HPV Viral Load Research Articles

HPV status and HPV16 viral load in anal cancer and its association with clinical outcome.

The incidence of anal cancer is increasing globally. Evidence-based improvement in early detection and management of this morbid cancer is thus required. In other cancers associated with Human Papillomavirus (HPV), viral status and dynamics, including viral load (VL) has been shown to influence clinical outcome. Our aim was to determine the influence of HPV status and HPV16 VL on the clinical outcomes of anal cancer patients. A total of 185 anal cancer lesions were genotyped for HPV. Of the HPV16 positive component, VL was determined using a digital droplet PCR assay. The association of qualitative HPV status and VL (low (<12.3), medium (12.3-57) and high (>57 copies/cell)) on overall survival and hazard of death was assessed. Of the 185 cases, 164 (88.6%) samples were HPV positive. HPV16 was detected in 154/185 samples (83.2%). HPV positive status was associated with improved overall survival in the univariate analysis [hazard ratio (HR) of 0.44, 0.23-0.82, p=0.01]. When adjusted by age, sex, stage and response to treatment, the association of positive HPV status with improved survival remained (HR 0.24 [0.11-0.55] p < 0.001). High VL was associated with improved overall survival in the univariate analysis with a HR of 0.28 (0.11-0.71, p=0.007). When adjusted only by age and sex, high VL was associated with better overall survival (HR 0.27, 0.11-0.68 p=0.006). HPV status appears to be independently associated with improved outcomes in anal cancer patients. Moreover, HPV viral load quantification may be informative for further risk stratification and warrants further investigation.

Verification of the association of the cycle threshold (Ct) values from HPV testing on Cobas4800 with the histologic grades of cervical lesions using data from two population-based cervical cancer screening trials

ObjectiveTo verify the association of high-risk human papillomavirus (hrHPV) viral load reflected by cycle threshold (Ct) values from HPV testing on Cobas4800 assay with the histologic grades of cervical lesions via analysis on the combined data from two cervical cancer screening trials and to explore the referability of Ct values in management of the abnormalities from cervical cancer primary screening.MethodsWe analyzed the data from Chinese Multi-Center Screening Trial (CHMUST) and BUJI Cervical Cancer Screening Study Project (BUJI Study). All data to be analyzed in this paper were related to provider-collected samples. One-way ANOVA was performed to compare the Ct values among different histological groups, and Kendall’s tau-b correlation was applied to examine the association between Ct values and cervical lesion grades. The stepwise incidence of CIN2+ and CIN3+ in every 100 HPV positive individuals were calculated according to the descending of the genotype specific Ct values. The highest Ct values related to CIN3+ incidence rate 4% (or 25%) were used as the cutoffs to distinguish low-Ct value cases from the high-Ct value ones.ResultsA total of 1376 women in CHUMUST and BUJI Study who were aged 30–59 and positive of hrHPV for provider-collected samples on Cobas4800 with complete data in terms of the relevant Ct values (CtV) and the histological diagnosis were included for analysis. Our data showed significant difference among different histological grades of cervical lesions in the CtV of hrHPV, HPV16-plus (positive of HPV16 only or HPV16 plus 18 and/or pooled 12-HPV), and pooled 12-HPV (P < 0.05). No significant difference was found among different grades of lesions in term of correlated CtV of HPV18-plus (positive of HPV18 only or HPV18 plus pooled 12-HPV) (P > 0.05). The CIN2+ or CIN3+ incidence per 100 positives significantly increased corresponding to the descending of the CtV of hrHPV, HPV16-plus and pooled 12-HPV. Compared with high-CtV groups (CtV > 33.2 for hrHPV, CtV > 29.6 for pooled 12-HPV), the relevant risks (RRs) of CIN2+ for hrHPV and pooled 12-HPV positive groups with low-CtV (CtV ≤ 33.2 and ≤ 29.6, respectively) were 3.2 (95%CI 2.18–4.80) and 2.3 (95%CI 1.50–3.45). Similarly, the RRs of CIN3+ for hrHPV and pooled 12-HPV positive groups with low-CtV were 6.5 (95%CI 2.83–14.80) and 2.7 (95%CI 1.15–6.39), respectively. The RRs of CIN2+ for medium- (30.3 < CtV ≤ 37.4) and low- (≤ 30.3) CtV HPV16-plus positives were 5.1 (95%CI 0.68–38.38) and 20.6 (95%CI 2.96–143.92) related to high-CtV (> 37.4) groups, and the CIN3+ incidence in low-CtV value group was nine-fold higher of that in medium-CtV ones [RRs, 9.0 (95%CI 2.89–28.10)]. In comparing with the algorithms of “HPV16-plus/18-plus + cytology ≥ ASCUS for pooled 12-HPV”, triage algorithm “HPV16-plus/18-plus + Ct value ≤ 33.2 for pooled 12-HPV” could achieve a comparable sensitivity of 93.2%.ConclusionHPV viral loads reflected by Ct values for hrHPV, HPV16-plus and pooled 12-HPV from Cobas4800 HPV testing were directly associated with the severity of cervical lesions. A lower HPV genotype-specific Ct value prompted a significantly high CIN3+ risk of 4% or higher in women positive of hrHPV, HPV16-plus or pooled 12-HPV, indicating that HPV viral load reflected by Ct values on Cobas4800 may be a promising risk indicator in management of abnormalities from primary cervical cancer screening.

