Human Papillomavirus Deoxyribonucleic Acid Research Articles

Current role of viral biomarkers in cervical carcinogenesis

Viral biomarkers for cervical cancer screening are valuable in improving timely diagnosis and detection at early stage. The various biomarkers currently there is evidence include high-risk human papillomavirus (hrHPV) deoxyribonucleic acid (DNA) testing, there is place for further research for biomarkers such as hrHPV genotyping hrHPV transcriptional status, and host DNA methylation. Though the evidence is conclusive for hrHPV DNA testing, there is place for further research for biomarkers such as hrHPV genotyping hrHPV transcriptional status, and host DNA methylation. This application of these biomarkers in context of low resource settings has its limitations despite high prevalence of the disease. Improved women participation can be achieved by use of self-samples thereby improving diagnoses rate of the disease and higher cost effectiveness of the screening programme. In due course, biomarkers will be made available in the screening programmes together with self-sampling that will detect hrHPV infections and low-grade squamous intraepithelial lesions (LSIL) before they progress to high-grade squamous intraepithelial lesions (HSIL), and from there to malignancy. This would facilitate prudent timely clinical decisions, reduced patient anxiety, reduction in over referral and unnecessary treatments in women, especially in developing countries.

Cervical cancer screening program in Indonesia: is it time for HPV-DNA tests? Results of a qualitative study exploring the stakeholders’ perspectives

ObjectivesCervical cancer is a significant public health concern in Indonesia, and effective screening methods are necessary to improve the detection and reduce mortality. This study aimed to explore the perspectives of high-level stakeholders involved in cervical cancer screening in Indonesia and whether the use of human papillomavirus-deoxyribonucleic acid (HPV-DNA) methods for cervical cancer screening is acceptable in Indonesian settings.MethodsA qualitative research approach guided by realist evaluation was applied using focus group discussions (FGDs) between December 2021 and February 2022, conducted with stakeholders involved in cervical cancer screening in Indonesia. They were representatives of practitioners and policymakers involved in the screening, and were recruited through purposive recruitment. The data were analysed using inductive approach of thematic analysis.ResultsThe analysis of two FGDs with 29 participants identified four main themes: (i) Visual inspection with acetic acid (VIA) method as the most common modality used for cervical cancer screening, (ii) the applied screening programs in the community, (iii) the perceived challenges on the screening program, such as limitations of the National Health Insurance benefits package and a lack of regulations regarding screening procedures, and (iv) the possibilities of HPV-DNA testing as another modality for cervical cancer screening. Incorporating HPV-DNA testing also needs to ensure the capacity of the workers and the readiness of healthcare facilities.ConclusionAlthough HPV-DNA testing is a promising modality, challenges on the cervical cancer screening in Indonesia remain on the coverage, accessibility of the tools in practice and the women’s awareness towards the screening. Ultimately, the findings of this study would help inform policies to improve cervical cancer screening programs in Indonesia.

Cervical cancer screening and treatment costing in Senegal.

in Senegal, cervical cancer is the leading cause of cancers among women. This study estimated the costs associated with cervical cancer screening and treatment for precancerous lesions from the health system perspective. we estimated costs for screening, diagnostics, and treatment. We conducted a cross-sectional study in seven regions with primary data collected from 50 health facilities. Data collection included structured questionnaires, with secondary data from the Ministry of Health and other sources. A mixed-methods approach combined ingredients-based costing and financial expenditures to estimate direct medical and non-medical costs. All costs are reported in 2019 USD. average costs were $3.71 for visual inspection with acetic acid, $16.49 for Pap smear, and $46.65 for human papillomavirus deoxyribonucleic acid (HPV DNA) testing. Screening cost drivers were clinical exam supplies and clinical equipment for visual inspection with acetic acid, offsite processing of specimens for Pap smear, and lab equipment costs for HPV DNA procedure. The average cost of diagnosis via colposcopy alone was $25.73, and colposcopy with biopsy/endocervical curettage was $74.96. The average cost of treatment followed by one visit for pre-cancerous lesions was $195.24 for loop electrosurgical excision, $47.35 for cryotherapy, and $32.35 for thermal ablation. Clinical equipment and lab costs were the largest contributors to colposcopy and endocervical curettage/biopsy expenses. Clinical equipment made up the largest portion of cryotherapy, loop electrosurgical excision, and thermoablation costs. this study is the first to estimate the costs of HPV screening and treatment in Senegal, which can be used to inform decision-making on cervical cancer investments.

