Unveiling the burden of human papillomavirus infection and risk factors among Indigenous women in Mizoram, Northeast India

BackgroundA government funded HPV vaccination program was implemented across Australia from April 2007. The aim of this study was to ascertain whether HPV genotype prevalence, prior to vaccination, differed significantly...

BackgroundCervical cancer (CC) is the leading cancer among women in Tanzania, especially among those between the ages of 15 and 44. The prevalence of high-risk Human papillomavirus (HR-HPV)-16/18 women in the general population at any given time is 3.3%. HR-HPVs 16 or 18 are the primary cause of CC. The distribution of HPV genotypes among women with CC according to HIV status is unknown in Tanzania. This study aimed to determine the HPV genotype distribution according to HIV status among women with CC in Tanzania.MethodsThis cross-sectional study was done at Ocean Road Cancer Institute (ORCI) in Tanzania among women with histologically confirmed CC. HIV serology testing was performed. Biopsy was taken from cervical lesions, and DNA was extracted. HPV DNA was amplified by using a previously validated multiplex HPV PCR assay targeting 14 high-risk HPV genotypes (16,18,30,31,33, 35, 39, 45, 51, 52, 56, 58, 59, and 66) and two low‐risk HPV genotypes (6 and 11). Continuous variables were compared using either a student t-test or the Mann-Whitney U test. Fisher’s exact test was employed to compare discrete variables. A P-value less than 0.05 was considered statistically significant.ResultsWe included 100 women with CC. The prevalence of HIV infection in this study was 42%. The prevalence of any HPV infection was 94%, ranging from 1–3 genotypes per woman. HPV. The median age for women living with HIV (WLWH) with CC patients was 45 years (IQR, 31–60), while the median age for HIV-uninfected women with CC patients was 57 years (IQR, 30–78). (p = 0.0001). WLWH and HIV-uninfected women had similar HPV prevalence, except for HPV 35, which was more common in WLWH. There was a trend of high prevalence of HPV 52 and HPV 58 in WLHH compared to HIV-uninfected women, but this difference was not statistically significant. The prevalence of HPV 16 and/or 18 infection in the entire sample was 85%. The combined prevalence of HPV 16 and/or 18 was 76% WLWH and 91% amongst HIV-uninfected women (p = 0.036).The majority of women (77.9%) had single-genotype HPV infection. There was no difference in the distribution of multiple or single HPV genotypes infection by HIV status (p = 0.25).ConclusionIn this study, HIV positive women with CC presented at a significantly younger age (45 years) compared to the HIV-negative women (57 years). The prevalence of high-risk HPV is high among women with CC in Tanzania. Distribution of most high-risk HPV genotypes among women with CC was not significantly influenced by HIV status except for HPV 35, which appeared to be more in HIV positive women compared to HIV-negative women. While the majority of the high-risk HPV infections were with single HPV genotypes, the prevalence of multiple high-risk HPV infections was at 22%, with no significant difference between the two HIV statuses. A vaccination program that aptly targets HPV 16 and 18 could prevent up to 85% of CC cases in Tanzania, regardless of HIV. Keywords: Human papillomavirus, cervical cancer, HIV, Tanzania.

