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Federschneider, Jerome M., and Christopher P. Crum. "HPV Testing." American Journal of Clinical Pathology 120, no. 4 (2003): 483–84. http://dx.doi.org/10.1309/66ut87wy1pur3pr8.
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Bowers, Taysa. "HPV testing." Evidence-Based Practice 23, no. 5 (2020): 7–8. http://dx.doi.org/10.1097/ebp.0000000000000837.
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Elliott, Tamara, Racquel E. Kohler, Barati Monare, et al. "Performance of vaginal self-sampling for human papillomavirus testing among women living with HIV in Botswana." International Journal of STD & AIDS 30, no. 12 (2019): 1169–76. http://dx.doi.org/10.1177/0956462419868618.
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In Botswana, where human immunodeficiency virus (HIV) prevalence remains high, cervical cancer is the leading cause of cancer deaths in women. Multiple organizations recommend high-risk human papillomavirus (hr-HPV) testing as a screening tool; however, high coverage may not be feasible with provider-collected samples. We conducted the first assessment of self- versus provider-collected samples for hr-HPV testing in HIV-positive women in Botswana and report prevalence of hr-HPV and histological outcomes. We recruited HIV-positive women ≥25 years attending an HIV clinic in Gaborone. Self- and provider-collected samples from participants were tested for hr-HPV using Cepheid GeneXpert. Women testing positive for any hr-HPV returned for colposcopy. We used unweighted κ statistics to determine hr-HPV agreement. We report that 31 (30%) of 103 women tested positive for any hr-HPV. The most common genotypes were HPV 31/33/35/52/58. Overall agreement between self- and provider-collected samples for any hr-HPV was 92% with a κ of 0.80. Ten of the 30 hr-HPV-positive women attending colposcopy had CIN2+ (33%). In conclusion, in this HIV-positive population, there was excellent agreement between self and provider samples, and self-sampling may play an important role in screening programs in high HIV burden settings with limited resources like Botswana.
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Pisano, Luigi, Claudia Giachini, Martina Turco, et al. "PAP-HPV Co-Testing in Anal Cancer Screening: An Italian Experience." Journal of Clinical Medicine 14, no. 7 (2025): 2186. https://doi.org/10.3390/jcm14072186.
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Background/Objectives: Squamous cell carcinoma of the anus (SCCA) remains a relatively rare form of cancer linked to high-risk human papillomavirus (HR-HPV) infection; however, its incidence has been increasing globally. Anal cytology and HR-HPV testing can identify precursors, though standardized screening guidelines are still lacking. This study aimed to assess the correlation between high-resolution anoscopy (HRA) findings and primary screening results through PAP-HPV co-testing in high-risk patients. Methods: A retrospective, single-center study was conducted collecting data from the joint multidisciplinary anal cancer clinic of Piero Palagi Hospital in Florence (Italy), between August 2019 and September 2022. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of anal cytology, HR-HPV testing, and PAP-HPV co-testing were assessed. Results: In 577 HRAs, histology revealed 31 AIN2+ lesions (5.4%) and 220 AIN1 lesions (38.1%), while 326 (56.5%) were negative. Cytology alone showed a sensitivity of 74.2% and specificity of 63.3% for AIN2+ lesions, while HR-HPV testing alone had a sensitivity of 96.8% and specificity of 38.1%. Co-testing demonstrated 100% sensitivity and a 100% NPV for AIN2+ lesions. Among men who have sex with men (MSM), no significant differences in outcomes were observed between HIV-positive and HIV-negative patients, likely reflecting similar high-risk behaviors and effective HIV treatments. Conclusions: Co-testing with anal cytology and HR-HPV testing provides the most reliable screening for high-grade lesions (AIN2+), surpassing the reliability of individual methods. Tailored co-testing strategies are crucial for early detection and effective prevention in high-risk groups.
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Hubbard, Roger A. "Human Papillomavirus Testing Methods." Archives of Pathology & Laboratory Medicine 127, no. 8 (2003): 940–45. http://dx.doi.org/10.5858/2003-127-940-hptm.
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Abstract Testing for human papillomavirus (HPV) relies exclusively on techniques of molecular biology using nucleic acid probes. Tests for HPV using nucleic acid probes have been commercially available since the late 1980s, but early tests were cumbersome, involving the use of nucleic acid probes labeled with radioactive phosphorus (32P). These early HPV tests did not achieve widespread use because they did not detect all oncogenic HPV genotypes. The current commercial HPV detection kit, Digene's Hybrid Capture 2 kit, detects virtually all high-risk oncogenic HPV types, as well as most low-risk nononcogenic HPV genotypes. The Hybrid Capture 2 test format is a proprietary nucleic acid hybridization signal amplification system owned by Digene Corporation. Virtually all test formats for DNA sequence analysis are amenable to applications intended to detect and perhaps quantify the various HPV genotypes. These methods can involve direct hybridization with complementary DNA probes, such as Southern blotting or in situ hybridization, signal amplification, such as the Hybrid Capture 2 method or target nucleic acid amplification, most notably the polymerase chain reaction (PCR). Polymerase chain reaction has been used for HPV detection, genotyping, and viral load determination. General or consensus primer–mediated PCR assays have enabled screening for a broad spectrum of HPV types in clinical specimens using a single PCR reaction. Following amplification using consensus primers, individual HPV genotypes are identified using a variety of methods. Using consensus primers in a test format known as real-time quantitative PCR (RQ-PCR), it is possible to generate viral load (concentration) data from reaction curves generated by monitoring PCR reaction kinetics in real time.
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Omenge, Elkanah, Yan Tong, Philip Tonui, et al. "Comparison of HPV detection in HIV-infected and HIV-uninfected Kenyan women with or without cervical dysplasia." Journal of Clinical Oncology 37, no. 15_suppl (2019): e17015-e17015. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e17015.
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e17015 Background: Cervical cancer, a malignancy caused by human papillomavirus (HPV) infection, is the most common malignancy in women living in sub-Saharan African countries including Kenya. HIV co-infection accelerates the natural course of cervical cancer. To determine the specific HPV type distribution in HIV-infected women compared to HIV-uninfected women, with and without evidence of cervical dysplasia. Methods: Demographic information, behavioral data, and a cervical swab were collected from women 18 and 45 years of age, HIV-infected or HIV-uninfected, who presented for cervical cancer screening at Moi Referral and Teaching Hospital in Eldoret, Kenya. Women were triaged based on the presence or absence of cervical dysplasia. HPV testing was performed using the Roche Linear Array Assay. Results were compared between women with or without HIV co-infection and between those with or without cervical dysplasia, using Chi-square tests or Fisher’s exact tests. Results: 223 women had normal VIAs. All had HPV testing, 221 had valid results: 115 HIV-infected women (mean age 37 years) and 106 HIV-uninfected (mean age 33 years). 175 women had abnormal VIAs. 143 women had HPV testing performed, 140 had valid results: 70 HIV-infected women (mean age 38.5 years) and 70 HIV-uninfected (mean age 31.3 years). Greater than 90% of all HIV-infected women in both projects were receiving anti-retroviral therapy at enrollment. HPV of any type was detected in 48% of all women with normal VIA vs. 61% of women with abnormal VIA (P = 0.018). High risk (HR)-HPV was detected in 38% of all women with normal VIA vs. 51% of all women with abnormal VIA (P = 0.012). HIV-uninfected women with normal VIA had significantly lower detection of all HPV (P = 0.026), high risk-HPV (P = 0.018), IARC high risk-HPV (P = 0.047), A9 types (P = 0.050), and individual types HPV 16 (P = 0.0274), HPV 18 (P = 0.007), and HPV 51 (P = 0.009) than HIV-uninfected women with abnormal VIA. Among HIV-infected women, there was no difference in detection of any group of HPV types or individual types with respect to VIA results. Conclusions: HIV-uninfected women without cervical dysplasia had lower detection of oncogenic HPV than HIV-uninfected women with dysplasia. In contrast, HPV detection did not differ among HIV-infected women between those with or without cervical dysplasia. In addition, VIA appears to lack specificity for HPV-associated cervical dysplasia, as 39% of women with abnormal VIA examinations did not have any HPV detected, and 49% of women with abnormal VIA examinations did not have any HR-HPV detected.
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Clarke, Megan A., Li C. Cheung, Thomas Lorey, et al. "5-Year Prospective Evaluation of Cytology, Human Papillomavirus Testing, and Biomarkers for Detection of Anal Precancer in Human Immunodeficiency Virus–Positive Men Who Have Sex With Men." Clinical Infectious Diseases 69, no. 4 (2018): 631–38. http://dx.doi.org/10.1093/cid/ciy970.