Cost-utility and budget impact analyses of cervical cancer screening using self-collected samples for HPV DNA testing in Thailand

IntroductionCervical cancer ranks as the third most prevalent cancer among women in Thailand. However, the effectiveness of cervical cancer screening programs is limited by several factors that impede the screening rate. The utilization of self-collected samples for screening purposes has the potential to alleviate barriers to screening in Thai women. This study assessed the cost-utility and budget impact of implementing cervical cancer screening using self-collected samples for human papillomavirus (HPV) deoxyribonucleic acid (DNA) testing in Thailand.Materials and methodsWe employed a decision tree integrated with a Markov model to estimate the lifetime costs and health benefits associated with the cervical cancer screening program for women aged 25–65. The analysis was conducted from a societal perspective. Four screening policy options were compared: (1) additional self-collected samples for HPV DNA testing, (2) clinician-collected samples for HPV DNA testing only, (3) clinician-collected samples for cytology test (i.e., status quo), and (4) no screening. The model inputs were based on unvaccinated women. The screening strategies and management in those with positive results were assumed followed to the Thai clinical practice guideline. Costs were reported in 2022 Thai baht. Sensitivity analyses were conducted. The ten-year budget impacts of the additional self-collected samples for HPV DNA testing were calculated from a payer perspective.ResultsAll screening policies were cost-saving compared to no screening. When comparing the additional self-collected samples for HPV DNA testing with the clinician-collected samples policy, it emerged as the dominant strategy. The incremental benefit in cervical cancer prevention achieved by incorporating self-collected samples for screening was observed at any additional screening rate that could be achieved through their use. Sensitivity analyses yielded consistently favorable results for the screening policies. The average annual budget impact of the additional self-collected samples for screening policy amounted to 681 million Thai baht. This budget allocation could facilitate cervical cancer screening for over 10 million women.ConclusionsAn addition of self-collected samples for HPV DNA testing into the cervical cancer screening program is cost-saving. The benefits of this screening policy outweigh the associated incremental costs. Policymakers should consider this evidence during the policy optimization process.

Human Papillomavirus among Women Undergoing Papanicolaou Smear Test in the Department of Gynaecologic Oncology of a Tertiary Care Centre.

In invasive cervical specimens or precursors, high-risk human papillomavirus Deoxyribonucleic acid may be detected to identify females at risk of developing cervical cancer. This study aimed to find out the prevalence of human papillomavirus among women undergoing Papanicolaou smear tests in a tertiary care centre. A descriptive cross-sectional study was conducted among women undergoing the Papanicolaou smear test in the Department of Gynaecologic Oncology, Nepal Armed Police Force Hospital, between 1 June 2022 and 15 November 2022. Ethical approval was obtained from the Ethical Review Board. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among the 199 women, 6 (3.02%) (0.64-5.40, 95% Confidence Interval) had human papillomavirus infection. The mean age of the infected females was 31.17±5.57 years. Human papillomavirus DNA for 16 and 18 were detected in 4 (66.67%) and 2 (33.33%) females, respectively. The prevalence of human papillomavirus in females was found to be lower than other studies done in similar settings. cytology; histology; human papillomavirus; Nepal; prevalence.

Is HPV-negative cervical carcinoma a different type of cervical cancer?