Cervical cancer (CC) is the leading cancer among women in Tanzania, especially among those between the ages of 15 and 44. The prevalence of high-risk Human papillomavirus (HR-HPV)-16/18 women in the general population at any given time is 3.3%. HR-HPVs 16 or 18 are the primary cause of CC. The distribution of HPV genotypes among women with CC according to HIV status is unknown in Tanzania. This study aimed to determine the HPV genotype distribution according to HIV status among women with CC in Tanzania. This cross-sectional study was done at Ocean Road Cancer Institute (ORCI) in Tanzania among women with histologically confirmed CC. HIV serology testing was performed. Biopsy was taken from cervical lesions, and DNA was extracted. HPV DNA was amplified by using a previously validated multiplex HPV PCR assay targeting 14 high-risk HPV genotypes (16,18,30,31,33, 35, 39, 45, 51, 52, 56, 58, 59, and 66) and two low-risk HPV genotypes (6 and 11). Continuous variables were compared using either a student t-test or the Mann-Whitney U test. Fisher's exact test was employed to compare discrete variables. A P-value less than 0.05 was considered statistically significant. We included 100 women with CC. The prevalence of HIV infection in this study was 42%. The prevalence of any HPV infection was 94%, ranging from 1-3 genotypes per woman. HPV. The median age for women living with HIV (WLWH) with CC patients was 45 years (IQR, 31-60), while the median age for HIV-uninfected women with CC patients was 57 years (IQR, 30-78). (p = 0.0001). WLWH and HIV-uninfected women had similar HPV prevalence, except for HPV 35, which was more common in WLWH. There was a trend of high prevalence of HPV 52 and HPV 58 in WLHH compared to HIV-uninfected women, but this difference was not statistically significant. The prevalence of HPV 16 and/or 18 infection in the entire sample was 85%. The combined prevalence of HPV 16 and/or 18 was 76% WLWH and 91% amongst HIV-uninfected women (p = 0.036).The majority of women (77.9%) had single-genotype HPV infection. There was no difference in the distribution of multiple or single HPV genotypes infection by HIV status (p = 0.25). In this study, HIV positive women with CC presented at a significantly younger age (45 years) compared to the HIV-negative women (57 years). The prevalence of high-risk HPV is high among women with CC in Tanzania. Distribution of most high-risk HPV genotypes among women with CC was not significantly influenced by HIV status except for HPV 35, which appeared to be more in HIV positive women compared to HIV-negative women. While the majority of the high-risk HPV infections were with single HPV genotypes, the prevalence of multiple high-risk HPV infections was at 22%, with no significant difference between the two HIV statuses. A vaccination program that aptly targets HPV 16 and 18 could prevent up to 85% of CC cases in Tanzania, regardless of HIV. Keywords: Human papillomavirus, cervical cancer, HIV, Tanzania.

The prevalence and impact of HPV infection among Chinese males have not been comprehensively explored. This systematic review and meta-analysis aims to investigate the prevalence of HPV infection among Chinese males diagnosed with HPV-related diseases. A systematic search was conducted across multiple electronic databases from inception to June 2023. Studies reporting the prevalence of HPV infection among Chinese males diagnosed with diseases potentially associated with HPV, without requiring sample type documentation, were included. Data extraction and quality assessment were performed independently by two reviewers. A random-effects meta-analysis was used to estimate the pooled prevalence of HPV infection. Among 105 studies on genital warts, the pooled prevalence was 81.25% for any HPV type, with 55.84% for low-risk (LR) genotypes and 20.11% for high-risk (HR) genotypes. Single infections (53.93%) were most common, with HPV 6 and 11 being the most prevalent. Among the LR genotypes, the prevalence was 73.76% for HPV 6 or 11. The most prevalent HR genotypes were HPV 16, 52, 58, 18, and 51. Among 102 studies on cancers, the prevalence was 10.83%, 28.97%, 28.14%, 19.50%, and 45.01% for oropharyngeal cancer, oral cancer, tonsil cancer, laryngeal cancer, and penile cancer, respectively. For anal cancer, one study reported 87.5% were HPV-positive. This study highlights the prevalence of HPV genotypes 6, 11, 16, 18, 52, and 58 in males with genital warts, and the prevalence of HPV 16 and 18 in males with cancers in which HPV has been detected. Future investment in resources focused on male is needed.

BackgroundPreviously we observed elevated HPV seroprevalence in men who had sex with men (MSM) and men who had sex with men and women (MSMW) compared to men who had sex...

