Reviewer ’s report  
Title:  Recurrence of cervical intraepithelial lesions after Thermo -coagulation in HIV -positive 
and HIV-negative Nigerian women  
 
Version:  0 Date:  15 Nov 2015  
 
Reviewer: Elizabeth  Stier  
 
Reviewer's report:  
This manuscript, which compiles data from 6 see and treat clinics in Nigeria, reviews the 6 -
month recurrence of VIA/VILI+ lesions after treatment with thermo -coagulation from 2010 -
2014.  
398 women including 265 HIV+ and 133 HIV - women had + VIA/VILI screeni ng, and of these 
262 were appropriate for ablative therapy with thermoc oagulation.  Of those treated, 177 returned 
for follow -up and recurrence of VIA/VILI lesions overall was 16%.  
 
The results are based on VIA/VILI findings alone without cytologic or h istologic correlation.  
Given the resources  available, this is acceptable.  However, the lack of histologic assessment 
should be commented on in the intro/discussion perhaps with accompanying data demonstrating 
the accuracy/reproducibility of these finding s. 
 
Were all of the women HIV tested?  
 
This tells us that recurrence of apparent lesions at short term follow -up is overall about 16%, 
however this does not tell us whether the initial positive screening nor th e recurrence was CIN1 
or CIN2+.  If the treate d lesions were HSIL and the recurrenc e only LSIL, that would be ok, 
however, without histologic correlates it is difficult to determine which + lesions are significant.  
 
The best comparative studies would be those looking at +VIA/VILI for baseline and fol low-up. 
(I am not aware of such studies but if they exist would be the appropriate comparison)  
The discussion lists the limitations include short term follow -up and significant loss to follow -up. 
 
The first paragraph  of the discussion needs work -- to sa y that something is "more common" but 
not statistically significant.  
 
The second paragraph does not quit e give the right comparisons -- the cited studies re: recurrence 
have longer follow -up confirmed by cytologic/histologic findings.  
 
It is interesting that younger women had higher recurrence rates.  Are they getting re -infected 
with HPV more readily?  It is unclear why the lower prevalence of +VIA/VILI lesions in women 
30+ would account for the lower risk of recurrence.  
 
Interesting t hat the lower CD4 counts were associated with higher risk of recurrence, however, 
HIV infectio n, overall was not associated. (although likely the sample size was not sufficiently 
large to detect a difference.)  
 
The size of the cervical lesions (e.g., numb er of quadrants involved in the VIA/VILI lesions) as a 
possible factor was not included.  Was this data not available?  
 
Table 1, neglects to include the number/% of women with screen+ tests at each clinical site.  
 
Are the methods appropriate and well describ ed? 
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
  
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
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