Human papillomavirus (HPV), which is known to play a very important role in genital area (vulva, vagina, and cervix) cancers in women, is responsible for almost all cervical cancers. However, a significant proportion of cervical carcinomas (approximately 7%) is HPV-negative. Therefore, there are still two important questions to be answered: 1. Why is HPV Deoxyribonucleic acid (DNA) not found in all cervical carcinomas? 2. Are HPV-DNA-negative cervical cancers a specific subgroup of cervical cancers with different biological behavior (worse prognosis)? In this article, we aimed to evaluate the clinicopathological characteristics and survival of patients with confirmed HPV-negative tumors in order to answer these two questions. A total of 97 patients who underwent HPV-DNA testing and received a histological diagnosis of cervical cancer were included in the study. 14 HPV-DNA negative and 83 HPV-DNA positive cervical carcinoma patients were detected. Demographic profiles, clinicopathological characteristics, progression-free, and overall survival of all patients were analyzed. Women with HPV-negative tumors were diagnosed at an older age range (p=0.05), and their demographic data other than age range were similar to HPV-positive tumors. P16 staining pattern was not observed in any of the HPV-negative tumors (p=0.001), and a positive P53 staining pattern was detected in 35.7% of the HPV-negative tumors. Although disease-free survival (PFS) (p=0.224) and overall survival (OS) (p=0.219) were worse in the HPV-negative patient group, this difference was not statistically significant. HPV-negative cervical cancers do not have a poor prognosis unlike their counterparts in other anatomical regions where HPV-associated tumors are present.

Intra- and interlaboratory reproducibility of the RIATOL qPCR HPV genotyping assay.

The implementation of cervical screening based on human papillomavirus (HPV) continues to progress rapidly across countries. Evidence has shown that assays detecting high-risk human papillomavirus (hrHPV) deoxyribonucleic acid (DNA) are more effective than cytology-based screening. Validation of new hrHPV DNA assays requires both noninferior clinical accuracy compared to a standard comparator for cervical precancer and good reproducibility. This study builds upon previous diagnostic accuracy assessments of the RIATOL HPV genotyping qPCR assay and aims to evaluate the international validation criteria for reproducibility. The intra- and interreproducibility of the RIATOL-qPCR assay were assessed using 550 remnant cervical cell material from the cytology archive of the National Reference Center for HPV in Belgium. Specimens were collected in the context of cervical cancer screening and tested in two different laboratories. The international reproducibility criteria include the lower bound of 95% confidence interval of the intra- and interlaboratory agreement regarding the detection of hrHPV DNA exceeding 87% with kappa ≥0.50. The RIATOL-qPCR assay demonstrated excellent intralaboratory reproducibility, achieving an overall agreement of 98.2 (95% CI 96.6-99.1%) and a kappa of 0.96. Interlaboratory testing showed an overall agreement of 98.5 (95% CI 97.1-99.4%) with a kappa of 0.97. The RIATOL-qPCR assay fulfills the third criterion for HPV test reproducibility requirement for use in cervical cancer screening.

Knowledge of Cervical Cancer Screening and Prevention by Human Papillomavirus Deoxyribonucleic Acid and Human Papillomavirus Vaccination among Women Attending a Tertiary Care Centre.

Cervical cancer is one of the leading causes of morbidity and mortality among women globally as well as in Nepal. It is attributable to persistent infection by high-risk human papillomavirus, especially human papillomavirus-16 and human papillomavirus-18. The aim of this study was to find out the knowledge of cervical cancer screening and prevention by human papillomavirus deoxyribonucleic acid and human papillomavirus vaccination among women attending a tertiary care centre. A descriptive cross-sectional study was conducted in patients attending the outpatient Department of Gynaecology in a tertiary care centre from 18 March to 30 April 2023. After calculating sample size and taking a convenience sampling a survey questionnaire on knowledge of Cervical Cancer Screening and Prevention by Human Papillomavirus Deoxyribonucleic Acid and Human Papillomavirus Vaccination was collected. The point estimate was calculated at a 95% confidence interval. Among 508 women, 42 (8.25%) (5.86-10.64, 95% Confidence Interval) had knowledge of cervical cancer screening and prevention by human papillomavirus deoxyribonucleic acid and human papillomavirus vaccination. According to the questionnaires with a total sample of 508, 164 (32.28%) know about cervical cancer, 15 (2.95%) know about HPV infection, 14 (2.76%) know about HPV infection causes cervical cancer, and 21 (4.13%) know about HPV transmitted through multiple sex partners. The knowledge of cervical cancer screening and prevention by human papillomavirus deoxyribonucleic acid and human papillomavirus vaccination among women is very low. This study recommends having a health education and awareness programme on it to increase knowledge. cervical cancer; human papillomavirus; pap smear; sexual intercourse; vaccination.