BackgroundA persisting high-risk human papillomavirus (HR-HPV) infection is causal for cervical cancer; however, there is limited population-based data on the prevalence of HPV infections in Germany. We assessed the age and type-specific HPV prevalence, and associated risk factors in HPV unvaccinated women aged 30 and above.MethodsThe MARZY prospective population-based cohort study was conducted between 2005 and 2012 in Mainz and Mainz-Bingen, Germany. Eligible women were randomly recruited from population registries and invited for cervical cancer screening (n = 5,275). A study swab (liquid-based cytology) was taken and HPV testing was performed with GP5+/6 + polymerase chain reaction (PCR) followed by genotyping. We assessed HPV types as HR-HPV, ‘moderate’ risk and low-risk (LR-HPV). Logistic regression was performed to identify factors associated with HPV infection, stratified by HPV types.Results2,520 women were screened with a valid PCR result. Overall HPV prevalence was 10.6% (n = 266), with 6.5% HR-HPV positive (n = 165), 1.5% ’moderate’ risk type (n = 38) and 3.3% LR-HPV type (n = 84) positive. 8.9% had a single infection (n = 225) and 1.6% had multiple types (n = 41). The most common HR-HPV types were 16, 56, 52 and 31 and LR-HPV 90 and 42. Of 187 HR-HPV infections detected (among 165 women), 55.1% (n = 103) were with HPV types not covered by available bivalent or quadrivalent HPV vaccines. About 23% (n = 43) were of types not covered by the nonavalent vaccine (HPV 35, 39, 51, 56, 59). The HR and LR-HPV prevalence were highest in the age group 30–34 years (HR 9.8%, ‘moderate’ risk 3.0% and LR 5.6%), decreasing with increasing age. HR-HPV prevalence in women with normal cytology was 5.5%. In women with a high-grade squamous intraepithelial lesion (HSIL), prevalence was 66.7%. Women currently not living with a partner and current smokers had increased chances of an HR-HPV infection.ConclusionThe overall population-based HPV prevalence was relatively high. An important share of prevalent HR-HPV infections constituted types not covered by current HPV vaccines. With the advent of HPV screening and younger vaccinated cohorts joining screening, HPV types should be monitored closely, also in older women who were not eligible for HPV vaccination.

BackgroundGlobally, cervical cancer is an increasing public health issue, and vaccination against HPV has proven to be an effective strategy to reduce this neoplasia. The purpose of this study was to assess the effectiveness of the quadrivalent vaccine in reducing the prevalence and incidence of HPV infection in women, aged 18 to 24 years old, in the cities of Ouro Preto and Mariana, Minas Gerais, Brazil.MethodsA concurrent cohort study was performed, with an initial follow-up of 12 to 18 months. The selected young women were interviewed and divided into two groups: vaccinated and unvaccinated. Participants underwent a Pap smear and cervical sample collection for HPV detection, genotyping performed by PCR-RFLP, type-specific PCR, and using the PapilloCheck®. The prevalence of HPV infection was analyzed using the compare proportions test. Poisson and Cox multivariate regression models were used to estimate vaccine effectiveness.ResultsThere was no significant difference in the overall prevalence of HPV infection between vaccinated and unvaccinated groups (23.6% vs. 18.7%; p = 0.364). However, the prevalence of infection by HPV 6/11, 16 and 18 types in vaccinated young women (1.1%) was lower than in unvaccinated ones (7.5%; p = 0.030). Regarding non-vaccine types, a higher prevalence was identified among vaccinated women (22.5% vs. 11.2%; p = 0.018). The overall incidence of HPV infection was 15.75/100 young women/year in non-immunized women compared to 9.12/100 young women/year among those immunized. The effectiveness of the vaccine was 64.0%, regardless of the viral type, and no vaccinated woman was detected with the specific vaccine HPV-type in follow-up. HPV33/45, related to cross-protection, were detected in 12.3% of vaccinated women and 1.2% of unvaccinated ones (p < 0.001) at baseline. These viral types were identified at follow-up in 2.03/100 young women/year of vaccinated participants and 4.24/100 young women/year of unvaccinated ones.ConclusionsThe results showed that the quadrivalent HPV vaccine was effective in reducing the prevalence of vaccine-type HPV and the incidence of infection by any HPV type. Public health policies must encourage vaccination to prevent HPV infection. However, surveillance of HPV infection should be continued to assess the prevalence of different genotypes and the impact of the vaccination program.

