High-risk Human Papillomavirus In Women Research Articles

Cervical cancer screening in north east Thailand using the visual inspection with acetic acid (VIA) test and its relationship to high‐risk human papillomavirus (HR‐HPV) status

This study investigated the utility of visual inspection with acetic acid (VIA) as a method for cervical cancer screening in Thailand and examined the relationship of VIA to high-risk human papillomavirus (HR-HPV) status. Cervical cells were collected from 160 patients receiving a Pap smear. VIA was performed on the cervix of the patients by application of 5% acetic acid. HPV screening of DNA extracted from cytology samples was performed by PCR using the GP5+/6+ primer system followed by reverse line blot hybridization genotyping. The majority (96.9%) of the patients were diagnosed with normal or inflammatory cytologic changes. 32.8% of normal cytology and 42.0% of inflammation cases showed positive acetowhite staining. 3.1%, 38.1% and 42.5% of subjects were positive for an abnormal Pap test, VIA test, and HPV DNA, respectively. VIA demonstrated 50% sensitivity and 66.7% specificity for abnormal histology with PPV and NPV values of 50% and 66.7%, respectively, whereas HPV DNA test showed 100% sensitivity. HPV16 was the most common (54.4%) and HR-HPV was detected in 36.3% of all cases. 48.5% of HR-HPV positive and 36.8% of HR-HPV negative cervices stained with acetowhite following the VIA test. The VIA test is a simple method for cervical cancer screening; however, a significant proportion of patients with normal or inflammatory cytology were positive by this test. Further, HR-HPV in women without acetowhite staining was demonstrated. Therefore, some form of HR-HPV detection test may be required for combination with cervical cell screening even in low-resource nations.

Association between Infection Aspects in Women with Squamous Intraepithelial Lesions and Peniscopic Findings in Their Male Sexual Partners

PURPOSE: To correlate colposcopy of women having squamous intraepithelial lesions (SIL) and peniscopic findings in their male sexual partners, to determine the prevalence of human papillomavirus (HPV) DNA in the male partners of women affected by SIL, and to assess the concordance of the viral group in the infected couple. PATIENTS AND METHODS: 27 females with different grade of SIL were examined by cytology, colposcopy and histology and their male sexual partners underwent clinical examination, peniscopy and biopsy. HPV testing was performed for all. RESULTS: 50 % of the sexual partners of women with low-grade squamous intraepithelial lesions (LSIL) were peniscopically negative. 36 % of the male partners of women with high-grade squamous intraepithelial lesions (HSIL) were peniscopically negative. Clinical lesions were observed in 50 and 9 % of the sexual partners of women with LSIL and HSIL, respectively, while subclinical lesions were found only in male partners of women with HSIL (45 %). Sexual partners of women with LSIL enrolled in our study were not HPV-positive. Male partners of patients with HSIL were HPV-positive in 63 % cases with 59 % being infected with high-risk viruses and 4 % with low-risk HPV viruses. The same genotypes were found in 19 % of couples, similarity in one genotype and difference in the other was found in 29.6 % of couples, while complete discordance was found in 48 % of couples. Highest concordance was achieved by high-risk types, especially type 16. CONCLUSION: Male sexual partners of women with SIL lesions have penile lesions determined by peniscopical examination that are mostly associated with the presence of high-risk HPV in women with HSIL. High-risk HPV prevalence is found among male partners with clinical and especially subclinical penile manifestations. Concordance of the viral group in infected pair needs to be more elucidated.

Prevalence of infection with high-risk human papillomavirus in women in Colombia

The prevalence of human papillomavirus (HPV) infections in 2109 females inhabiting five cities of Colombia was determined. Of the 49.2% with an HPV infection, 59.8% were infected with more than one viral type. Species 7 (of the the genus Alphapapillomavirus) was associated with multiple infections. Analysis of the socio-demographic data revealed a statistically significant protective effect associated with the status of civil union (civil recognition of cohabitation without marriage), and indigenous ethnicity proved to be a risk factor for HPV infection. This is the first study comparing HPV infection among women from geographical regions of Colombia with different socio-cultural structures.