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Abstract Background Human papillomavirus (HPV)-related biomarkers have shown good cross-sectional performance for anal precancer detection in human immunodeficiency virus–positive (HIV+) men who have sex with men (MSM). However, the long-term performance and risk stratification of these biomarkers are unknown. Here, we prospectively evaluated high-risk (HR) HPV DNA, HPV16/18 genotyping, HPV E6/E7 messenger RNA (mRNA), and p16/Ki-67 dual stain in a population of HIV+ MSM. Methods We enrolled 363 HIV+ MSM between 2009–2010, with passive follow-up through 2015. All had anal cytology and a high-resolution anoscopy at baseline. For each biomarker, we calculated the baseline sensitivity and specificity for a combined endpoint of high-grade squamous intraepithelial lesion (HSIL) and anal intraepithelial neoplasia grade 2 or more severe diagnoses (HSIL/AIN2+), and we estimated the 2- and 5-year cumulative risks of HSIL/AIN2+ using logistic and Cox regression models. Results There were 129 men diagnosed with HSIL/AIN2+ during the study. HR-HPV testing had the highest positivity and sensitivity of all assays, but the lowest specificity. HPV16/18 and HPV E6/E7 mRNA had high specificity, but lower sensitivity. The 2- and 5-year risks of HSIL/AIN2+ were highest for those testing HPV16/18- or HPV E6/E7 mRNA–positive, followed by those testing dual stain–positive. Those testing HR-HPV– or dual stain–negative had the lowest 2- and 5-year risks of HSIL/AIN2+. Conclusions HPV-related biomarkers provide long-term risk stratification for anal precancers. HR-HPV– and dual stain–negativity indicate a low risk of HSIL/AIN2+ for at least 2 years, compared with negative anal cytology; however, the high positivity of HR-HPV in HIV+ MSM may limit its utility for surveillance and management in this population.
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Bogale, Agajie Likie, Tilahun Teklehaymanot, Getnet Mitike Kassie, Girmay Medhin, Jemal Haidar Ali, and Nega Berhe Belay. "Performance of visual Inspection With Acetic Acid for Cervical Cancer Screening as Compared to Human papillomavirus Deoxyribonucleic acid Testing Among Women With HIV in Ethiopia: A Comparative Cross-sectional Study." Cancer Control 29 (January 2022): 107327482211149. http://dx.doi.org/10.1177/10732748221114980.
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Objectives The aim of this study was to evaluate the performance of visual inspection with acetic acid compared with Human papillomavirus Deoxyribonucleic acid (HPV DNA) testing among women with HIV in Ethiopia. Methods A comparative cross-sectional study was conducted to address the aforementioned objective. Data were collected from January to October 2021, to compare the performance of these two screening modalities. Trained clinicians collected cervical specimens and immediately applied acetic acid for visual inspection. The HPV DNA testing was done using Abbott m2000rt/SP by trained laboratory professionals in accredited laboratories. A total of 578 women with HIV aged 25-49 years were included. Results Test positivity was 8.9% using visual inspection with acetic acid (VIA) and 23.3% using HPV DNA test. The sensitivity and specificity of the VIA test were 19.2% and 95.1%, respectively. The strength of agreement between the two screening methods was poor (k = .184). The burden of genetic distribution of high risk HPV16 was 6.1%, and HPV18 was 1.1%. Other high risk HPV types (ie non-HPV 16/18 high risk HPV genotypes) were predominant in this study (18.6%). Conclusion The higher positivity result using HPV DNA testing compared with VIA, and low sensitivity of VIA are indicating that the implementation of HPV DNA testing as the primary screening strategy is likely to reduce cervical cancer cases and deaths of women in the country.
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Farnsworth, Annabelle. "Self‐sampling HPV testing versus mainstream cervical screening and HPV testing." Medical Journal of Australia 204, no. 5 (2016): 171. http://dx.doi.org/10.5694/mja16.00017.
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Ko, Emily M., Rosemary Tambouret, David Wilbur, and Annekathryn Goodman. "HPV Reflex Testing in Menopausal Women." Pathology Research International 2011 (April 7, 2011): 1–4. http://dx.doi.org/10.4061/2011/181870.
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Objective. To determine the frequency of high risk (HR) HPV and intraepithelial neoplasia following ASCUS pap cytology screens in menopausal women. Study Design. Following IRB approval, we performed a retrospective review of all cases of ASCUS pap tests, HPV results, and relevant clinical-pathologic data in women age 50 or over from November 2005 to January 2007 within a tertiary care center. Statistical analyses were performed in EXCEL. Results. 344 patients were analyzed for a total of 367 screening pap tests. 25.29% (87/344) patients were HR HPV positive, with greater percentages of HR HPV cases occurring in women age 65–74. Within HR HPV cases, 79.3% (69/87) underwent colposcopy. 27.5% (19/69) biopsy proven lesions were discovered, including cervical, vulvar or vaginal (intraepithelial neoplasia). Within the negative HR HPV group 3.1% (8/257) patients were diagnosed with dysplasia or carcinoma. Within both HR HPV positive and negative groups, patients with no prior history of lower genital tract lesions or cancer were identified. Conclusion. Reflex HPV testing plays an important role in ASCUS triage in menopausal women. Pap test screening and HPV testing should not be limited to women of reproductive age as they may aid in the diagnosis of intraepithelial neoplasia in women of older age.
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Dabeski, Drage, Sotirija Duvlis, Neli Basheska, et al. "Comparison Between HPV DNA Testing and HPV E6/E7 MRNA Testing in Women with Squamous Cell Abnormalities of the Uterine Cervix." PRILOZI 40, no. 1 (2019): 51–58. http://dx.doi.org/10.2478/prilozi-2019-0003.
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Abstract Introduction: The aim of the study was to compare the results of two human papillomavirus (HPV) diagnostic techniques: human papillomavirus deoxyribonucleic acid (HPV DNA) testing and human papillomavirus E6/E7 messenger ribonucleic acid (HPV E6/E7 mRNA) testing in women with squamous cell abnormalities of the uterine cervix. Material and Methods: Comparative prospective study, conducted in the period from January 2016 to June 2017 of 128 sexually active women, age groups of 20 to 59 years (40.50 ± 10.85) with squamous cell abnormalities on the cervical cytology. All patients were subject to: HPV DNA testing, HPV E6/E7 mRNA testing and colposcopic cervical biopsy with endocervical curettage for histopathologycal analysis. HPV DNA testing was done using multiplex polymerase chain reaction (PCR) and reverse hybridization methods. HPV E6/E7 mRNA testing was done using real-time PCR method. Results: Data analysis showed an association between the results of HPV DNA testing and HPV E6/E7 mRNA testing (p˂0.0001). The concordance between the results of both tests was moderate (55.47%). The results show that HPV E6/E7 mRNA testing had a higer specificity 88.89% and positive predictive value (PPV) 93.59% for HSIL + invasive squamous cell carcinoma compared to HPV DNA testing that had specificity of 55.56% and PPV 84.61%, respectively. Conclusion: The results of our study suggested that HPV E6/E7 mRNA testing is more specific and has a higher positive predictive value than HPV DNA testing and that viral oncoproteins E6 and E7 are superior biomarkers for the detection of high-risk HPV-associated squamous intraepithelial lesions of the uterine cervix.
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Smith, Laurie W., C. Sarai Racey, Lovedeep Gondara, et al. "Women’s acceptability of and experience with primary human papillomavirus testing for cervix screening: HPV FOCAL trial cross-sectional online survey results." BMJ Open 11, no. 10 (2021): e052084. http://dx.doi.org/10.1136/bmjopen-2021-052084.
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ObjectiveTo study participant’s acceptability of and attitudes towards human papillomavirus (HPV) testing compared with cytology for cervical cancer screening and what impact having an HPV positive result may have in future acceptability of screening.DesignCross-sectional online survey of clinical trial participants.SettingPrimary care, population-based Cervix Screening Program, British Columbia, Canada.ParticipantsA total of 5532 participants from the HPV FOCAL trial, in which women received HPV and cytology testing at study exit, were included in the analysis. Median age was 54 years. The median time of survey completion was 3 years after trial exit.Outcome measuresAcceptability of HPV testing for primary cervical cancer screening (primary); attitudes and patient perceptions towards HPV testing and receipt of HPV positive screen results (secondary).ResultsMost respondents (63%) were accepting of HPV testing, with the majority (69%) accepting screening to begin at age 30 years with HPV testing. Only half of participants (54%) were accepting of an extended screening interval of 4–5 years. In multivariable logistic regression, women who received an HPV positive screen test result during the trial (OR=1.41 95% CI 1.11 to 1.80) or were older (OR=1.01, 95% CI 1.00 to 1.02) were more likely to report HPV testing as acceptable.ConclusionsIn this evaluation of acceptability and attitudes regarding HPV testing for cervix screening, most are accepting of HPV testing for screening; however, findings indicate heterogeneity in concerns and experiences surrounding HPV testing and receipt of HPV positive results. These findings provide insights for the development of education, information and communication strategies during implementation of HPV-based cervical cancer screening.Trial registration numbersISRCTN79347302 and NCT00461760.
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Kuhn, Louise, Rakiya Saidu, Cecilia Svanholm-Barrie, et al. "HPV Testing of Self-Collected Vaginal Swabs for Cervical Cancer Prevention in South Africa." Journal of Global Oncology 2, no. 3_suppl (2016): 65s—66s. http://dx.doi.org/10.1200/jgo.2016.003749.
