HPV viral load in self-collected vaginal fluid samples as predictor for presence of cervical intraepithelial neoplasia

Malin Berggrund,Julia Hedlund-Lindberg,Riina Aarnio,Matts Olovsson,Ingrid Wikström,Karin Sanner,Stefan Enroth,Inger Gustavsson,Ulf Gyllensten

doi:10.1186/s12985-019-1253-2

Malin Berggrund, Julia Hedlund-Lindberg + Show 7 more

Open Access

https://doi.org/10.1186/s12985-019-1253-2

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Journal: Virology journal	Publication Date: Nov 27, 2019
Citations: 13	License type: open-access

Affiliation: Science for Life Laboratory, Uppsala University

Abstract

ObjectiveThis study was performed to evaluate the use of high-risk HPV (hrHPV) viral load in screening tests for cervical cancer to predict persistent infection and presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+).MethodsWe followed women between 30 and 60 years of age who performed self-sampling of vaginal fluid and subsequently a hrHPV test. Women who were hrHPV positive in their screening test repeated the hrHPV test 3–6 months later and were included in the present study.ResultsOur results show that women with a persistent HPV16 infection had higher HPV viral load in their primary screening test than women with transient infections (p = 5.33e-03). This was also true for sum of viral load for all hrHPV types in the primary screening test (p = 3.88e-07). 48% of women with persistent HPV16 infection and CIN2+ had an increase in HPV16 titer in the follow-up test, as compared to only 20% of women with persistent infection but without CIN2+ lesions. For the sum of all hrHPV types, 41% of women with persistent infection and CIN2+ had an increase in titer as compared to 26% of women without CIN2 + .ConclusionsThe results show that hrHPV viral load in the primary screening HPV test is associated with the presence of CIN2+ and could be used in triaging hrHPV positive women for different follow-up strategies or recall times. Serial testing of hrHPV viral load has the potential to distinguish women with CIN2+ lesions from women with persistent infection but without CIN2+ lesions.

Highlights

Human papilloma virus (HPV) genital infection is associated with the development of cervical cancer
A total of 752 high-risk HPV (hrHPV) infections were detected in the primary screening test, with HPV16 being the most prevalent type and the HPV type most likely to be present in the two consecutive hrHPV tests (HPV16 persistence; 76%, non-HPV16 persistence; 20–61%) (Table 1)
The analysis was performed for both hrHPV copy number and hrHPV titer, i.e. hrHPV copy number normalized for amount of human cellular material

Summary

Introduction

Human papilloma virus (HPV) genital infection is associated with the development of cervical cancer. Cytology has been the most commonly used screening method to identify cervical lesions but due to its low sensitivity it is currently being replaced with hrHPV testing. HrHPV testing has a higher sensitivity than cytology but does not provide as high specificity. The specificity of hrHPV testing can be increased by triage with cytology or by repeating the HPV test in 4–6 months [2, 3]. About 40% of women that are hrHPV positive in their screening test have cleared their infection after 4–6 months [3]. The strategy of repeating the hrHPV test reduces the number of women that require follow-up and increases the specificity for identification of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) [2]. It would be optimal to use a single primary screening test to determine whether an hrHPV infection is likely to become

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Discussion

Conclusion