The Prevalence of High-Risk Human Papillomavirus in Women with Different Types of Cervical Cancer

Letters19 August 2008The Prevalence of High-Risk Human Papillomavirus in Women with Different Types of Cervical CancerS. Deblina Datta, MD and Hillard Weinstock, MD, MPHS. Deblina Datta, MDFrom the Centers for Disease Control and Prevention, Atlanta, GA 30333.Search for more papers by this author and Hillard Weinstock, MD, MPHFrom the Centers for Disease Control and Prevention, Atlanta, GA 30333.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-4-200808190-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The prevalence of HPV DNA in LSIL and HSIL is known to be very high; therefore, management decisions are based on the presence of the cytologic abnormality alone. The management of LSIL (referral for colposcopy) and that of HSIL (loop electrosurgical excision procedure) are similar in that procedural evaluations are needed (with the exception of special patient populations) and HPV DNA testing would not influence management. The management of atypical squamous cells of undetermined significance (ASC-US), however, is dependent on the results of HPV DNA testing (1). The ALTS (Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion ...

The Prevalence of High-Risk Human Papillomavirus in Women with Different Types of Cervical Cancer

TO THE EDITOR: Datta and colleagues (1) reported that high-risk human papillomavirus (HPV) was widespread among women receiving cervical screening. Their study showed that the prevalence of cytology results with low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), or adenocarcinoma in situ (AIS) was statistically significantly higher in women younger than age 30 years than in those age 30 years or older (P 0.001), whereas the median age at cervical cancer diagnosis was 48 years in the United States (2). More than 50% of women with HSIL have cervical intraepithelial neoplasia grade 2 or greater, and 2% of women with HSIL have invasive carcinoma. However, LSIL is associated with a transient HPV infection in adolescents, and both HPV infection and LSIL usually resolve over time (3). A study involving 187 persons age 13 to 22 years with LSIL showed that 61% of the lesions regressed within 1 year and 91% regressed within 3 years (4). Because the risk for cervical intraepithelial neoplasia grade 2 or 3 in women with LSIL differs from that in women with HSIL, management of LSIL is different from that of HSIL. Clinicians will have difficulties in drawing a definite conclusion from the study because the number of women with LSIL, HSIL, and AIS was not shown separately. We ask the authors to provide information on the number of enrollees and the prevalence of high-risk HPV among women with LSIL, HSIL, and AIS, respectively.

International Correlation between Human Papillomavirus Prevalence and Cervical Cancer Incidence

Data from population-based human papillomavirus (HPV) surveys in regions of low, intermediate, and high cervical cancer incidence were used to study the ecologic correlation between high-risk HPV prevalence and cervical cancer incidence. All the surveys were conducted by the IARC according to a standardized protocol for the collection of female population samples and detection of HPV DNA using PCR assay in a central laboratory. Cervical cancer incidence data were extracted, when available, from a cancer registry covering the surrounding or nearby area of the prevalence survey. Thirteen areas were included in this analysis. The relation between high-risk HPV prevalence and cervical cancer incidence was investigated within 10-year age groups from age 25 to 65 years. A Poisson regression model was used to predict cervical cancer incidence from HPV prevalence, and the strength of the correlation was assessed using Spearman's rank correlation coefficient. The rank correlation was weakest in women ages 25 to 34 years and strongest in women ages 55 to 64 years. In addition, the prevalence of high-risk HPV was not able to predict cervical cancer incidence accurately in every country. Nevertheless, our data raise a concern about the cervical cancer burden in areas where reliable cervical cancer statistics do not exist but where the prevalence of high-risk HPV in women over age 45 is high.

The significance of high-risk human papillomavirus detection in women aged ≥ 50 years with atypical squamous cells of undetermined significance cytologic preparations

The use of high-risk human papillomavirus (HRHPV) testing in the triage of women with a cytologic diagnosis of atypical squamous cells of undetermined significance (ASC-US) has gained widespread acceptance. To date, very little has been reported on the significance of the detection of HRHPV in elderly women. Results of HRHPV testing performed on women aged > or =50 years were examined for a 20-month period. Reflex testing for HRHPV was performed on residual liquid-based cytology specimens from women who were diagnosed with ASC-US by using the Digene Hybrid Capture method. Follow-up information on women who had HRHPV detected was obtained from subsequent pathology reports (cytology and surgical). HRHPV testing was performed on 762 specimens from women aged > or =50 years; virus was detected in 105 specimens (13.8%), and follow-up was available in 63 of those women (60%). Follow-up results included negative tests in 32 women (50.8% of those with follow-up available), low-grade squamous intraepithelial lesion in 26 women (41.3%), and high-grade squamous intraepithelial lesion (HSIL) in 5 women (7.9%). No glandular neoplasia or invasive carcinoma was identified. Relative light units/cutoff (RLU/CO) values ranged from 1 RLU/CO to 1705 RLU/CO; no significant associations were identified between RLU/CO values and follow-up results. Although HRHPV was detected in a minority of samples, HSIL was present in 7.9% of those with HRHPV. This confirms that the presence of HRHPV in women aged > or =50 years with ASC-US specimens needs clinical follow-up. There were no significant differences in RLU/CO values between women with positive versus negative follow-up to allow for further discrimination for follow-up.