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Abstract 33 Background: Cervical cancer screening programs in Low and Middle Income Countries (LMIC) need to be strengthened. One of the challenges is insufficient health care personnel to achieve optimal coverage. We evaluated the potential of human papillomavirus (HPV) testing using self-collected vaginal swabs to improve screening. Methods: As part of a larger NCI-supported study in Cape Town, South Africa, we recruited 261 HIV-uninfected and 237 HIV-infected women aged 30-60 years, at one primary health care site. All women were instructed to self-collect a vaginal swab on site immediately prior to a gynecologic exam, during which a cervical sample was collected. Both self- and clinician-collected samples were tested for high risk HPV types (16, 18, 45, 31, 33, 35, 52, 58, 51, 59, 39, 56, 66, 68) using Cepheid GeneXpert (HPV XpertTM). All women underwent at least one colposcopy with histological sampling. Classification of endpoint was based on expert pathology review. Results: The HPV prevalence using the cervical vs. self sample, respectively, was 14% vs. 25% among HIV-uninfected and 50% vs. 62% among HIV-infected women. Among women who were diagnosed with grade 2 or 3 cervical intraepithelial neoplasia (CIN) or cervical cancer, 94% were positive on HPV Xpert on the cervical and 88% on the vaginal swab, ignoring HIV status. However, specificity was poor for HPV tests done on self samples, 78% in HIV-uninfected and 52% in HIV-infected women. On a patient preference questionnaire, >90% of women stated they would be prepared to collect a sample at home and two-thirds expressed a preference to be examined by a clinician. Conclusion: Even in self-collected vaginal samples, HPV Xpert has excellent sensitivity for detecting cervical cancer precursor lesions. In LMIC settings where the ratio of health care workers to the population is low, HPV testing of self-collected samples could successfully triage women who require further evaluation and treatment. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Louise Kuhn No relationship to disclose Rakiya Saidu No relationship to disclose Cecilia Svanholm-Barrie No relationship to disclose Ana Tergas Consulting or Advisory Role: Helomics Rosalind Boa No relationship to disclose Jennifer Moodley No relationship to disclose Thomas C. Wright No relationship to disclose David Persing No relationship to disclose Scott Campbell No relationship to disclose Lynette Denny No relationship to disclose
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Díez-Martínez, Marcos, Juana Perpiñá-Galvañ, Joaquín Ferri, Maripaz Ventero, Joaquin Portilla, and María José Cabañero-Martínez. "Evaluation of the validity of the HPV viral load compared to conventional techniques for the detection of high-grade anal intraepithelial lesions in men with HIV who have sex with men." PeerJ 11 (August 23, 2023): e15878. http://dx.doi.org/10.7717/peerj.15878.
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Background The incidence of high-grade anal intraepithelial lesions (HSILs) has increased in recent years among men who have sex with men with human immunodeficiency virus (HIV). This work evaluated the validity of the human papilloma virus viral load (HPV-VL) versus cytological and qualitative HPV results to detect HSILs. Methods From May 2017 to January 2020, 93 men who have sex with men and HIV were included in an anal cancer screening program from the Infectious Diseases Unit at a tertiary-care hospital in Alicante (Spain). The gold-standard for the screening of anal HSILs is the anal biopsy using high-resolution anoscopy. The diagnostic methods compared against gold-standard were HPV-16-VL, HPV-18-VL, and HPV-16-18-VL co-testing, anal cytology, and qualitative HPV detection. The receiver operating characteristic (ROC) curve and cut-off points for HPV-VL were calculated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s Kappa coefficient (κ) were also calculated. Results The mean patient age was 44.6 ± 9.5 years. All of them received antiretroviral treatment, 96.8% had an HIV viral load of <50 copies/mL and 17.2% had a previous diagnosis of AIDS. The diagnosis of the anal biopsies were: 19.4% (n = 18) HSIL, 29.1% (n = 27) LSIL, and 51.6% (n = 48) negative. An HPV-16-VL >6.2 copies/cell was detected in the HSIL biopsy samples (p = 0.007), showing a sensitivity of 100% and a specificity of 46.2%. HPV-18-VL and HPV16-18-VL co-testing showed a sensitivity of 75% and 76.9% and a specificity of 72.7% and 61.3%, respectively. The highest PPV was 50% obtained with the cytology and HPV-18-VL. The HPV-16-VL showed a NPV of 100%, followed by 88.9% in the HPV-18-VL and 87% in the abnormal cytology. Cohen’s Kappa coefficient were: HPV-18-VL (κ = 0.412), abnormal cytology (κ = 0.353) and HPV-16-VL (κ = 0.338). Conclusions HPV-VL testing improved the detection sensitivity but not the specificity for HSIL biopsies compared to anal cytology and the qualitative detection of HPV. In men who have sex with men and HIV the HPV-VL could be an useful tool for diagnosis of HSILs in anal cancer screening programs. Further studies will be needed to evaluate the clinical implications of HPV-VL in these programs.
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Fracella, Matteo, Giuseppe Oliveto, Piergiorgio Roberto, et al. "The Epidemiology of Anal Human Papillomavirus (HPV) in HIV-Positive and HIV-Negative Women and Men: A Ten-Year Retrospective Observational Study in Rome (Italy)." Pathogens 13, no. 2 (2024): 163. http://dx.doi.org/10.3390/pathogens13020163.
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Human papillomaviruses (HPVs) commonly infect the anogenital mucosa; most infections are transient, but a fraction of those caused by high-risk (HR) types persist and may lead to anogenital cancer. The epidemiology of HPV genotypes in anal infections in groups at different risk for anal cancer has not been well described in Italy. This retrospective study reports the results of HPV DNA testing and complete genotyping performed on anal swabs from 691 female and male patients attending proctology clinics in Rome during 2012–2021; one-third had repeated testing. Cumulative HPV positivity in 1212 anal swabs was approximately 60%, was not age related, and showed an increasing trend over the study period. HPV rates differed significantly by sex and HIV status: HIV-negative women had the lowest (43.6%) and HIV-positive men the highest (83.5%) HPV prevalence. HIV-positive men had more oncogenic HPV genotypes detected, more multiple infections, and the highest frequency of persistent infections. Two-thirds of all infections were vaccine-preventable. This study found that anal HPV infection rates are still elevated and even increasing in groups at low and high risk of developing anal cancer. Prevention programs need to be improved to reduce rates of anal infection in young women and men.
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Hagen, Bjørn, and Kåre Augensen. "Villedende om HPV-testing." Tidsskrift for Den norske legeforening 131, no. 1 (2011): 14. http://dx.doi.org/10.4045/tidsskr.10.1356.
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Sørbye, Sveinung, Silje Fismen, Tore Gutteberg, and Elin Mortensen. "HPV-testing og livmorhalskreft." Tidsskrift for Den norske legeforening 131, no. 4 (2011): 333. http://dx.doi.org/10.4045/tidsskr.10.1426.
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Forus, Anne. "HPV-testing og livmorhalskreft." Tidsskrift for Den norske legeforening 133, no. 3 (2013): 272. http://dx.doi.org/10.4045/tidsskr.12.1419.
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Kitchener, H. C., and G. L. Owens. "Urine testing for HPV." BMJ 349, sep16 14 (2014): g5542. http://dx.doi.org/10.1136/bmj.g5542.
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Friedrich, M. J. "Self-Testing for HPV." JAMA 309, no. 23 (2013): 2430. http://dx.doi.org/10.1001/jama.2013.7389.
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Malik, Sunita, Supriti Kumari, Harsha S. Gaikwad, Archana Mishra, and Mausumi Bharadwaj. "Prevalence of abnormal cervical cytology and HPV DNA positivity among HIV positive women." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 9 (2019): 3649. http://dx.doi.org/10.18203/2320-1770.ijrcog20193791.
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Background: The relationship among HIV, HPV, and development of CIN is complex and incompletely understood. Present study is undertaken to find out the prevalence and relationship of abnormal cervical cytology and HPV infection in HIV positive women.Methods: This was a cross-sectional, case control study conducted on 95 HIV seropositive and 95 seronegative women. Specimen was collected from the cervix for HPV DNA testing, subtyping and cytology.Results: HPV DNA positivity was higher in seropositive group (18.6% vs. 7.4%). Premalignant conditions were found only in seropositive group. At CD4 count <249 HPV DNA positivity was 53%, at 250-499 the percentage of HPV DNA positivity was 31% and at >500 HPV DNA positivity was 19%.Conclusions: Prevalence of abnormal cytology and HPV DNA positivity is higher amongst HIV positive women and there is an association between HPV DNA positivity with lower CD4 counts.
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Joseph, Jessica, Owen Demke, Lola Ameyan, et al. "Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries." BMJ Open 13, no. 1 (2023): e065074. http://dx.doi.org/10.1136/bmjopen-2022-065074.
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ObjectivesTo demonstrate acceptability and operational feasibility of introducing human papillomavirus (HPV) testing as a principal cervical cancer screening method in public health programmes in sub-Saharan Africa.Setting45 primary and secondary health clinics in Malawi, Nigeria, Senegal, Uganda and Zimbabwe.Participants15 766 women aged 25–54 years presenting at outpatient departments (Senegal only, general population) or at antiretroviral therapy clinics (all other countries, HIV-positive women only). Eligibility criteria followed national guidelines for cervical cancer screening.InterventionsHPV testing was offered to eligible women as a primary screening for cervical cancer, and HPV-positive women were referred for visual inspection with acetic acid (VIA), and if lesions identified, received treatment or referral.Primary and secondary outcome measuresThe primary outcomes were the proportion of HPV-positive women who received results and linked to VIA and the proportion of HPV-positive and VIA-positive women who received treatment.ResultsA total of 15 766 women were screened and tested for HPV, among whom 14 564 (92%) had valid results and 4710/14 564 (32%) were HPV positive. 13 837 (95%) of valid results were returned to the clinic and 3376 (72%) of HPV-positive women received results. Of women receiving VIA (n=2735), 715 (26%) were VIA-positive and 622 (87%) received treatment, 75% on the same day as VIA.ConclusionsHPV testing was found to be feasible across the five study countries in a public health setting, although attrition was seen at several key points in the cascade of care, namely results return to women and linkage to VIA. Once women received VIA, if eligible, the availability of on-site cryotherapy and thermal ablation allowed for same-day treatment. With sufficient resources and supportive infrastructure to ensure linkage to treatment, use of HPV testing for cervical cancer screening as recommended by WHO is a promising model in low-income and middle-income countries.