Manageable risk factors for progression of HPV-associated cervical intraepithelial neoplasia

Objective: to identify informative markers of the progression of cervical intraepithelial lesions of low degree.Materials and methods: the dynamics of the results of the cytological study of cervical epithelium, genotyping of human papilloma viruses of high carcinogenic risk (HPV) with an assessment of the viral load, an immunocytochemical study of the expression of protein p16 (p16INK4α), serum folic acid in 90 HPV-positive patients of reproductive age was analyzed. 43 of the 90 patients (47.8%) who made up group I had regression of the disease. Group II included 30 of 90 patients (33.3%) with disease persistence - no significant changes in the results of laboratory and instrumental research methods. Group III was 17 out of 90 patients (18.9%) with disease progression. Statistical processing of the results was carried out using parametric and non-parametric analysis methods using IBM SPSS Statistics 28.0.1.1 (developed by IBM Corporation), STATISTICA 13.5.0.17 (developed by StatSoft.Inc) and MedCalc 20.027. Results: factors that significantly distinguish patients with persistence or progression of low grade cervical intraepithelial lesions from women with regression of the disease are: earlier age of sexual onset, detection of atypical changes in low grade cervical epithelium, clinically significant HPV viral load, detection of p16INK4a protein expression, serum folic acid below 3.1 ng/ml. Conclusions: deficiency of serum folic acid in HPV of positive patients should be considered as a pathogenetically significant risk factor for the implementation of infection into the clinical form of the disease, which is confirmed by its correlation with the cytological detection of LSIL, progressive increase in the copy of HPV, and p16INKα expression. The patient management strategy, which provides a personalized assessment of the risk of progression of cervical intraepithelial lesions, expands the monitoring of patients with cervical neoplasias associated with HPV.

Diagnostic value of colposcopy in patients with cytology-negative and HR-HPV-positive cervical lesions

High-risk human papillomavirus (HR-HPV)-positive but cytology-negative cervical cancer screening results are not uncommon. This study aimed to investigate colposcopy's accuracy and diagnostic value in patients with cytology-negative HR-HPV-positive screening results. This retrospective study included patients with HR-HPV-positive cytology-negative screening results who underwent electronic colposcopy with acetic acid and multi-point cervical biopsy, HPV typing (24 HPV subtypes), and quantitative HPV detection. Among 229 patients, 130 had chronic cervicitis, and 99 had cervical lesions (CIN1, n = 37; CIN2/3, n = 55; invasive carcinoma, n = 7). Using colposcopy as a reference, the cervical cytology false-negative rate was 43.2% (99/229). Colposcopy was more accurate in patients with HR-HPV16/18 or high viral loads. Multivariable analyses showed HPV viral load and childbearing history were the independent factors affecting the accuracy of colposcopy (P < 0.05). Colposcopy in HR-HPV-positive cytology-negative patients has a moderate diagnostic accuracy. The type of cervical transformation zone and HPV viral load are independent factors affecting the accuracy of colposcopy-based diagnosis.

High levels of HPV16-L1 antibodybut not HPV16 DNA load or integration predict oropharyngeal patient outcome: The Papillophar study.

The incidence of oropharyngeal cancers (OPC) is increasing in the world. Among OPC, those induced by human papillomaviruses have a better prognosis than non-HPV-associated OPC. The objective of this study was to highlight the relevance of HPV16 load, HPV16 DNA integration and HPV16-L1 serology on progression-free survival and overall survival of OPC patients. The PAPILLOPHAR cohort consists of 362 patients with oropharyngeal squamous cell carcinomas prospectively followed up for 5years after treatment. Tumor biopsies and sera were collected at inclusion to investigate tumor HPV DNA/RNA characteristics and HPV16 L1 serology, respectively. Twenty-seven percent of tumor biopsies were HPV DNA- and RNA-positive and HPV16 represented 93% of HPV-positive cases. Among them, neither HPV16 viral load nor HPV16 DNA integration was associated with overall survival (OS) or progression-free survival (PFS). In contrast, high anti-HPV16 L1 antibody titers were significantly associated with a better OS and PFS. This study reveals that HPV16 load and integration are not relevant prognosis biomarkers in OPC patients.Clinical Relevance: High levels of HPV16 L1 antibodies may be useful to predict OPC patient outcome following treatment.ClinicalTrials.gov Identifier: NCT00918710, May 2017.