EE278 A Systematic Review of Economic Evaluations of Cervical Cancer Screening Methods

Cervical cancer screening is a public health priority with the potential to improve pre-cancerous lesion detection in high-risk females for disease prevention. The objective of the systematic review was to identify primary and model-based economic evaluations of cervical cancer screening methods, and to provide a contextual summary of valuation outcomes associated with three types of cervical cancer screening tests: Visual Inspection with Acetic Acid, Human Papilloma Virus Deoxyribonucleic Acid, and Papanicolaou Smear.

A Descriptive Study of Different Methods of Cervical Cancer Screening among Ever-Married Women in 35-Year and 45-Year Cohorts in Kalutara District, Sri Lanka.

Screening for cervical cancer in Sri Lankan females with Pap smears (conventional cytology) has shown no marked reduction in cervical cancer incidence over the past two decades. The study aims to compare the efficacy of Pap smear, with other screening tools such as Liquid Based Cytology (LBC) and Human Papilloma Virus/deoxyribonucleic acid (HPV/DNA) (using cobas 4800) in detection of underlying cervical intraepithelial neoplasia (CIN) and cervical cancer among 35 and 45 year old ever married women in Kalutara districtin Sri Lanka. Women from 35-year cohort and 45-year cohort were selected from all Public Health Midwife areas (n=413) in Kalutara district by random sampling. Pap smear, LBC, and HPV/DNA specimen were collected s from women who attended the Well Woman Clinics (WWC) . Women with positive results from any method were confirmed by colposcopy. Results: Of the, 510 and 502 women in the 35-year cohort and 45-year cohort, respectively, included in the analysis, nine women among 35-year cohort (1.8%) and 7 women among 45-year cohort (1.4%) had cytological abnormality (positive results) with Pap smears. Thirteen women among 35-year cohort (2.5%) and 10 women among 45-year cohort (2%) age groups had cytological abnormality (positive results) with Liquid Based Cytology reports. Total of 32 women among 35-year cohort (6.2%) and 24 women among 45-year cohort (4.8%) were positive for HPV/DNA test. Of the women tested positive on screening, colposcopy revealed that HPV/DNA method was superior to Pap and LBC for detecting CIN while the results of latter two were comparable. The CIN detection rate by colposcopy was high with HPV/DNA screening with cobas 4800, whereas the detection rate by LBC was insignificantly higher than Pap smears.

Detection of Human Papillomavirus among Cervical Cancer Patients by Qualitative Polymerase Chain Reaction on Formalin- fixed, Paraffin-embedded Tissue: A Retrospective Observational Analysis