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Hui, Ben B., Caitlin P. Reulein, Rebecca J. Guy, et al. "Impact of replacing cytology with human papillomavirus testing for cervical cancer screening on the prevalence of Trichomonas vaginalis: a modelling study." Sexually Transmitted Infections 94, no. 3 (2018): 216–21. http://dx.doi.org/10.1136/sextrans-2017-053294.
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ObjectivesTrichomonas vaginalis (TV) is the most common curable STI worldwide and is associated with increased risk of HIV acquisition and serious reproductive morbidities. The prevalence of TV infection is very low in Australian cities, and this is thought to be at least partly due to incidental detection and treatment of TV in women participating in the cervical cytology screening programme. In 2017, the national cervical screening programme will transition to a new model based on testing for high-risk (HR) human papillomavirus (HPV), with a reduced frequency and commencement at an older age. We model the potential impact of this transition on TV prevalence in Australia.MethodsA mathematical model was developed to describe the transmission of TV in the general population and used to evaluate scenarios that capture the switch from cytology-based screening to HR HPV testing. Under these scenarios, individuals with asymptomatic TV who test negative for HR HPV will remain undiagnosed and untreated. We estimate the change in TV prevalence expected to occur due to the switch from cytology to HR HPV testing and changes to the frequency and age at commencement of screening.ResultsOur results suggest that with the transition to HR HPV testing, TV prevalence may increase from the current ~0.4% to 2.8% within 20 years if TV testing coverage is not increased and HR HPV prevalence does not decline further. If HR HPV prevalence continues to decline at its current rate with ongoing vaccination, TV prevalence is predicted to increase to 3.0% within this time frame.ConclusionsOur modelling suggests that in a setting like Australia, where TV can be detected incidentally through cytology-based cervical screening, a transition to HPV testing is likely to result in increasing TV prevalence over time unless additional measures are implemented to increase TV testing and treatment.
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Hopkins, Kathryn L., Maya Jaffer, Khuthadzo E. Hlongwane, et al. "Assessing national cervical cancer screening guidelines: Results from an HIV testing clinic also screening for cervical cancer and HPV in Soweto, South Africa." PLOS ONE 16, no. 7 (2021): e0255124. http://dx.doi.org/10.1371/journal.pone.0255124.
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Objective A screening centre in Soweto, South Africa (SA), investigated high-risk human papillomavirus (HR-HPV), HIV, cervical cancer risk amongst women. Methods This cross-sectional study (June 2018-March 2019) describes screening results (Roche Linear Array HPV test and Pap smear liquid based cytology) and history of screening (known HIV status, antiretroviral therapy [ART] use, previous Pap smears). Data were stratified by age group (18–29, 30+ years), HIV status, Pap smear results and tested for statistical significance. Results Of 280 women, 20.4% were HIV-positive, 18.2% had abnormal Pap smears, 41.8% had HR-HPV. Of older women, 48.2% (n = 78/162) had never had a Pap smear. Of younger women, 89.0% (n = 105/118) never had a Pap smear, but had significantly more low-grade squamous intraepithelial lesions (LSIL) and other HR-HPV infection than older women (12.7%[n = 15/118] vs 4.9%[n = 8/162], p = 0.0193; and 49.2%[n = 58/118] vs 29.0%[n = 47/162], p = 0.0006; respectively). HIV-positive women had more abnormal cytology results and infection with other HR-HPV types or co-infection with other HR-HPV type(s)/HPV-16 compared to HIV-negative women (35.1%[n = 20/57] vs 13.9%[n = 31/223], p = 0.0002; 56.1%[n = 32/57] vs 32.7%[n = 73/223], p = 0.001; and 12.3%[n = 7/57] vs 4.9%[n = 11/223], p = 0.044; respectively). Of 57 HIV-positive women, 45.6% (n = 26) already knew their HIV status; of which 69.2% were on ART and 34.6% never had a Pap smear. Conclusion South African women have high rates of HIV, Pap smear abnormalities and HR-HPV, with low cervical cancer screening coverage. SA cervical cancer screening policy excludes (undiagnosed) HIV-positive and HIV-negative women <30 years, both populations found to have high prevalence of HR-HPV. HPV-based primary screening from 25 years could improve outcomes.
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Knežević, Aleksandra. "The role of HPV DNA testing in the prevention of cervical cancer." Glasnik javnog zdravlja 96, no. 3 (2022): 302–12. http://dx.doi.org/10.5937/serbjph2203302k.
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The well-established etiological association between cervical cancer development and the infection with high risk genotypes of Human papilloma viruses (hr-HPV) signify the role of HPV testing in both primary and secondary cervical cancer prevention. HPV testing methods are grouped into diagnostic and prognostic tests with the use of various techniques of molecular biology. Diagnostic tests enable detection the presence of HPV DNA (screening) and identification of HPV genotypes (genotyping). Prognostic or triage tests are used for the determination of HPV infected women who are at high risk for the development and/or progression to cervical cancer. hr-HPV testing in cervical cancer screening protocols can be implemented as primary testing or co-testing with cytology and as testing in a triage of women with high risk. The inclusion of hr-HPV testing as primary testing or co-testing is based on higher sensitivity and negative predictive value for the detection of CIN3 lesions compared to cytology alone. Several triaging tests are recommended for risk stratification such as genotyping for HPV 16 and 18, detection of E6/E7 mRNA and DNA methylation marker tests. For an efficient reduction of cervical cancer pervasiveness in Serbia, the implementation of cervical cancer organized population-based screening program that includes HPV testing is essential.
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Cudós, Elena Sendagorta, Maria P. Romero Gomez, Beatriz Hernandez Novoa, et al. "8. Human papillomavirus mRNA testing for the detection of anal high-grade squamous intraepithelial lesions in HIV-positive men who have sex with men." Sexual Health 10, no. 6 (2013): 573. http://dx.doi.org/10.1071/shv10n6ab8.
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Background Currently, screening for anal high-grade squamous intraepithelial lesions (HSIL) relies on anal cytology and high-resolution anoscopy (HRA). Since this approach has limited sensitivity and specificity for detecting anal HSIL, there is increasing interest in the role of biomarkers for predicting anal HSIL. The aim of this study is to evaluate the diagnostic accuracy of HPV E6/E7-mRNA expression for the detection of anal HSIL in MSM HIV-infected patients, in comparison to DNA-HR-HPV and anal cytology. Methods: This cross-sectional screening study included 101 MSM followed at the HIV-unit of La Paz University Hospital. Intra-anal swabs from patients participating in a screening program including cytology, HRA and histology were analysed. HR-HPV-DNA detection was performed by means of the CLART HPV2 assay (GENOMICA SAU.). E6/E7-mRNA detection of HR-HPV types 16, 18, 31, 33 and 45 was performed using the NucliSENS-EasyQ assay (BioMérieux, Marcy l’Etoile, France). Results: HR-HPV DNA and HPV E6/E7 mRNA were detected in 82% and 57% of the anal smears, respectively. Anal cytology screening was abnormal in 70.3%. For the detection of HSIL sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.7%, 55.6%, 57.9%, and 69.8% for E6/E7-mRNA testing, respectively, compared with 97.9%, 31.5%, 55.4% and 94.4%, respectively, for HR-HPV DNA testing and 83%, 40.7%, 54.9%, 73.3%, respectively, for cytology testing. Conclusions: In comparison with the other tests, the NucliSENS EasyQ HPV assay yielded a lower clinical sensitivity but a higher clinical specificity and PPV for the detection of anal HSIL in MSM HIV-infected patients.
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Kim, Mee-seon, Eun Hee Lee, Moon-il Park, et al. "Utility of Human Papillomavirus Testing for Cervical Cancer Screening in Korea." International Journal of Environmental Research and Public Health 17, no. 5 (2020): 1726. http://dx.doi.org/10.3390/ijerph17051726.
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(1) Background: Cervical cancer is one of the most common cancers in Korean women. This study was performed to discover the utility of HPV (Human Papillomavirus) testing in screening of cervical lesions and to provide the prevalence of HPV and the genotype distribution in a single center of Korea. (2) Methods: A total of 15,141 women who underwent both HPV testing and cervical cytology were enrolled in this retrospective medical record review study. (3) Results: HPV testing showed higher sensitivity than cytology for the detection of histological high-grade squamous lesions. Furthermore, the sensitivity and specificity of HPV testing varied depending on the method used. The BD Onclarity™ HPV assay had higher sensitivity (90%) than the MyHPV CHIP™ kit (all types of HPV: 82%; high-risk HPV: 76%) for high-grade squamous lesions. A combination of MyHPV CHIP™ and cytology detected 90.9% (30/33) of histological high-grade squamous lesions. A combination of BD Onclarity™ HPV assay and cytology detected 96.55% (84/87) of histological high-grade squamous lesions. In addition, HPV prevalence and genotype distribution were different depending on the HPV testing method used. (4) Conclusion: HPV testing showed higher sensitivity than cytology, but the sensitivity and specificity of HPV testing had variation depending on the method used.