Surgical Drain Fluid as a Novel Liquid Biopsy Analyte to Measure Postoperative Minimal Residual Disease in HPV+ Oropharyngeal Cancer

<h3>Purpose/Objective(s)</h3> Postoperative risk stratification of patients undergoing surgery for HPV⁺ oropharyngeal squamous cell carcinoma (OPSCC) is controversial. While pathologic staging and extranodal extension (ENE) are established criteria for adjuvant radiotherapy+/-chemotherapy in HPV-negative head and neck cancer, their prognostic significance in HPV⁺ OPSCC is less clear. Moreover, pathologic interpretation can be variable, especially in the community setting. We propose an objective measure of postoperative minimal residual disease (MRD) using HPV DNA in surgical drain fluid (SDF). Unlike plasma, this novel liquid biopsy analyte provides a proximal, site-specific measure of locoregional MRD. We hypothesize that elevated HPV viral load in SDF predicts the presence of established pathological features crucial to adjuvant radiotherapy decision-making. <h3>Materials/Methods</h3> Thirty-two SDF specimens were collected from the surgical wound bed of 24 HPV⁺ OPSCC patients undergoing transoral resection and neck dissection. Each specimen was collected 24 hours after surgery and was treated independently in cases of bilateral neck dissection. DNA was isolated to compare HPV16 load as measured by TaqMan quantitative PCR (qPCR) to pathological diagnosis of ENE, number of positive lymph nodes, and positive lymph node size. Paired plasma samples were obtained from 21 node⁺ patients at the time of SDF collection, to compare HPV DNA detection between biofluid types. Serial dilutions of the HPV16 E6T2aE7 plasmid were used to establish the limit of detection (LOD) for our assay. Statistical analyses included Wilcoxon rank-sum test, Spearman correlation, and Fisher's exact test. AJCC 8^th edition criteria were used for nodal staging. <h3>Results</h3> TaqMan qPCR revealed a lower LOD of 20 HPV copies/µL. The median HPV copies/µL was 43-fold higher in ENE⁺, compared to ENE⁻ necks (<i>P</i> = 0.003). Moreover, 67% of ENE⁺ necks had detectable HPV in SDF, indicative of MRD, compared to only 26% of ENE⁻ necks (<i>P</i> = 0.0049). Additionally, the number of positive nodes correlated with HPV copies/µl measured in SDF (ρ = 0.45, <i>P</i> = 0.0098), with N1/N2 necks harboring 7.5-fold higher HPV copies/µl than N0 necks (<i>P</i> = 0.0003). Size of largest metastatic deposit also correlated significantly with HPV levels in SDF (ρ = 0.75, <i>P</i> < 0.0001). Only 1 paired plasma sample from an ENE⁺ patient had detectable HPV by TaqMan, illustrating the importance of proximal biofluid sampling to most sensitively detect MRD after surgery. <h3>Conclusion</h3> Postoperative TaqMan qPCR of SDF enables MRD detection of HPV⁺ OPSCC, which is highly enriched compared to plasma, and correlates significantly with aggressive pathologic features including nodal stage and ENE. If confirmed, SDF-based HPV quantitation could become a useful and automated adjunct to traditional pathology for personalized adjuvant radiotherapy decision-making.

Significance of the viral load of high-risk HPV in the diagnosis and prediction of cervical lesions: a retrospective study

BackgroundThe significance of HPV viral load in the detection of cervical lesions is still controversial. This study analyzed the correlation between the high-risk HPV viral load and different cervical lesion degrees.MethodsThis retrospective study included women positive for high-risk HPV DNA and screened for cervical lesions between 01/2015 and 06/2018. The high-risk HPV DNA load was measured by the second-generation Hybrid Capture technology and classified as low, moderate, and high. Colposcopy and biopsy were performed in all patients. The patients were grouped as normal, cervical intraepithelial neoplasia (CIN) grade 1, CIN grade 2, CIN grade 3, and cervical cancer. Multivariable logistic regression was performed to explore the association between high-risk HPV DNA load and cervical lesions. The odds ratios (ORs) represent the odds for increasing from low to high viral load.ResultsFinally, 265 patients were grouped as normal (n = 125), CIN 1 (n = 51), CIN 2 (n = 23), CIN 3 (n = 46), and cervical cancer (n = 20). Among them, 139 (52.5%) had a low viral load, 90 (34.0) had a moderate viral load, and 36 (13.4%) had a high viral load. Taking the normal control group as a reference, a high viral load was an independent factor for CIN 1 (OR = 3.568, 95% CI: 1.164–10.941, P = 0.026), CIN 2 (OR = 6.939, 95% CI: 1.793–26.852, P = 0.005), CIN 3 (OR = 7.052, 95% CI: 2.304–21.586, P = 0.001), and cervical cancer (OR = 8.266, 95% CI: 2.120–32.233, P = 0.002).ConclusionsAmong women who underwent cervical biopsy, higher high-risk HPV viral load in cervical lesions was associated with a higher risk of high-grade cervical lesions.