ABSTRACTOBJECTIVE Estimate the prevalence of cervical HPV infection among women assisted by the Family Health Strategy and identify the factors related to the infection.METHODS A cross-sectional study involving 2,076 women aged 20–59 years old residing in Juiz de Fora, State of Minas Gerais, who were asked to participate in an organized screening carried out in units were the Family Health Strategy had been implemented. Participants answered the standardized questionnaire and underwent a conventional cervical cytology test and HPV test for high oncogenic risk. Estimates of HPV infection prevalence were calculated according to selected characteristics referenced in the literature and related to socioeconomic status, reproductive health and lifestyle.RESULTS The overall prevalence of HPV infection was 12.6% (95%CI 11.16–14.05). The prevalence for the pooled primer contained 12 oncogenic HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) was 8.6% (95%CI 7.3–9.77). In the multivariate analysis, it was observed that the following variables were significantly associated with a higher prevalence of HPV infection: marital status (single: adjusted PR = 1.40, 95%CI 1.07–1.8), alcohol consumption (any lifetime frequency: adjusted PR = 1.44, 95%CI 1.11–1.86) and number of lifetime sexual partners (≥ 3: adjusted PR = 1.35, 95%CI 1.04–1.74).CONCLUSIONS The prevalence of HPV infection in the study population ranges from average to particularly high among young women. The prevalence of HPV16 and HPV18 infection is similar to the worldwide prevalence. Homogeneous distribution among the pooled primer types would precede the isolated infection by HPV18 in magnitude, which may be a difference greater than the one observed. The identification of high-risk oncogenic HPV prevalence may help identify women at higher risk of developing preneoplastic lesions.

BackgroundHuman papilloma virus (HPV) infection among female is the cause of cervical cancer and genital warts. In China, the HPV vaccination rate and the target population screening rate among females are low, and the aims of this study on the genotype distribution and prevalence of HPV infection were to provide more targeted strategies for the prevention and treatment of cervical cancer and HPV-related diseases.MethodsPolymerase chain reaction-reverse dot blot (PCR-RDB) was adopted for HPV genotyping test, the prevalence and 23 genotypes distribution of HPV infections among 181,705 women in Chengdu from 2013 to 2020 were analysed.ResultsThe overall prevalence rate of HPV infection among 181,705 cases was 23.28%, the prevalence of HR-HPV at the age group < 20 years, 60–69 years and ≥ 70 years were higher than the overall prevalence.The prevalence of HPV showed a bimodal U-shaped curve with age; the first and second peak common occurred among females < 20 years old (42.97%) and 60–69 years old (37.56%), respectively.The top five genotypes of HPV infection among females in Chengdu were HPV52/16/58/81/53. Single infection (73.26%) was the main HPV infection pattern, followed by double infection (19.17%) and multiple infection (7.57%), the infection rate of HPV showed a gradual declined as the patterns of HPV coinfections increased, low-risk and high-risk coinfection was higher in low-risk HPV infection (43.68%) and lower in high-risk HPV infection (13.59%). The prevalence of genotypes − 6 and − 81 infection was the second highest at the age group of 20 and 40–59, respectively, while the prevalence of HPV16 was the highest at the age group of ≥ 70 among 23 genotypes among the 181,705 women.ConclusionsThe prevalence of HPV infections among women in Chengdu is higher than domestic certain developed citys, among the five vaccines available, nonavalent vaccine is more suitable for Chengdu females. For young females prioritizing vaccination is essential in the current context.Double screening for HPV DNA is important in middle-aged women (30–49 years), and screening should not be lacking in older women (> 65 years). Additionally,for patients with genital warts, it is necessary to screen for high-risk HPV infection and provide appropriate management and treatment. Given the limitations of this study, future HPV research should aim to achieve full coverage of the target population, and our studies should also include cellular or pathological data of HPV-positive cases, vaccination rates, and various lifestyle details.