Comparison of the AMPLICOR Human Papillomavirus Test and the Hybrid Capture 2 Assay for detection of high-risk human papillomavirus in women with abnormal PAP smear

Infection with human papillomavirus (HPV) is a necessary step in the progression to cervical cancer. Many methods for HPV testing are currently available, mostly developed to detect pools of HPV types. Hybrid Capture 2 (HC2) is one of the most widely used. A new PCR-based assay, the Roche AMPLICOR HPV test, has been recently developed. Both assays recognize a group of 13 HR HPV types contemporaneously. This study evaluated the performance of both methods for detecting high-grade cervical lesions as a part of management for abnormal PAP smears. The study population was composed of 213 women, all referred to colposcopy and histologic diagnosis following an abnormal PAP test. Biopsy-confirmed high-grade cervical intraepithelial neoplasia was used as a gold standard. Overall agreement was 84.9% with a kappa value of 0.6. When comparing the ability to detect moderate cervical intraepithelial neoplasia (CIN2+) and high-grade cervical intraepithelial neoplasia (CIN3+/cancer), AMPLICOR proved slightly more sensitive than HC2, a finding that is important when HPV testing is used in a triage of borderline smear results. Genotyping of discordant results showed a prevalence of LR-HPV types in HC2 positive/AMPLICOR negative samples, and a similar prevalence of HR- and LR-HPV types in AMPLICOR positive/HC2 negative samples. In conclusion, the study shows that the AMPLICOR assay is more sensitive than HC2, which makes it a valid alternative for routine clinical use.

Genotipos de virus del papiloma humano más frecuentes en mujeres con citología cervicovaginal alterada utilizando técnicas de captura de híbridos y reacción en cadena de la polimerasa

Introduction Infection with high-risk genotypes of human papillomavirus (HPV) is the main cause of cervical cancer. The HPV tests currently used to detect high-risk HPV in cervical scrapings are hybrid capture (HC) and polymerase chain reaction (PCR). However, because of their cost and the need for technical resources and experienced personnel, none of these techniques is appropriate for screening. Objective To study the prevalence of high-risk HPV in women with abnormal cytology using two commercially available tests: HC and PCR. Material and methods A total of 342 cervical samples from 171 patients with abnormal cytology were studied to detect the presence of high-risk HPV using HC (Hybrid CaptureTM, Digene Corporation, Gaithersburg, USA) and PCR (PVHfastTM, Genomica SA) following the manufacturers’ instructions. Results There were 69 positive samples and 58 negative samples with both assays (kappa: 0.65). In 17 samples, no results were obtained by PCR because of assay inhibition. Of these, 9 were positive and 8 were negative using HC. Analysis of the prevalence of HPV types showed that the most common was genotype 16/82 (the PCR technique used does not discriminate genotypes 16-82) in 20 samples followed by genotype 53 in 8 samples. Discussion Both assays are useful for the detection of high-risk HPV in cervical scrapings. Unlike other authors, we found that the HC assay was more sensitive in detecting high-risk HPV. PCR has the advantage of identifying an exact genotype and mixed infections and is also useful for epidemiologic purposes. The most prevalent genotype in women with abnormal cytology was type 16 but the second most frequent genotype, type 53, was not found in women with cervical cancer and was therefore classified as «probably carcinogenic ». The epidemiological importance of this genotype should be investigated with a view to including it in future vaccines.

Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear

We studied the natural course of high-risk human papillomavirus (HPV) infection and cytological regression in women referred for colposcopy because of abnormal cervical smears. We found that high-risk HPV clearance preceded regression of cervical lesions by an average of 3 months. The cumulative 1-year rate of cytological regression was similar in women with mild and moderate dyskaryotic cervical smears. Thus, retesting of high-risk HPV after 6 months in women with mild to moderate dyskaryosis predicts cytological regression.