HPV16 Load Is a Potential Biomarker to Predict Risk of High-Grade Cervical Lesions in High-Risk HPV-Infected Women: A Large Longitudinal French Hospital-Based Cohort Study.

Simple SummaryThis study aimed at assessing HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 885 women positive for hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 135 developed a high-grade lesion during the follow-up. Considering an HPV16 viral load cut-off set at 3.2 log10 GE/103 cells a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97 p ≤ 0.0001) has been identified. Moreover, a composite score based on HPV16 load, cytology and hrHPV detection allowed for CIN2+ risk stratification. To conclude, HPV16 load is a relevant biomarker to identify women at high risk for developing precancerous lesions of the cervix. High-risk HPV (hrHPV) testing has been implemented as a primary screening tool for cervical cancer in numerous countries. However, there is still a need for relevant triage strategies to manage hrHPV positive women to avoid excessive referral to colposcopy. The objective of this study was to assess, in women infected by hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 2102 women positive for hrHPV, 885 had no lesion or mild cytological abnormalities at baseline and had at least one follow-up (FU) visit. HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 15% developed a high-grade lesion during the FU. An HPV16 viral load cut-off set at 3.2 log10GE/103 cells permitted to identify a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97; p ≤ 0.0001). No specific HPV18 viral load threshold could have been defined in regard to the present study. In multivariate analysis, HPV16 load (absence/log10GE/103 cells < 3.2 vs. ≥3.2), RLU/PC 239 (1–100 pg/mL vs. >100 pg/mL) and cytology (normal vs abnormal) were independently associated with a significant increased risk of high-grade lesion development and were used to construct the prognostic score. In conclusion, HPV16 load is a relevant biomarker to identify women at high risk for developing cervical precancerous lesions.

Influence of TLR4 and TLR9 polymorphisms and haplotypes on multiple hrHPV infections and HPV16 copy number in cervical cancer and cervicitis

Genetic polymorphism in pathogen recognition receptors tends to influence infection, disease susceptibility, and progression. We analyzed the association of TLR4 and TLR9 gene polymorphisms with multiple hrHPV infections and HPV16 copy number in cervicitis and cervical cancer. A total of 440 cervical cancer, cervicitis, and healthy individuals were studied using PCR-based assays. Student t-test, chi-square test, Welch's t-test, and Fisher's Exact test were utilized to evaluate the association of HPV infection with polymorphisms. Haploview and FAMHAP were used to analyze haplotype association with HPV infection and viral load. Study results revealed HPV45 infection as the most common one in cervical cancer after HPV16, and one-fourth HPV positive cervical cancer patients possessed multiple HPV infections. Mean HPV16 copy number of 264.4 ± 58.7 and 2.1 ± 3.3 copies/cell was detected in cervical cancer and cervicitis, respectively. TLR4 rs10759931 was protective against multiple hrHPV infections. TLR4 haplotype ACAC was associated with an increased risk of multiple hrHPV infections. TLR9 SNPs rs187084, rs352140, and rs352139 were associated with decreased risk of high HPV16 copy number. Augmentation of efforts for the multivalent HPV vaccination in India is suggested. The analyzed polymorphisms were shown to modulate hrHPV co-infections and HPV16 viral load that warrants further analysis.

Abstract 2264: Molecular detection and genotyping of human papillomavirus in presence of some oncogenic viruses among Egyptian breast cancer women