Human papillomavirus (HPV) accounts for over 80% of anal cancer cases. In the effort to prevent HPV-related cancers, the 9-valent HPV vaccine emerged as a crucial intervention, targeting HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58; the previous 4-valent (types 6,11,16,18) and 2-valent (types 16, 18). This study involved 213 women aged 21-50 attending gynecology and colonoscopy clinics in San Juan, Puerto Rico. The study assessed anal HPV prevalence and analyzed vaccination status-related differences. Anal swabs were collected for HPV testing using the ATILA AmpFire, targeting 17 HPV types. This method identified 15 high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, and 68) and two low-risk HPV types (6 and 11). Prevalence of any HPV, HR-HPV, and LR-HPV, and of specific HPV types were calculated by overall and vaccination status. Differences were assessed for statistical significance (p&amp;lt;0.05) using Fisher's exact or Pearson χ2 test. The mean age of women was 36.0 ± 5.9 years. Overall, 19.7% (n=44) had received the HPV vaccine; among them, 52.2% (n=23) had received the 4-valent vaccine, 2.3% had received the 2-valent vaccine, 2.3% had received the 9-valent vaccine, and 43.2% were uncertain about their specific HPV vaccine type. The prevalence of anal HPV infection was 68.5% for any HPV, 61.5% for HR-HPV, and 15.0% for LR-HPV. The most prevalent HR-HPV types were HPV 56 (13.2%), HPV 68 (11.7%), and HPV 66 (11.2%). There were no statistically significant differences in the prevalence of any HPV, HR-HPV, and LR-HPV between vaccinated and unvaccinated women. The most common HR-HPV type among vaccinated were HPV 66 (20.5%), HPV 31 (18.2%), HPV 56 (15.9%), while the most common among unvaccinated women were HPV 56 (12.4%), HPV 68 (12.4%), and HPV 16 (12.4%). Additionally, when evaluating as a grouped variable, the HPV genotypes covered by the 4-valent, unvaccinated women had a significantly higher prevalence of these types as compared to those vaccinated (28.9% vs. 13.6%, respectively, p-value =.03). The unvaccinated women showed a lower prevalence for HPV types covered by the 9-valent vaccine compared to the vaccinated cohort (43.2% vs. 45.5%). However, this difference was not statistically significant. We found a high prevalence of anal HPV among these women, with lower prevalence of 4-valent and 2-valent HPV types among vaccinated women, evidencing the pivotal role of HPV vaccination. Future research should assess the 9-valent vaccine's long-term effectiveness against more HPV types. Funding: Research Centers in Minority Institutions (RCMI), University of Puerto Rico (NIMHD # 2U54MD007600-36), and CAPAC Research Training Program (NCI #R25CA240120). Citation Format: Anelisse Dominicci-Maura, Ana Patricia Ortiz, Josefina Romaguera, Filipa Godoy-Vitorino. Prevalence of anal HPV infection in women attending a gynecology and colposcopy clinic: Assessing the potential impact of HPV vaccination [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 4804.

Objective：To examine HPV infection of vagina in the absence of cervical tissue and, thus, to determine whether the cervix, and especially the cervical transformation zone, is required for HPV infection. Methods：We analyzed the result of pap smears that were interpreted with the Bethesda system, and the result of HPV tests of 376 hysterectomized women and 605 non-hysterectomized women who had visited in Korea medical health care center from August 2004 to December 2005. HPV test was performed with the commercially available Hybrid CaptureⅡ assay. We estimated the prevalence of vaginal HPV infection in hysterectomised and non-hysterectomized women. The variables selected for analysis were age, time of hysterectomy, self reported reasons for hysterectomy, parity and so on. Results：Prevalence of vaginal HPV infection in hysterectomized women was 12.5% and non-hysterectomized women was 11.7%, showed no difference (p=0.72). The mean viral load of hysterectomized group was 79.1 and that of non-hysterctomized group was 173.9, which show no statistical difference between group (p=0.28). The cause of operation, age, duration since the operation, age group-specific duration since operation showed no difference in prevalence of HPV infection. Menopause state also did not show difference in HPV infection (p=0.67). Conclusion：On the basis of the present study’s data, we suggest that the cervix, particularly the cervical transformation zone, may not be needed for HPV infection in vagina.