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Adler, David H., Melissa Wallace, Thola Bennie, et al. "Cumulative Impact of HIV and Multiple Concurrent Human Papillomavirus Infections on the Risk of Cervical Dysplasia." Advances in Virology 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/7310894.
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Infection with HIV is known to increase the risk of cervical cancer. In addition, evidence suggests that concurrent infection with multiple human papillomavirus (HPV) genotypes increases the risk of cervical dysplasia more than infection with a single HPV genotype. However, the impact of the combination of HIV coinfection and presence of multiple concurrent HPV infections on the risk of cervical dysplasia is uncertain. We compared the results of HPV testing and Pap smears between HIV-infected and HIV-uninfected young women to assess the cumulative impact of these two conditions. We found that both HIV and the presence of multiple concurrent HPV infections are associated with increased risk of associated Pap smear abnormality and that the impact of these two risk factors may be additive.
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Maatouk, Ismaël, and Khalil Abdo. "Human papillomavirus prevalence in the oral cavity of men who have sex with men: a study of its first from Beirut, Lebanon." Sexual Health 13, no. 4 (2016): 397. http://dx.doi.org/10.1071/sh16045.
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Background: Human papillomavirus (HPV) infection is the most common sexually transmissible viral infection worldwide. HPV is highly prevalent in sexually active men who have sex with men (MSM). The main objective of this study is to assess HPV prevalence in the oral cavity of MSM from Beirut, Lebanon. Methods: From November 2015 to January 2016, 42 MSM were recruited using respondent-driven sampling and provided oral samples for HPV DNA and for linear array testing to detect HPV type. Results: In total, 28 (66.67%) HIV-negative and 14 (33.33%) HIV-positive MSM were included. Overall, HPV prevalence in the oral cavity was 10% (95% CI 0.93–19.07) among all participants, but there was no statistical difference according to HIV status. The HPV type was exclusively HPV-6. Conclusions: These findings did not find an urgent need for routine HPV prevalence and screening for cancers in the oral cavity of a MSM group in Lebanon; however, they confirm previous findings about geographic variations in HPV prevalences.
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Zhiang, Jianjun, Elkanah Omenge, Titus Maina, et al. "Association of detection of aflatoxin in plasma of Kenyan women with increased detection of oncogenic HPV." Journal of Clinical Oncology 37, no. 15_suppl (2019): 5530. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.5530.
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5530 Background: Cervical cancer is the leading cause of cancer-related deaths among women living in Africa. Only a small proportion of HPV-infected women develop cervical cancer and other cofactors may increase a woman’s risk of developing cervical cancer. Aflatoxin, a potent carcinogen and immunosuppressive agent, is produced by fungi that contaminate corn and other staple foods in sub-Saharan Africa. Women who ingest aflatoxin may be more likely to have persistent infections with oncogenic HPV type. Methods: Demographics, behavioral data, plasma, and cervical swabs were collected from HIV-uninfected women 18 and 45 years of age who presented for cervical cancer screening at Moi Referral and Teaching Hospital (Eldoret, Kenya) and had normal VIA examination. HPV testing was performed on cervical swabs using the Roche Linear Array Assay. Aflatoxin-albumin adduct (AFB1-lys) was detected and quantified in plasma. The association of plasma AFB1-lys detection and concentration and the detection of HPV was examined. Results: Sufficient plasma was available from 88 HIV-uninfected women and was transported to the U.S. for aflatoxin testing. Valid HPV testing results were available for 86 of these women (mean age 34.0 years); 49 women (57.0%) had detectable AFB1-lys and 37 (43.0%) had no detection. Substantial variation existed in plasma AFB1-lys concentrations among the 49 women (range 0.02 to 0.21 pg/µL). Detection of AFB1-lys was not associated with age, and other behavioral factors such as number of lifetime partners, marital status and age at first sex. AFB1-lys detection was associated with detection of A9 HPV types (HPV 16, 31, 33, 35, 52, and 58) as a group in cervical swabs (p = 0.029) as well as A9 types excluding HPV 16 (p = 0.020), but not with individual A9 types, A7 HPV types (such as HPV 18), or low-risk HPV types. A concentration dependent association of AFB1-lys was seen with detection of A9 HPV types as a group (p = 0.009), non-HPV 16 A9 types (p = 0.005), and HPV 52 (p = 0.042), but not with the A7 HPV types. Conclusions: AFB1-lys was detected in 57% of HIV-uninfected Kenyan women without cervical dysplasia. AFB1-lys-positive women were more likely than AFB1-lys-negative women to have oncogenic HPV A9 types detected. Higher plasma AFB1-lys concentrations were associated with increased likelihood of oncogenic HPV A9 type detection. Further studies are needed to determine if chronic exposure to aflatoxin interacts with HPV infection (and possibly HIV co-infection) to modulate the risk of cervical cancer in women in Kenya and other developing countries.
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Moriarty, Ann T., Mary R. Schwartz, Galen Eversole, et al. "Human Papillomavirus Testing and Reporting Rates: Practices of Participants in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology in 2006." Archives of Pathology & Laboratory Medicine 132, no. 8 (2008): 1290–94. http://dx.doi.org/10.5858/2008-132-1290-hptarr.
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Abstract Context.—Oncogenic, high-risk human papillomavirus (HR-HPV) testing is used to evaluate women who are older than 20 years with atypical squamous cells of undetermined significance (ASC-US) and in conjunction with a screening Papanicolaou test in women older than 30 years. Objectives.—To evaluate the 2006 laboratory practice data from laboratories incorporating human papillomavirus (HPV) testing with the Papanicolaou test. Design.—To use the College of American Pathologists (CAP) Supplemental Questionnaire Survey for 2006 to determine laboratory practices of participants in the CAP Interlaboratory Comparison Program in Cervicovaginal Cytology. Results.—A total of 679 laboratories responded to the questionnaire. Most (73%) refer HPV testing to reference laboratories. Nine percent perform HPV testing in cytology. Forty-five percent offer low-risk HPV (LR-HPV) testing. The most common reflex is ASC-US, although HR-HPV is also offered with low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), or any other Papanicolaou test result. Digene Hybrid Capture II is the most common method. Human papilloma virus median test volumes are 55 monthly. Frequency distributions of HPV test volumes are significantly different from those found in 2003. Laboratories performing in-house testing reported significantly higher monthly HPV volumes (P &lt; .001). Median rates for HR-HPV positivity are 36.6% for ASC-US, 50.0% for atypical squamous cells, cannot exclude HSIL (ASC-H), and 4% for women 30 years of age and older in conjunction with a screening Papanicolaou test. Conclusions.—Reference HPV testing remains the most common pattern. The most common reflex indication is for ASC-US, but HPV testing is modified locally to include a variety of scenarios. LR-HPV testing is commonly offered despite its lack of clinical significance. These data form a baseline for ongoing monitoring of HPV testing practice trends.
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Viciana, Pompeyo, Yusnelkis Milanés-Guisado, María Fontillón, et al. "High-risk Human Papilloma Virus Testing Improves Diagnostic Performance to Predict Moderate- to High-grade Anal Intraepithelial Neoplasia in Human Immunodeficiency Virus–infected Men Who Have Sex With Men in Low-to-Absent Cytological Abnormalities." Clinical Infectious Diseases 69, no. 12 (2019): 2185–92. http://dx.doi.org/10.1093/cid/ciz144.
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Abstract Background Screening methods for anal squamous intraepithelial lesions (SILs) are suboptimal. We aimed to determine the diagnostic performance of a composite endpoint comprising anal liquid-based cytology (aLBC) and high-risk human papillomavirus (HR-HPV) testing to predict histological high-grade SILs (hHSILs). Methods From the SeVIHanal cohort, human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) who had an aLBC with concomitant HR-HPV testing were included. hHSILs were determined by high-resolution anoscopy (HRA)–guided biopsy. Results A total of 705 visits obtained from 426 patients were included. The prevalence of HR-HPV among aLBC results were 51.9% (133/215) normal, 87.9% (20/232) low-grade SILs (LSILs), and 90.9% (149/164) high-grade SILs; P (linear association) < .001. Low prevalence of hHSILs was only observed for the composite aLBC/HR-HPV testing endpoint “normal/noHR-HPV” (10%) and “LSIL/noHR-HPV” (4%). The prognostic values (95% confidence interval) for HR-HPV to predict hHSILs in normal cytology were positive predictive value (PPV), 29.3% (25.6%–33.3%); negative predictive value (NPV), 90.2% (82.8%–94.7%); sensitivity, 83% (69.2%–92.4%); and specificity, 44.1% (36.4%–51.9%). Corresponding figures for cytologic LSILs were PPV, 39.2% (37.4%–41.1%); NPV, 96.4% (78.9%–99.5%); sensitivity, 98.8% (93.3%–99.9%); and specificity, 17.9% (12.1%–24.9%). A positive interaction and a synergistic effect for the composite endpoint were observed (relative excess risk = 1.50, attributable proportion of histological results to interaction = 0.17, synergy index = 1.24). Conclusions HRA should not be indicated in the setting of LSILs/noHR-HPV following aLBC-based screening. In contrast, HIV-infected MSM with normal aLBC/HR-HPV infection should be considered for HRA. Clinical Trials Registration NCT03713229.
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Dodd, Rachael Helen, Olivia Mac, Julia M. L. Brotherton, Erin Cvejic, and Kirsten J. McCaffery. "Levels of anxiety and distress following receipt of positive screening tests in Australia’s HPV-based cervical screening programme: a cross-sectional survey." Sexually Transmitted Infections 96, no. 3 (2020): 166–72. http://dx.doi.org/10.1136/sextrans-2019-054290.