Abstract Introduction High risk human papillomaviruses (HR-HPVs) has a possible role in development and pathogenesis of breast cancer (BC) disease. Other oncogenic viruses showed to be linked to BC such as Epstein Barr virus (EBV), and Human mammary tumor virus (HMTV). Presence of high risk HPV genotypes, EBV or HMTV could affect the severity course of BC. Therefore, the aim of the current study is to explore distribution of HPV with regards to its genotypes and the presence of EBV and HMTV among Egyptian BC women with its correlation to age and hormonal status. Patients &amp; Methods This study was conducted on 40 fresh tissues of BC patients and blood samples from 30 apparently healthy controls. All samples were investigated for detection of HPV, EBV and HMTV DNAs using qualitative PCR. Detection of HPV viral load was performed using quantitative real time PCR. HPV genotypes were determined on 10 purified positive PCR product using Sanger sequencing of HPV L1 region. The obtained sequences were compared to the known HPV DNA sequences at National center for biotechnology information (NCBI) and/or Papillomavirus Episteme (Pave) data bases using their online BLAST and taxonomy tools. Data were correlated with age and hormonal status. Results All the tested 3 oncogenic viruses were not detected into 30 controls. HPV, EBV and HMTV were detected in 20 (50%), 23 (57.5%), 28 (70%) respectively of the 40 BC patients by using PCR assay. HPV median load of the 20 positive samples was 4800 copies/μL. Seven different HPV genotypes were detected included high risk genotypes ((HPV 18 in 3 samples), 70 and 52), low risk genotype (11) detected into only one sample along with 3 other genotypes (102, 114 and 151). One sample showed no significant similarity with any sequence registered in the used databases. Presence of EBV and HMTV DNAs and high risk HPV genotypes was more associated with young age (lower than 50 years), P value = 0.015, 0.001 and 0.05, respectively but were not associated with hormonal status of BC patients. Conclusion HMTV was the most detected viral DNAs among BC patients, High risk HPVs were identified into 10% of studied Egyptian BC patients and were associated with young age. Further larger sample size study is needed to evaluate role of HPV genotypes on pathogenesis and outcome of BC disease. STDF Acknowledgment This project was supported financially by the Science and Technology Development Fund (STDF), Egypt, Grant No.22944. Citation Format: Nasra F Abdel Fattah, Shimaa A Metwally, Samah A Loutfy, Maha A Abo-Shadi, Ahmed B Barakat, Omar A Rabee, Ahmed M Osman, Amany M Helal, Tarek M Hashem, Manar M Moneer. Molecular detection and genotyping of human papillomavirus in presence of some oncogenic viruses among Egyptian breast cancer women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2264.

Successful retrieval of human papillomavirus DNA after a 4.5 year storage on FTA elute cards

Efficient primary (vaccination) and secondary (screening) prevention strategies have the potential to eliminate cervical cancer worldwide. In this context, surveillance of HPV infections remains mandatory to assess the efficacy and the impact of screening and vaccination policies. Therefore there is a need to safely store cervical samples to conduct long-term studies in vaccinated and non-vaccinated subjects. Up-dated data on cervical specimen preservation on FTA® cards indicate that HPV DNA can be safely retrieved after 54 months of storage. A concordance of 97 % was achieved between HPV genotypes detected in initial cervical samples and on FTA® cards 4.5 years later. Even if a drop in HPV viral loads was observed in some cases at 4.5 years, using FTA® cards for safe and long-term storage of cervical samples represents an interesting option.

Investigation and Follow-up of HPV Infection on Married Mongolian Women in Hulunbuir.

The aim of the study was to determine the high-risk factors of Mongolian human papillomavirus (HPV) infection in Hulunbuir area and to explore the guiding role of HPV16 viral load change in the treatment of cervical intraepithelial neoplasia 1 (CIN 1). The HPV qualitative results of 963 married women of Mongolian nationality aged 21 - 65 were screened using real-time PCR in the Hulunbeir area, logistic analysis statistics was used to judge the high-risk factors of infection, and the χ2 test was the analysis method of the count data; hybrid capture was used. II technology was used to detect the changes of HPV DNA content of CIN I outpatients before treatment, 6, 12, and 18 months after treatment. At the same time the change trend of vaginal secretions and thinprep cytologic test (TCT) was observed. The measurement data between the two groups by was compared using t-test. The positive rate of HPV infection was 22.31% in Mongolian married women in Hulunbuir area. Drinking habits and the number of sexual partners were the common infection factors of all high-risk types. Infection factors of HPV16, 18, and other high-risk types also included number of marriages. There was a significant difference between the content of HPV DNA in CIN I patients before treatment and the two groups at 12 and 18 months after treatment (p < 0.05). The number of patients with degree III or IV of cleanliness and TCT showed that the number of patients with low-grade atypical hyperplasia decreased with the treatment time, which was consistent with the change of HPV DNA content. In the Hulunbuir area, the number of Mongolian women with HPV infection is higher than that of the Han nationality, so we should strengthen the popularization and propaganda of the knowledge about HPV infection in the Mongolian population settlement. The change of DNA content of high-risk HPV can be used as the observation index of CIN I treatment evaluation.