Well-defined pre-cancerous stages help early detection of uterine cervical cancer by Pap smear or human papillomavirus (HPV) analysis. HPV induces atypical squamous cells of undetermined significance (ASCUS) which can progress to higher grade lesions depending on persistence of infection with High-risk human papillomavirus (HrHPV). The HrHPV prevalence and persistence after 18-36 months, associated risk factors for persistence among women with ASCUS, and the effect of persisting HrHPV in the cytological progression upto a period of seven years are analyzed. In the routine Pap smear clinic of a Women and Children Hospital, women who had ASCUS in Pap smear in 2009-2011 were the sample for the study. A sample of 152 women with ASCUS in Pap smear, were subjected for HrHPV (16, 18, 31, 33 and 42) analysis. These women were invited for a repeat Pap smear and HrHPV analysis after 18 months. Women with HrHPV in both the rounds were advised to come for yearly routine follow-up Pap smear upto seven years. The HrHPV prevalence was 46%, HrHPV persistence within 18-36 months was 60.8% and clearance was 39%. Among many risk factors for HrHPV persistence in univariate analysis, having more than two pregnancies and unhealthy appearing cervix were significant in multivariate analysis. 94% of the women with persistent ASCUS or higher lesion within seven years were initially persistent HrHPV positives. Since persistence of HrHPV in the cervix at least for 2 years helps in the persistence or progression of ASCUS even after seven years, routine HPV analysis should be done for women with ASCUS cytology, and who have high parity and unhealthy cervix. These women should be closely followed up to identify the progression to higher grade lesions.

Cervical cancer, caused by oncogenic (high risk [hr]) human papillomavirus (HPV) subtypes, is the most common cancer in women in Guatemala and the most common cause of cancer mortality in women aged 15-44 years. Visual inspection with acetic acid (VIA) with onsite cryotherapy “test-and-treat” is recommended for underserved Guatemalan indigenous rural women. This research assessed: 1) hrHPV infection prevalence in women screened by VIA; 2) Sensitivity and specificity of VIA in detecting hrHPV infection and cytologically identified precancerous and cancerous lesions; and 3) Factors associated with hrHPV infection. Analysis of anonymous data collected during VIA clinics in 2013 (N = 205) and 2017 (N = 234) for indigenous women aged 21-65 years in six villages showed 22.6% (95% confidence interval [CI]=18.7%-27.2%) had hrHPV cervical infection. VIA results were abnormal in 5.9% (95%CI=3.8%-8.8%). Only nine VIA exams in 89 women with hrHPV were abnormal (Sensitivity=10.1%, 95%CI=4.7%-18.3%), although abnormal VIA was associated with hrHPV (Prevalence Ratio [PR])=1.8; 95%CI=1.1-3.1; P=.05). Of 221 women who had VIA, hrHPV nucleic acid testing and liquid preparation cytology (equivalent to Papanicolaou or “Pap”) testing, 10 (4.7% [95%CI=2.3%-8.5%]) had abnormal cytological results, including one cancer, four high- and five low-grade squamous intraepithelial lesions. VIA sensitivity and specificity for detection of precancerous cytological abnormalities and cancerous lesions were 20.0% (95%CI=2.5%-55.6%) and 96.0% (95%CI=92.3%-98.3%) respectively. In contrast, hrHPV sensitivity and specificity were 100% (95%CI=71.7%-100%) and 88.7% (95%CI: 83.9%-92.7%). In both years combined, women aged fewer than 29 years or reporting fewer than four pregnancies were more likely to have hrHPV cervical infection (36.8%, 27.3%, respectively) than those who were older or reported more pregnancies (18.7; P=.025, respectively); 60.0% reported some form of modern contraception. Progesterone injections or implant users were more likely to have hrHPV infection (31.9%) than women using other or no contraceptives (19.5%); PR=1.6; 95%CI=1.1-2.4; P=.01). These data suggest that VIA may not be sufficiently sensitive for use in cervical cancer screening. “Test-and-treat” screening using hrHPV real-time testing, as recommended by the World Health Organization may be preferable to VIA, and may be acceptable using self-collected specimens.

Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies.

Clinical guidelines for women in the general population with a Pap test read as atypical squamous cells of undetermined significance (ASC-US) recommend reflex testing for oncogenic human papillomavirus (oncHPV) infection. Those who test positive for oncHPV are triaged to colposcopy while those who are oncHPV-negative have repeat testing in three years.[1] In women with HIV infection, however, there are currently conflicting clinical recommendations regarding the follow-up of an ASC-US Pap test. The United States Public Health Service guidelines recommend that HIV-seropositive women with ASC-US have immediate colposcopy or a repeat Pap test 6–12 months later, whereas the American Society for Colposcopy and Cervical Pathology guidelines allow for oncHPV reflex triage, as in the general population. To date, one small study of oncHPV testing for triage of ASC-US among HIV-infected women found 100% sensitivity and 70% specificity, but involved only 5 cases of pre-cancer (i.e., cervical intraepithelial neoplasia grade 2 or worse; CIN-2+) and 35 controls.[2] A second study found much lower sensitivity, but tested only cervicovaginal lavage specimens, not cervical swabs used in clinical practice.[3] OncHPV DNA testing was conducted in convenience specimens (i.e., cervical swabs initially collected for HIV RNA testing) obtained at the time of the first ASC-US Pap detected during semi-annual follow-up between 2000–2008 in a cohort of HIV-seropositive women. Each specimen had been used in prior PCR testing. Overall, 140 women with ASC-US and available swabs were evaluated, including all 24 CIN2+ cases and a random sample of 116 controls (30 CIN-1 and 86 normal) in the WIHS cohort. Swabs were tested for oncHPV using a well-established HPV DNA PCR assay.[4, 5] OncHPV types included HPV 16/18/31/33/35/39/45/51/52/56/ 58/59/68, with specimen adequacy determined by amplification of the human beta-globin gene. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined using a logistic regression model incorporating inverse sampling fractions as weights,[6] to account for the sampling strategy, as well as specimen unavailability or inadequacy.[6] Characteristics of CIN-2+ cases and controls at the time of their ASC-US diagnosis were similar (supplemental table 1). Patients with CIN2+ did not differ significantly from controls in terms of demographics, current CD4 cell count, current tobacco use, and current of lifetime sexual behaviors. Table 1 shows the HPV DNA test results by case-control status. OncHPV detection was more common in CIN-2+ cases (16/17; 94%) than controls (35/97; 36%; p<0.001). This included oncHPV in 4 of 4 (100%) cases of CIN-3+, 3 of 3 (100%) CIN-2/3, and 8 of 9 (92%) CIN-2. While amplification was not obtained in 19% of the convenience specimens tested, the oncHPV rate in cases shows that under-detection of oncHPV was not a problem among women with adequate specimens. Table 1 Oncogenic HPV DNA detection in cervical swabs from 140 HIV co-infected women with ASC-US Pap test results, according to their colposcopic / histologic findings Overall, sensitivity was 94% (95% CI: 68% –99%)and specificity was 64% (95% CI: 54% – 73%) for CIN2+ (Table 1).The weighted PPV was 23% (95% CI: 14% – 34%) and the weighted NPV was 99% (95% CI: 93% – 100%). The current study provides evidence that oncHPV reflex testing ispotentially useful in the triage of ASC-US among HIV-seropositive women. The high sensitivity and moderate observed specificity of oncHPV reflex testing indicate that few cases of CIN2+ would be missed, and unnecessary colposcopy would be avoided in approximately two-thirds of HIV-seropositive women with ASC-US who do not have CIN-2+. The chief limitations of the current investigation were moderate size and the non-amplification of a subset of the convenience specimens used in this study. Additional larger and more comprehensive studies are warranted.