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ObjectiveFrom December 2017, the Australian National Cervical Screening Program commenced 5 yearly primary human papillomavirus (HPV) screening; one of the first high-income countries to implement primary HPV screening. This study aimed to examine the psychosocial impact of self-reporting testing HPV positive in a sample of women screened since the renewal of the programme.MethodsWomen in Australia aged 25–74 years who reported participating in cervical screening since December 2017 were recruited through an online market research company to complete a cross-sectional survey. The primary outcomes were anxiety and general distress.Results1004 women completed the online survey; 80.9% reported testing HPV negative (HPV−), 6.5% reported testing HPV positive (HPV+) and 12.9% did not know/remember their test result. Women who reported testing HPV+ had significantly poorer psychological outcomes on a range of measures. Those who reported testing HPV+ had higher anxiety scores (53.03 vs 43.58 out of 80, p<0.001), showed more general distress (3.94 vs 2.52 out of 12, p=0.004), concern about their test result (5.02 vs 2.37, p<0.001), expressed greater distress about their test result (7.06 vs 4.74, p<0.001) and cancer worry (quite or very worried 35.4% vs 11.6%, p<0.001) than women who reported testing HPV−. Concern regarding test results was also significantly higher in women who did not know/remember their test result (3.20 vs 2.37, p<0.001) compared with women who reported testing HPV−. Women who reported testing HPV+ had greater knowledge of HPV (9.25 vs 6.62, p<0.001) and HPV testing (2.44 vs 1.30, p<0.001) than women who reported testing HPV−.ConclusionsReceipt of an HPV+ test result was associated with high levels of anxiety and distress, which reached clinical significance. Further work is needed to understand whether distress and concern could be reduced by ensuring all women receive high-quality standardised information with their results or by other interventions.
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Khunamornpong, Surapan, Jongkolnee Settakorn, Kornkanok Sukpan, Suree Lekawanvijit, Narisara Katruang, and Sumalee Siriaunkgul. "Comparison of Human Papillomavirus Detection in Urine and Cervical Samples Using High-Risk HPV DNA Testing in Northern Thailand." Obstetrics and Gynecology International 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/6801491.
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Objective. To evaluate the performance of high-risk human papillomavirus (HPV) DNA testing in urine samples compared to that of cervical sample testing in Northern Thailand. Methods. Paired urine and cervical samples were collected during the follow-up of women with a previous positive HPV test. HPV testing was performed using the Cobas 4800 HPV Test. Linear Array assay was used for genotyping in selected cases. Results. Paired urine and cervical samples were obtained from 168 women. Of 123 paired samples with valid results, agreement in the detection of high-risk HPV DNA was present in 106 cases (86.2%), with a kappa statistic of 0.65 (substantial agreement). Using the cervical HPV results as a reference, the sensitivity of urine HPV testing was 68.6% (24/35) and the specificity 93.2% (82/88). For the detection of histologic high-grade squamous intraepithelial lesion or worse (HSIL+), the sensitivity of urine HPV testing was 80.0% (4/5) and the specificity 78.0% (92/118). Conclusion. Although urine HPV testing had a rather low sensitivity for HPV detection, its sensitivity for histologic HSIL+ detection was high. For clinical use of urine HPV testing, standardization of specimen collection and processing techniques or application of a more sensitive test, especially in the detection of HPV52 and HPV58, is necessary.
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Auvert, Bertran, Dianne Marais, Pascale Lissouba, Kevin Zarca, Gita Ramjee, and Anna-Lise Williamson. "High-Risk Human Papillomavirus Is Associated with HIV Acquisition among South African Female Sex Workers." Infectious Diseases in Obstetrics and Gynecology 2011 (2011): 1–9. http://dx.doi.org/10.1155/2011/692012.
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Background. Mounting evidence suggests an association between human papillomavirus (HPV) and HIV acquisition. This study aimed to explore this association among South African female sex workers (FSWs).Methods. We used data from 88 HIV-negative FSWs who participated in a vaginal gel (COL-1492) trial. Cervicovaginal rinse samples, obtained before HIV-seroconversion, were genotyped into high-risk (HR-) and low-risk (LR-) HPV. HIV-adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) were estimated using Cox survival analysis.Results. HR- and LR-HPV prevalences were 70.5% (95% CI : 60.5–79.2) and 60.2% (95% CI : 49.9–70.0), respectively. Twenty-five women HIV seroconverted. Controlling for background characteristics and other sexually transmitted infections, HIV aHR increased by a factor of 1.7 (95% CI : 1.01–2.7,Plinear trend= 0.045) for an increase of one unit of the number of HR-HPV genotypes.Conclusions. HIV seroconversion among FSWs is associated with genital HR-HPV infection. Further investigation is warranted, including testing the possible protective effect of available HPV vaccines on HIV acquisition.
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Mwenda, Valerian, Joan-Paula Bor, Mary Nyangasi, et al. "Integrating human papillomavirus testing as a point-of care service using GeneXpert platforms: Findings and lessons from a Kenyan pilot study (2019–2020)." PLOS ONE 18, no. 5 (2023): e0286202. http://dx.doi.org/10.1371/journal.pone.0286202.
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Background Globally, cervical cancer is a major public health problem, with about 604,000 new cases and over 340,000 deaths in 2020. In Kenya, it is the leading cause of cancer deaths, with over 3,000 women dying in 2020 alone. Both the Kenyan cancer screening guidelines and the World Health Organization’s Global Cervical Cancer Elimination Strategy recommend human papillomavirus (HPV) testing as the primary screening test. However, HPV testing is not widely available in the public healthcare system in Kenya. We conducted a pilot study using a point of care (POC) HPV test to inform national roll-out. Methods The pilot was implemented from October 2019 to December 2020, in nine health facilities across six counties. We utilized the GeneXpert platform (Cepheid, Sunnyvale, CA, USA), currently used for TB, Viral load testing and early infant diagnosis for HIV, for HPV screening. Visual inspection with acetic acid (VIA) was used for triage of HPV-positive women, as recommended in national guidelines. Quality assurance (QA) was performed by the National Oncology Reference Laboratory (NORL), using the COBAS 4800 platform (Roche Molecular System, Pleasanton, CF, USA). HPV testing was done using either self or clinician-collected samples. We assessed the following screening performance indicators: screening coverage, screen test positivity, triage compliance, triage positivity and treatment compliance. Test agreement between local GeneXpert and central comparator high-risk HPV (hrHPV) testing for a random set of specimens was calculated as overall concordance and kappa value. We conducted a final evaluation and applied the Nominal Group Technique (NGT) to identify implementation challenges and opportunities. Key findings The screening coverage of target population was 27.0% (4500/16,666); 52.8% (2376/4500) were between 30–49 years of age. HPV positivity rate was 22.8% (1027/4500). Only 10% (105/1027) of HPV positive cases were triaged with VIA/VILI; 21% (22/105) tested VIA/VILI positive, and 73% (16/22) received treatment (15 received cryotherapy, 1 was referred for biopsy). The median HPV testing turnaround time (TAT) was 24 hours (IQR 2–48 hours). Invalid sample rate was 2.0% (91/4500). Concordance between the Cepheid and COBAS was 86.2% (kappa value = 0.71). Of 1042 healthcare workers, only 5.6% (58/1042) were trained in cervical cancer screening and treatment, and only 69% (40/58) of those trained were stationed at service provision areas. Testing capacity was identifed as the main challenge, while the community strategy was the main opportunity. Conclusion HPV testing can be performed on GeneXpert as a near point of care platform. However, triage compliance and testing TAT were major concerns. We recommend strengthening of the screening-triage-treatment cascade and expansion of testing capacity, before adoption of a GeneXpert-based HPV screening among other near point of care platforms in Kenya.
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Naucler, Pontus, Flora Mabota da Costa, Joao Leopoldo da Costa, Otto Ljungberg, Antonio Bugalho, and Joakim Dillner. "Human papillomavirus type-specific risk of cervical cancer in a population with high human immunodeficiency virus prevalence: case–control study." Journal of General Virology 92, no. 12 (2011): 2784–91. http://dx.doi.org/10.1099/vir.0.034298-0.
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There are limited data on human papillomavirus (HPV) type-specific cervical cancer risk among human immunodeficiency virus (HIV)-positive women. Previous studies have suggested that HPV 16 would be relatively less important as a causative agent among HIV-positive compared with HIV-negative women. This study investigates HPV type-specific cervical cancer risk in a population in which HIV is endemic. At the Central Hospital, Maputo, Mozambique, 221 cervical cancer cases and 203 hospital-based controls were consecutively enrolled. HPV typing from cervical samples, HIV testing and recording of socio-demographic factors were performed. Logistic regression modelling was used to assess HPV type-specific risk and effect modification between HIV and HPV infection. Infection with HPV 16, 18 and ‘high-risk non-HPV 16/18 types’ (HPV 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59) was associated with cervical cancer in both crude and adjusted analyses. HPV 16 and 18 were the most common types detected in cancer biopsies among both HIV-negative and HIV-positive women. There was no significant evidence of effect modification between any HPV type and HIV infection, and there were no significant differences in the HPV type-specific prevalence when cervical cancers among HIV-positive and HIV-negative women were compared. Within the limitations of the study, the relative importance of different HPV types in cervical carcinogenesis appears not to be modified greatly by HIV infection, suggesting that HPV vaccines might not need to be type-specifically modified to be suitable for populations where HIV is endemic.