ULTRASONIC CAVITATION USEAGE FOR TREATMENT HPV CERVICAL INTRAEPITELIAL NEOPLASIA ASSOCIATED WITH TRICHOMONIASIS

Despite the existence of a clear concept of background, dysplastic processes, cervical cancer, as well as reliable and affordable screening, precancerous and cervical cancer remains an urgent problem of modern gynecology and oncogynecology. The incidence of cervical epithelial pathology is 15-20% among women of reproductive age.The purpose of the study was to compare cervical intraepithelial neoplasia treatment effectiveness in case of genital papillomavirus infection associated with trichomoniasis by systemic antiprotozoal and combination of antiprotozoal therapy and ultrasonic cavitation.Research methods and material. A study and treatment of 200 reproductive age women with cervical intraepithelial neoplasia in case of genital papillomavirus infection associated with trichomoniasis, divided into two groups. The main one is 133 women who received combined four sessions of cyclic antiprotozoal therapy with ultrasonic cavitation. Comparison group - 67 women who underwent four sessions of cyclic antiprotozoal monotherapy. The examination included:a anamnestic part, general examination, colposcopic, cytological, cultural, cytomorphological and PCR studies with HPV genotyping and viral load before therapy and 3 months after. Research results and discussion. Before the start of therapy, specific signs of HPV infection were revealed cytologically: binuclear coilocytes, visualization of coilozones, mild discariosis, enlargement of squamous cells, uneven staining of the cytoplasm. Colposcopy signs was specific by diffuse (39%) or local hyperemia (21.5%) of the epithelium, white and red spotting, spotting (23.5%), inflammatory exudate (6%), pustules and vesicles (4%), contact bleeding (21 %), copious discharge (90%), epithelial defects, leukoplakia (3.5%). A direct correlation was established with cervical damage and viral load. A comparative assessment of the treatment of trichomonas infection revealed that the method that includs usage of ultrasonic cavitation and as a result destroy of the pathological biological film is almost 6 times more effective than traditional methods in the existing protocols.Conclusion: Proposed cycle trichomonal infection treatment method with usage of ultrasonic cavitation proved its effectiveness in 95.5% patients and allowed to reduce the number of relapses by 5.9 times. The complex treatment helped to reduce quantity of cases of highly oncogenic types of HPV and reduce viral load activity, allowed to normalize colposcopy and cytology results in 50.3% patients, facilitated the regression of H-SIL to L-SIL cervical intraepithelial neoplasia in 17.4% of cases.

STAT1 expression and HPV16 viral load predict cervical lesion progression.

Cervical cancer is the fourth leading cause of cancer-associated mortality worldwide. However, its underlying molecular mechanisms are unclear. It is important to explore these mechanisms in order to identify novel diagnostic and prognostic biomarkers. The present study determined the association between STAT1 and human papillomavirus (HPV)16 in cervical lesions. STAT1 expression was detected by immunohistochemistry. Quantitative PCR was used to detect HPV16 viral load and STAT1 expression in cervical lesions. The potential associations among STAT1 expression, HPV16 viral load and the severity of cervical lesions in patients were analyzed using receiver operating characteristic (ROC) curves. The Cancer Genome Atlas database was used to analyze STAT1 expression and survival. High STAT1 expression was observed in 10.71 (3/28), 41.18 (14/34), 53.06 (26/49) and 90.00% (27/30) of normal tissue, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and cervical squamous cell carcinoma samples, respectively. The HPV16 copy number gradually increased with the progression of cervical lesions, with the highest copy number observed in cervical cancer samples. In addition, STAT1 expression was positively correlated with HPV16 viral load. Furthermore, ROC curve analysis demonstrated that the combination of STAT1 expression and HPV16 viral load was able to differentiate between LSIL/HSIL and cervical cancer samples. Bioinformatics analysis revealed that STAT1 expression was associated with improved survival in cervical cancer. Additionally, STAT1 expression was positively associated with the progression of cervical lesions, and HPV16 viral load may affect STAT1 expression. Overall, these findings indicate that STAT1 may be an indicator of the status of cervical lesions.

Droplet digital PCR quantification suggests that higher viral load correlates with improved survival in HPV-positive oropharyngeal tumours.

Although HPV-positive oropharyngeal cancer (OPC) patients have improved prognosis compared to HPV negative patients; there remains an HPV-positive group who have poor outcomes. Biomarkers to stratify discrete patient outcomes are thus desirable. Our objective was to analyse viral load (VL) by droplet digital PCR (ddPCR), in HPV-positive patients with OPC on whom clinical outcome data were available. In a cohort of patients that had previously tested HPV positive via conventional PCR, VL was determined using ddPCR assays for HPV16 L1 and E6 genes. VL was classed as "medium/high" if more than 5.57 copies or 8.68 copies of the HPV 16 L1 or E6 gene were detected respectively. Effect of VL on overall survival and hazard of death & disease progression was performed with adjustments made for sex, age, deprivation, smoking, alcohol consumption and stage. L1 VL ranged from 0.0014-304 gene copies per cell with a mean of 30.9; comparatively E6 VL ranged from 0.0012-356 copies per cell with a mean of 37.9. Univariate analysis showed those with a medium/high VL had a lower hazard of death; this was significant for L1 (p = 0.02) but not for E6 (p = 0.67). The ratio of E6 to L1 deviated from n = 1 in most samples but had no influence on clinical outcomes. HPV viral load may be informative for the further stratification of clinical outcomes in HPV positive OPC patients.

Long-term Persistence of Oral HPV Over 7 Years of Follow-up.