High‐risk HPV testing in women with borderline and mild dyskaryosis: long‐term follow‐up data and clinical relevance

In The Netherlands and most other European countries, women with two serial cervical smears with borderline or mild dyskaryosis (BMD) within 6 months are referred for colposcopy-directed biopsies. Only about 10% of these women have high-grade cervical intraepithelial neoplasia (CIN). This study therefore investigated whether human papillomavirus (HPV) testing could identify which women with smears read as BMD are most likely to have high-grade CIN, either at referral or during follow-up and the relationship was determined between clearance of high-risk HPV and regression of abnormal cytology. Women with smears read as BMD (n=278) were referred to the gynaecologist for colposcopy. They were subdivided into two groups; group A comprised women with a single smear (n=172) and group B women with two sequential smears (n=106) read as BMD before referral. High-risk HPV detection with Hybrid Capture II (HC II) was performed on a cervical scrape taken at the first visit before colposcopy (i.e. baseline smear) and during follow-up. Biopsies were taken when lesions suspected for CIN were seen at colposcopy. High-risk HPV DNA was present in the baseline smears of 126 (45.0%) women; 26 (20.6%) of them had histologically confirmed CIN 2/3 at the first visit and another 14 (11.1%) during follow-up. Only one of the 152 women (0.7%) with a negative high-risk HPV test had a CIN 2 lesion at the first visit and no CIN lesions were detected during follow-up of these women. After exclusion of women who were treated for prevalent high-grade CIN, the median follow-up times were 1.3 years (range 0.0–4.3 years) and 1.6 years (range 0.0–4.5 years) for women with HPV-negative and HPV-positive baseline smears, respectively. The sensitivity of a positive high-risk HPV test for CIN 2/3 at the first visit was 96.3%, the specificity 60.2%, the positive predictive value 20.6%, and the negative predictive value 99.3%. These values did not change markedly when stratified for group A or group B. Thus, a high-risk HPV positive test was strongly associated with the presence at the first visit and the development of CIN 2/3 lesions during follow-up. Moreover, regression of abnormal cytology in women with a positive high-risk HPV test at baseline was strongly associated with viral clearance and occurred 0.3 years (range −1.2 to 1.7 years) later than HPV clearance. This study establishes the value of a high-risk HPV positive test for women at risk of high-grade CIN, with virtually no risk for missing CIN 2/3. Addition of a test on high-risk HPV in women with BMD could prevent 55% of the referrals and/or repeat smears. Copyright © 2001 John Wiley & Sons, Ltd.

High‐risk HPV testing in women with borderline and mild dyskaryosis: long‐term follow‐up data and clinical relevance

In The Netherlands and most other European countries, women with two serial cervical smears with borderline or mild dyskaryosis (BMD) within 6 months are referred for colposcopy-directed biopsies. Only about 10% of these women have high-grade cervical intraepithelial neoplasia (CIN). This study therefore investigated whether human papillomavirus (HPV) testing could identify which women with smears read as BMD are most likely to have high-grade CIN, either at referral or during follow-up and the relationship was determined between clearance of high-risk HPV and regression of abnormal cytology. Women with smears read as BMD (n=278) were referred to the gynaecologist for colposcopy. They were subdivided into two groups; group A comprised women with a single smear (n=172) and group B women with two sequential smears (n=106) read as BMD before referral. High-risk HPV detection with Hybrid Capture II (HC II) was performed on a cervical scrape taken at the first visit before colposcopy (i.e. baseline smear) and during follow-up. Biopsies were taken when lesions suspected for CIN were seen at colposcopy. High-risk HPV DNA was present in the baseline smears of 126 (45.0%) women; 26 (20.6%) of them had histologically confirmed CIN 2/3 at the first visit and another 14 (11.1%) during follow-up. Only one of the 152 women (0.7%) with a negative high-risk HPV test had a CIN 2 lesion at the first visit and no CIN lesions were detected during follow-up of these women. After exclusion of women who were treated for prevalent high-grade CIN, the median follow-up times were 1.3 years (range 0.0-4.3 years) and 1.6 years (range 0.0-4.5 years) for women with HPV-negative and HPV-positive baseline smears, respectively. The sensitivity of a positive high-risk HPV test for CIN 2/3 at the first visit was 96.3%, the specificity 60.2%, the positive predictive value 20.6%, and the negative predictive value 99.3%. These values did not change markedly when stratified for group A or group B. Thus, a high-risk HPV positive test was strongly associated with the presence at the first visit and the development of CIN 2/3 lesions during follow-up. Moreover, regression of abnormal cytology in women with a positive high-risk HPV test at baseline was strongly associated with viral clearance and occurred 0.3 years (range -1.2 to 1.7 years) later than HPV clearance. This study establishes the value of a high-risk HPV positive test for women at risk of high-grade CIN, with virtually no risk for missing CIN 2/3. Addition of a test on high-risk HPV in women with BMD could prevent 55% of the referrals and/or repeat smears.