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Dudding, Nicholas. "HPV testing alone is not as safe as cytology and selective HPV testing." BJOG: An International Journal of Obstetrics & Gynaecology 123, no. 1 (2015): 68. http://dx.doi.org/10.1111/1471-0528.13637.
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Kitchener, Henry. "HPV testing alone is not as safe as cytology and selective HPV testing." BJOG: An International Journal of Obstetrics & Gynaecology 123, no. 1 (2015): 68. http://dx.doi.org/10.1111/1471-0528.13638.
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Bruhn, Laerke Valsøe, Sisse Josephine Andersen, and Jalil Hariri. "HPV-testing versus HPV-cytology co-testing to predict the outcome after conization." Acta Obstetricia et Gynecologica Scandinavica 97, no. 6 (2018): 758–65. http://dx.doi.org/10.1111/aogs.13325.
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Zhao, Chengquan, Ann T. Moriarty, Mohiedean Ghofrani, et al. "Human Papillomavirus Testing and Reporting Rates in 2012: Results of a College of American Pathologists National Survey." Archives of Pathology & Laboratory Medicine 139, no. 6 (2014): 757–61. http://dx.doi.org/10.5858/arpa.2014-0393-cp.
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Context College of American Pathologists (CAP) surveys are used to establish national benchmarks for laboratory parameters. Objective To evaluate changes in laboratory human papillomavirus (HPV) testing patterns in laboratories incorporating HPV testing with Papanicolaou tests in 2012. Design Data were analyzed from the CAP HPV Supplemental Questionnaire distributed to 1771 laboratories participating in either CAP HPV or CAP Papanicolaou proficiency testing in 2013. Results A total of 1022 laboratories (58%) responded. There were more high-risk (HR) HPV tests performed per institution as compared to previous surveys. There were more HPV tests performed within an institution as compared to previous surveys. Hybrid Capture 2 (HC2) remains the most common method (42.4%, 239 of 564); Cervista and cobas methods are used in 37.2% (210 of 564) and 14.9% (84 of 564) of laboratories, respectively. Human papillomavirus testing is offered as a reflex test after a Papanicolaou test result of atypical squamous cells of undetermined significance (ASC-US) in 89.6% of laboratories (476 of 531); as a cotest for women aged 30 years and older in 60.3% (404 of 531); as reflex testing after atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) in 42.7% (320 of 531); and as reflex testing after atypical glandular cells (AGC) in 27.3% (145 of 531). The HPV-positive rates for ASC-US and ASC-H were similar in 2012 and 2006. Cervista (49.2%, 88 of 179) and Roche cobas (27.4%, 49 of 179) are the most common methods used for genotyping. Most laboratories use the CAP Human Papillomavirus for Cytology Program for proficiency testing. Conclusions There was an increase in annual volume of HR-HPV testing with a shift toward in-house HR-HPV testing. Genotyping volumes also increased. HC2 and Cervista are most commonly used, with an increasing volume of Roche cobas testing. The most common indication for HPV testing among all laboratories was ASC-US reflex testing, but an increase in HPV cotesting was observed. The data provide an update into persisting and newer trends in HPV testing practices.
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Bennis, Sarah L., Nicholas F. Yared, Keith J. Horvath, et al. "HPV Vaccination Status in HIV-Negative MSM and Its Association with High-Risk HPV Detection Using HPV Serology and Anorectal Swabs." Vaccines 12, no. 10 (2024): 1154. http://dx.doi.org/10.3390/vaccines12101154.
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Background/Objective: The aim of this study was to determine the prevalence of high-risk (HR) human papillomavirus (HPV) types by HPV vaccination status and the feasibility of using HPV L1 serology to identify HIV-negative men who have sex with men (MSM) who may be at risk for anal cancer. Methods: This cross-sectional study recruited HIV-negative MSM from a US metropolitan area. The prevalence of HR, quadrivalent, and nonavalent anorectal HPV DNA and HPV L1 serum antibodies was estimated. McNemar’s chi-square and kappa statistics were used to determine significant differences in HPV detection between anorectal DNA swabs and HPV L1 serology. Results: Eighty-two men had adequate anorectal swabs and serology samples for analysis. Men who self-reported receipt of the HPV vaccine (35.6%) had detectable L1 HPV antibodies (93.1%) and a lower prevalence of active anal HPV infections (20.7%) compared to those who reported none. Conclusions: If confirmed in larger prospective studies, a combination of HPV vaccination status or HPV L1 serology and anorectal swabs for HR HPV types could identify HIV-negative MSM who do not need to undergo follow-up anal testing.
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Lally, Michelle Ann, Kaitlin Lemei, Loida E. Bonney, and Gregory Zimet. "HPV Vaccination an Opportune Time for HIV Testing." Journal of Adolescent Health 40, no. 4 (2007): 384. http://dx.doi.org/10.1016/j.jadohealth.2006.11.001.
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Maiga, Mamoudou, Brehima Diakite, Yaya Kassogue, et al. "Implementation of Self-Sampling-Based Human Papillomavirus Screening in HIV-Infected Women in Mali." JCO Global Oncology 10, Supplement_1 (2024): 105. http://dx.doi.org/10.1200/go-24-86000.
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PURPOSE This study aimed to assess the implementation of self-sampling (SS)-based HPV screening among high-risk HIV-infected women in an HIV Care Center in Bamako, Mali. METHODS Participants received self-sampling kits after receiving explanations and answering questions regarding their preferences. The Cepheid Xpert HPV test, which detects the 14 most common HPV subtypes, was utilized. High-risk (hr)-HPV+ participants underwent visual inspection tests and histology if cancerous lesions were detected, followed by treatment. RESULTS Among the 100 enrolled HIV-infected women, 92% opted to conduct self-sampling on-site, while 8% preferred home sampling. Only four out of the eight women who chose home sampling returned their samples, whereas all participants who opted for on-site sampling provided their samples. The concept of self-sampling was well-received, with 40.6% of women testing positive for high-risk HPV, predominantly HPV18/45 (45%) and the P3 group (HPV31, 35, 33, 52, 58) (33%). Co-infections were common, and all positive cases agreed to undergo further testing and treatment as necessary. CONCLUSION The majority of women (92%) preferred on-site self-sampling. This self-sampling strategy for HPV screening appears to be acceptable among HIV-infected women in Mali and holds potential for widespread implementation to decrease cervical cancer incidence in resource-limited settings.
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Ren, Xuqi, Wujian Ke, Heping Zheng, et al. "Human Papillomavirus Positivity in the Anal Canal in HIV-Infected and HIV-Uninfected Men Who Have Anal Sex with Men in Guangzhou, China: Implication for Anal Exams and Early Vaccination." BioMed Research International 2017 (2017): 1–9. http://dx.doi.org/10.1155/2017/2641259.
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Background. The epidemiology of HPV in men who have sex with men (MSM) in Guangzhou, China, had not been reported previously. Methods. HIV-infected and HIV-uninfected MSM were recruited from a Guangzhou-based MSM clinic in 2013. Sociodemographic characteristics and sexual behaviors were collected. An anal cytological sample was taken for HPV testing. Results. We recruited 79 HIV-infected and 85 HIV-uninfected MSM. The median age was 26 years in both groups. The positivities of anal HPV of any type (81.0% versus 48.2%), any high risk type (50.6% versus 27.1%), any low risk type (55.7% versus 31.8%), and any 9-valent vaccine type (74.7% versus 36.5%) were all significantly higher among HIV-infected compared to that among HIV-negative MSM (p for all < 0.05). The great majority of HPV-infected MSM were infected with 9-valent vaccine types (59 out of 64 HIV-infected and 31 out of 41 HIV-uninfected). Anal bacterial infections were associated with higher anal HPV positivity and greater number of anal HPV types. Conclusion. Sexually active MSM in Guangzhou, especially those infected with HIV, had high and multiple HPV detections. The majority of these cases were potentially preventable by HPV vaccine. Regular anal exams and early HPV vaccination are warranted in this population.
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Dyer, Clare E. F., Fengyi Jin, Jennifer M. Roberts, et al. "Self- versus clinician-collected swabs in anal cancer screening: A clinical trial." PLOS ONE 20, no. 1 (2025): e0312781. https://doi.org/10.1371/journal.pone.0312781.
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Background Risk of anal cancer is high in certain populations and screening involves collection of anal swabs for HPV DNA and/or cytology testing. However, barriers exist, such as the need for an intimate examination, and stigma around HIV status, sexual orientation, and sexual practices. Self-collected anal swabs (SCA) are a proposed alternative to clinician-collected swabs (CCA) to overcome these barriers. Methods Participants were order-randomised to undergo SCA or CCA first, with a second swab taken immediately afterwards. Sample adequacy was assessed for HPV DNA and cytology testing. CCA was used as the gold standard to calculate sensitivity and specificity of SCA for cytology and HPV results. Acceptability of swab collection was assessed following the procedure. Results There was no significant difference in sample validity for HPV DNA testing between SCA and CCA (p = 0.564). Concordance was >90% for detection of any HR-HPV and HPV16. There was no significant difference in cellular adequacy for cytological testing between SCA and CCA, (p = 0.162). Concordance for cytologic prediction was 88.2% for any cytologic abnormality. Almost half (48.5%) of participants expressed no preference for SCA versus CCA; 15.2% preferred SCA and 35.4% CCA. Conclusions SCA may be an acceptable and feasible alternative to CCA for detecting HPV and cytological abnormalities in a clinic population.