BackgroundHuman papillomavirus–related oropharyngeal cancer (HPV-OPC) incidence is increasing, but the natural history of the precursor—oral HPV—has not been well described.MethodsThis observational cohort study of people living with HIV and at-risk HIV uninfected people evaluated participants semiannually using 30-second oral rinse and gargle specimens over 7 years. Initially, 447 participants were followed for 4 years as part of the Persistent Oral Papillomavirus Study, and a subset of 128 who showed persistent infections at the last Persistent Oral Papillomavirus Study visit had an additional visit, as part of the Men and Women Understanding Throat HPV Study, on average 2.5 years later. Extracted DNA from oral rinse and gargle specimens was amplified using polymerase chain reaction and type specification of 13 oncogenic HPV types. Risk factors for oncogenic oral HPV clearance were evaluated using Cox models.ResultsThe majority of oncogenic oral HPV infections cleared quickly, with a median time to clearance of 1.4 years (interquartile range = 0.5-3.9 years). After 7 years of follow-up, 97% of incident and 71% of prevalent infections had cleared. Lower HPV-16 viral load was statistically significantly associated with clearance (per 10-fold decrease in copy number: adjusted hazard ratio [aHR] = 2.51, 95% confidence interval [CI] = 1.20 to 5.26; P = .01). Adjusted analyses showed that oncogenic oral HPV clearance was lower among prevalent than incident-detected infections (aHR = 0.44, 95% CI = 0.35 to 0.55), among men than women (aHR = 0.74, 95% CI = 0.60 to 0.91), for older participants (aHR per 10 years increasing age = 0.81, 95% CI = 0.74 to 0.89), and among people living with HIV (aHR = 0.76, 95% CI = 0.60 to 0.95). One participant who had oral HPV-16 consistently detected at 10 study visits over 4.5 years was subsequently diagnosed with HPV-OPC.ConclusionsThis prospective study of oncogenic oral HPV infection is the longest and largest quantification of oral HPV-16 infections to date.

The effectiveness of HPV viral load, reflected by Cobas 4800 HPV-Ct values for the triage of HPV-positive women in primary cervical cancer screening: Direct endocervical samples.

ObjectiveTo explore the relationship between the viral load reflected by the Ct value of Cobas 4800 HPV test and cervical lesions, and the effectiveness of the viral load for secondary triage of HPV-positive women.MethodsThe Chinese Multi-Center Screening Trial (CHIMUST) evaluated both self-collected samples and physician-collected samples from women, aged 30 to 59, who were screened for cervical cancer in 6 regions across China. Using physician collected samples, the relationship between the HPV-Ct values of different subtypes and the cervical lesions was analyzed. Then the combined use of the HPV-Ct values with the HPV subtypes was evaluated as a secondary screening algorithm for the women who were HPV positive.ResultsThe Ct values of HPV16 and 12 other HPV subtypes(12-type pool), tested with Cobas decreased with the progression of cervical lesion (HPV16: r = -0.429, P<0.001; 12 other HR-HPV subtypes: r = -0.099, P<0.01). The HPV18-Ct value was not correlated with cervical lesion(P>0.05). Compared with HPV16/18 and cytology (HPV16/18 positive and 12-type pool plus cytology ≥ ASC-US), the sequential secondary screening using HPV16/18 and the viral load of 12-type pool (cut-point HPV-Ct≤31) had equal sensitivities for CIN2+ and CIN3+ (83.1%vs.80.3%,100%vs.92.6%,P>0.05), with slightly lower specificities (96.2%vs.94.4%,96.5%vs.93.9%,P<0.001) and higher colposcopy referral rate (4.90%vs.6.59%, P<0.05), but required no cytology.ConclusionType-specific HPV viral load is closely related to cervical lesions severity. It is feasible and efficient to use HPV16/18 and the viral load of 12 other HPV subtypes (with cut-point HPV-Ct≤31) as the secondary screening for HPV positive women. This algorithm may be useful in low resource regions.

Abstract A17: Human papillomavirus type 16 and 18 viral loads as predictors associated with abnormal cervical cytology among women in Saudi Arabia

