopsy at baseline and after two years. Lesions were categorized as regressing, persisting, or progressing based on histopathological assessments.