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Pimple, Sharmila A., Vandita Pahwa, Gauravi A. Mishra, Kavita V. Anand, Saleem Pathuthara, and Sanjay K. Biswas. "Screening for Early Detection of Cervical Cancer in Women Living with HIV in Mumbai, India - Retrospective Cohort Study from a Tertiary Cancer Center." Indian Journal of Medical and Paediatric Oncology 43, no. 01 (2022): 073–83. http://dx.doi.org/10.1055/s-0042-1742662.
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Abstract Introduction Women living with human immunodeficiency virus (HIV) have an increased risk of persistent human papillomavirus infection (HPV) of developing cervical cancer precursors and are, therefore, considered at higher risk for cervical cancer. Despite the higher risk, screening for cervical cancer is extremely low among HIV-positive women in India. Objectives Given the limited usefulness of cytology-based screening programs, the current study retrospectively evaluated the comparative performance of visual inspection with 5% acetic acid (VIA), conventional cytology, and human papillomavirus (HPV) testing among HIV-positive women attending the cancer screening clinic at the tertiary cancer center. Materials and Methods Retrospective analysis of 291 HIV-positive women attending cervical cancer screening services in a tertiary cancer center in Mumbai was undertaken. All underwent simultaneous screening with VIA, Pap cytology, and HPV DNA testing, followed by diagnostic colposcopy and histopathology. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to detect cervical intraepithelial neoplasia (CIN) 2/3 on histology were estimated. Results The screen positivity rate for cervical cancer screening by VIA, high-risk HPV DNA, and Pap cytology was 35.7, 34.4, and 6.2% respectively. At the CIN2+ disease threshold, the sensitivity, specificity, PPV, and NPV estimates were 80.00% (59.30–93.17), 68.42% (62.46–73.96), 19.23% (15.46–23.67), 97.33% (94.30–98.77) for VIA; 80.00% (68.78–97.45), 70.68% (64.81–76.08), 22.00% (18.22–26.32), 98.43% (95.58–99.45) for HPV DNA; and 64.00% (42.52–82.03), 98.12% (95.67–99.39), 76.19% (56.13–88.89), 96.67% (94.50–98.00) for cytology (HSIL cutoff). Conclusion The diagnostic performance of VIA and HPV DNA was comparable and better than cytology indicating that VIA as a cost-effective cervical cancer screening test can be incorporated within the services under sexually transmitted diseases /HIV testing and counseling centers within the country.
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Kamau, Caren, Alice Njoroge, Francis Makokha, and Kimlin T. Ashing. "Abstract 821: Uptake of cervical cancer screening services by women living with HIV in Kajiado County Kenya." Cancer Research 84, no. 6_Supplement (2024): 821. http://dx.doi.org/10.1158/1538-7445.am2024-821.
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Abstract Background: This project is an African Caribbean Cancer Consortium (AC3) facilitated study: Women living with HIV (WLHIV) are more susceptible to cancer due to their immune-compromised status. The Kenya Ministry of Health recommends that women diagnosed with HIV should be screened for cervical cancer annually by either visual inspection with acetic acid (VIA) or visual inspection with Lugol’s iodine (VILI), cytology and testing for HPV once every two years. Objective: We determined the uptake of cervical cancer screening and HPV testing by women living with HIV (WLHIV) in Kajiado County in 2022. Methodology: The electronic health information system was used to abstract data for WLHIV in Kajiado county. Kajiado county has 57 antiretroviral (ART) facilities. However, our analysis accessed data from 38 facilities whose data is captured in the health information system. Authorized health care workers from the county were requested to abstract redacted data from the health information system. No personal identifiers were collected from the system as a means of protecting the privacy of individuals and abiding with the Kenya’s data protection law. Authorization to access the county was obtained from the county’s department of health while ethical approval was obtained from Mount Kenya University’s Institutional Scientific and Ethics Review Committee. Results: A total of 16,827 people living with HIV were enrolled for care at the 38 ART selected sites in 2022. Out on the total population that was enrolled for care, 11,785 (70%) were women with an age range of 15 to 49 years. A total of 3342 WLHIV, representing 28.36% of the target population, were screened by using visual inspection with acetic acid (VIA). Data for other methods of screening and HPV testing was not available in the health information systems. Of those screened, 3240 (97%) tested negative, 78 (2.3%) had positive results while 24 (0.7%) had suspicious lesions. Conclusion: Our analysis shows low uptake of cervical cancer screening services with only 28.36% of the targeted women being screened in 2022. The only available testing method (VIA) is less robust as compared to cytology and HPV testing. We also found a gap in reporting of HPV testing in the county. We thus recommend implementation science research examining the systemic barriers to HPV testing and reporting to better inform best practice HPV-related cancer prevention and control policy and practice to reduce cancer-related morbidity and mortality among WLHIV. Citation Format: Caren Kamau, Alice Njoroge, Francis Makokha, Kimlin T. Ashing. Uptake of cervical cancer screening services by women living with HIV in Kajiado County Kenya [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 821.
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Njue, James Kinoti, Margaret Muturi, Lucy Kamau, and Raphael Lwembe. "Primary and Triage Cervical Screening Diagnostic Value of Methods for the Detection of Cervical Dysplasia." BioMed Research International 2022 (September 17, 2022): 1–10. http://dx.doi.org/10.1155/2022/1930102.
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Background. Cervical cancer is a leading cause of mortality among women globally. Approaches to reduce cervical cancer incidence and mortality are “screen-and-treat,” where positive primary test only is used in the treatment and “screen, triage and treat,” where treatment is based on positive primary and triage tests with/without histological analysis. Objectives. To determine cervical screening outcomes among HIV-infected and noninfected women using VIA, Pap smear, and HPV-PCR cervical screening methods and to determine the sensitivity, specificity, PPV and NPV of VIA, Pap smear, and HPV-PCR as primary test and sequential triage based on abnormal histopathology among HIV-infected and noninfected women. Methodology. This was a comparative cross-sectional study where women aged 18-46 years women underwent cervical screening and colposcopy-biopsy test as a positive-confirmatory test in the Referral Hospitals of Eastern Kenya. Results. A total of 317 (HIV negative: 156/317 (49.2%) and HIV positive: 161/317 (50.8%)) women were enrolled. Of these 81/317 (25.6%), 84/317 (26.5%), 96/317 (30.2%), and 78/122 (63.9%) participants had VIA, HPV DNA-PCR, Pap smear, and cervical histology positive results, respectively; average: 27.4% (HIV positive: 21.5%; HIV negative: 5.9%). Majority of women with LSIL [17/317 (5.4%)], HSIL [22/317 (6.9%)], invasive cancer [5/317 (1.6%)], cervicitis [45/317 (14.2%], and candidiasis 47/317 (14.8%) were HIV-infected ( p < 0.001 ). 78/317 (24.6%) participants had positive histology test [ASCUS: 34/317 (10.7%) CIN1:17/317 (5.3%), CIN2: 16/317 (5.0%), CIN3:6/317 (1.9%), and ICC: 5/317 (1.6%)] ( p > 0.001 ). A higher primary diagnostic accuracy was established by HPV DNA-PCR (sensitivity: 95.5%; specificity: 92.6%) than Pap smear and VIA test while in triage testing, high sensitivity was obtained by HPV DNA-PCR parallel testing with VIA test (92.6%) and Pap smear test (92.7%) and VIA cotesting with Pap smear (99.9%). HIV-infected women had increased specificity and reduced sensitivity and diagnostic accuracy by both primary and triage testing approaches. Discussion. Abnormal cervical screening outcome was high among HIV-infected than noninfected women. HIV-infected women had significantly high cases of cervical neoplastic changes. The diagnostic value of primary tests increased upon concurrent testing with other test methods hence reducing the number of women who would have been referred for biopsy. Conclusion. High sensitivity and specificity in detection of CIN+ were established among HIV-infected than HIV noninfected women by HPV DNA-PCR and Pap smear than VIA test. HPV DNA-PCR test and Pap smear are more accurate in primary and sequential triage cervical screening based on abnormal histopathology outcomes among HIV-infected than noninfected women.
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Clarke, Megan A. "HPV Testing and its Role in Cervical Cancer Screening." Clinical Obstetrics & Gynecology 66, no. 3 (2023): 448–69. http://dx.doi.org/10.1097/grf.0000000000000793.
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The recognition that persistent infection with carcinogenic human papillomavirus (HPV) is a necessary cause of cervical precancer and cancer has led to the introduction of HPV testing into cervical cancer screening, either as a primary screening test or in conjunction with cervical cytology (i.e., co-testing). HPV testing has much higher sensitivity for detection of cervical precancer and provides greater long-term reassurance if negative compared to cytology. However, most HPV infections are transient, and do not progress to invasive cancer, thus triage tests are required to identify individuals who should be referred to colposcopy for diagnostic evaluation. This chapter begins with a description of the biology, natural history, and epidemiology of HPV as a foundation for understanding the role of HPV in cervical carcinogenesis. This section is followed by a detailed discussion regarding the introduction of HPV-based testing and triage into cervical cancer screening and management. Summarized triage tests include cervical cytology, HPV genotyping, p16/Ki-67 dual stain, and HPV and cellular methylation markers. The final section of this chapter includes an important discussion on cervical cancer disparities, particularly within the United States, followed by concluding remarks.