Abstract The present study aimed to screen for and genotype HPV among Saudi women; develop sensitive quantitative polymerase chain reaction (qPCR) assays to detect the viral load for the two most common HPV types, namely 16 and 18; and assess whether HPV viral load could be used as a marker for cervical abnormality and disease progression. This study examined 733 specimens (both formalin-fixed, paraffin-embedded specimens and PAP smear samples) from women who underwent cervical screening. The specimens and samples were processed for DNA extraction and then tested for HPV DNA. Approximately 165 specimens (18%) were positive for HPV. Those specimens were genotyped using a reverse line blotting hybridization assay. The results indicated that the most common HPV types detected were a single infection with HPV 16 (51%) or with HPV 18 (28%) followed by infections with multiple HPV types (~7%). A qPCR TaqMan assay developed in-house was used to determine the viral load for HPV genotypes 16 (n=80) and 18 (n=45). Viral loads for both HPV types were significantly associated with cervical cytology grade (P &amp;lt; 0.05). The odds ratio (OR) for the HPV 16 viral load was high for specimens with cervical cancer (OR, 18.8; 95% CI, 4.3–82.9) or for those with high-grade squamous intraepithelial lesions (OR, 14.7; 95% Cl, 2.43–88.49). For the HPV 18 viral load, the OR was significant only for specimens with cervical cancer (OR, 11.1; 95% Cl, 2.2–54.9). Logistic regression models for HPV 16 and for HPV 18 viral load levels were significant, with higher viral load associated with cervical abnormalities. These findings indicate that viral load is a predictor significantly associated with cytology abnormality in women who are positive for high-risk HPVs and suggest integrating a viral load test into current clinical screening practices for HPV-positive women. Citation Format: Dalia Obeid, Shihana Almatrrouk, Hadeel Khayat, Turfah Al-Muammer, Asma Tullbah, Ismail Albadawi, Mohammed Alahdal, Fatimah Alhamlan. Human papillomavirus type 16 and 18 viral loads as predictors associated with abnormal cervical cytology among women in Saudi Arabia [abstract]. In: Proceedings of the AACR Special Conference on the Microbiome, Viruses, and Cancer; 2020 Feb 21-24; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2020;80(8 Suppl):Abstract nr A17.

Significance of HPV16 Viral Load Testing in Anal Cancer

Human papilloma virus (HPV) is highly frequent among patients with anal squamous cell carcinoma, but the viral load (VL) differs between patients. This study aimed to compare the rate of HPV positivity, HPV16VL, p16INK4A and p53 expression between treatment naive and recurrent anal cancer patients. HPV was genotyped via AmpliSens® HPV HCR-genotype-titre-FRT kit. HPV16 VL was determined via quantitative polymerase chain reaction-based in-house test. p16INK4A and p53 expression was tested via immunohistochemistry. The cohort comprised 13 treatment-naive and 17 recurrent anal SCC patients. High-risk HPV was detected in 87% of cases, and HPV16 (73%) was the predominant genotype. The rate of HPV positivity was higher among women and nonsmokers, and majority of HPV-positive cases were also p16INK4A-positive. All p53-negative tumors were HPV16-positive. The most predominant p53 staining pattern in the HPV-positive group was scattered type, whereas it was diffuse type in the HPV-negative group. The HPV16 VL was higher in the treatment-naive group. Further, in the treatment-naive group, cases with scattered staining pattern of p53 had higher HPV16 VL than cases with diffuse staining pattern. The opposite result was noted in the recurrent cancer group. Moreover, p16-positive cases with scattered p53 staining pattern in the treatment naive group had higher HPV16 VL than their counterparts in the recurrent cancer group. In conclusion, the HPV VL, as is the association between VL and p16INK4A /p53, is in an inversed trend in treatment naive and recurrent cancer patients, highlighting the importance of HPV VL measurement in anal SCC.

Multiple HPV Infections and Viral Load Association in Persistent Cervical Lesions in Mexican Women.

Persistent high-risk human papillomavirus (HR-HPV) infections play a major role in the development of invasive cervical cancer (CC), and screening for such infections is in many countries the primary method of detecting and preventing CC. HPV typing can be used for triage and risk stratification of women with atypical squamous cells of undetermined significance (ASC-US)/low-grade cervical lesions (LSIL), though the current clinical practice in Mexico is to diagnose CC or its preceding conditions mainly via histology and HR-HPV detection. Additional information regarding these HPV infections, such as viral load and co-infecting agents, might also be useful for diagnosing, predicting, and evaluating the possible consequences of the infection and of its prevention by vaccination. The goal of this follow-up hospital case study was to determine if HPV types, multiple HPV infections, and viral loads were associated with infection persistence and the cervical lesion grade. A total of 294 cervical cytology samples drawn from patients with gynecological alterations were used in this study. HPV types were identified by real-time PCR DNA analysis. A subset of HPV-positive patients was reevaluated to identify persistent infections. We identified HPV types 16, 18, and 39 as the most prevalent. One hundred five of the patients (59%) were infected with more than one type of HPV. The types of HPV associated with multiple HPV infections were 16, 18, and 39. In the follow-up samples, 38% of patients had not cleared the initially detected HPV infection, and these were considered persistent. We found here an association between multiple HPV infections and high viral loads with and infection persistence. Our findings suggest there are benefits in ascertaining viral load and multiple HPV infections status of HR-HPV infections for predicting the risk of persistence, a requirement for developing CC. These findings contribute to our understanding of HPV epidemiology and may allow screening programs to better assess the cancer-developing risks associated with individual HR-HPV infections.