Introduction: Cervical cancer is second most commonly diagnosed and third most common cause for cancer death among women in the developing countries. It is now-established that Human Papillomavirus (HPV) infection is responsible for pathogenesis of cervical cancer. HPV Deoxyribonucleic Acid (DNA) detection is generally done on cytology specimens to triage women undergoing cervical cancer screening, but testing of Formalin-fixed, Paraffin- embedded tissue (FFPE) is not yet widely used. Aim: To study the detection of HPV by Qualitative PCR by extraction of DNA from FFPE. Materials and Methods: This retrospective observational analysis was carried out at Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India, managed at the centre from 2008 to 2015. The data analysis was done Aug 2013-Oct 2015 on 35 patients of cervical cancer which were reconfirmed by histopatholgical study of sections. Tissue blocks were obtained from the selected subjects and 3-5 micron sections were taken and prepared for Haematoxylin and Eosin (H&E) staining. Qualitative PCR was run on DNA extracted from FFPE tissue for evaluation of HPV. The amplified DNA varied between 230-270 base pairs (bp) and was analysed for oncogenic HPV type 16, 18, 31, 33, 35, 45, 52b and 58 by gel electrophoresis. Data was tabulated in Microsoft excel and mean, frequency and percentages were calculated. Pearson’s Chi-square test was used to calculate the significance. Results: Out of the total 35 samples analysed (mean age: 51.08±10.6 years),15 cases were large cell non keratinising carcinoma, 12 cases of keratinising squamous cell carcinoma, 5 cases of carcinoma in-situ and 3 cases were adenocarcinoma. A total of 13 cases out of 35 showed the bands of HPV genomes, indicating either of the HPV strain. Conclusion: Although molecular diagnostics on FFPE tissue is need of hour, stringent protocols for timing of fixation, technical expertise for extraction of DNA or Ribonucleic Acid (RNA), careful handling of the sample and quality control is of paramount importance. Fragmentation is a problem in DNA extracted from FFPE tissue, so primers having small base pairs should be used to maximise the yield.

Demographic profile and risk factors of head-and-neck squamous cell carcinoma in west Tamil Nadu: A cross-sectional observational study

ABSTRACT JOURNAL/crsat/04.03/02201859-202306020-00007/figure1/v/2023-08-03T140821Z/r/image-tiff JOURNAL/crsat/04.03/02201859-202306020-00007/figure2/v/2023-08-03T140821Z/r/image-tiff Background: Head-and-neck squamous cell carcinomas (HNSCC) comprise 30% of all cancer cases in India. The risk factors for HNSCC include tobacco and alcohol consumption. Objectives: Our primary objective was to evaluate the epidemiological profile of patients with HNSCC in the western Tamil Nadu population. Our secondary objective was to assess the association of the epidemiological profile with different anatomical sites and risk factors. Materials and Methods: This was a cross-sectional study of data compiled from the clinical records of Sri Ramakrishna Institute of Oncology and Research Department, Sri Ramakrishna Hospital, Coimbatore (Tamil Nadu, India) from January 2018 to December 2021. Clinicodemographic data like age, sex, primary tumor site, clinical staging, family history, and exposure to risk factors (smoking, tobacco chewing, alcohol) were collected from patients with histologically confirmed HNSCC using a specially designed questionnaire. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry and validated using polymerase chain reaction (PCR) by employing consensus primers for HPV deoxyribonucleic acid (DNA). Results: We enrolled 150 patients. The male-to-female ratio was 3:1. The mean age was 54.4 ± 10.2 years; majority of patients (59 [39.3%]) were aged between 51 and 60 years. The most frequently affected site was the oral cavity (58 [38.7%]). Tobacco chewing was the most common and the only risk factor observed among female patients (23 [62.2%]), while smoking along with alcohol consumption was commonly observed among male patients (24 [21.2%]). Smoking in combination with other risk factors (44 [29.3%]) was more common than smoking alone (9 [8%]). Tobacco chewing was a predominant risk factor for nasopharyngeal (4 [63.6%]) and oral cavity cancer (19 [32.8%]), while smoking was a predominant risk factor for laryngeal cancer (3 [30%]). Smoking with alcohol consumption was largely seen in oropharyngeal cancer (5 [33.3%]), while all three risk factors were observed in hypopharyngeal cancer (4 [14.3%]). Out of 38 samples tested, only four were positive for HPV (10.5%). Conclusions: The most affected demographic group with regard to HNSCC is middle-aged men (51–60 years), and the oral cavity is the most commonly affected site. Tobacco chewing is the most prevalent risk factor among women while smoking and alcohol consumption are the most common risk factors among men. Spreading awareness about the risk factors of HNSCC and their prevention is crucial to optimizing disease control.

Impact of HPV vaccination on HPV infection and cervical related disease burden in real-world settings (HPV-RWS): protocol of a prospective cohort

BackgroundCervical cancer is one of the most common cancers in women and could be prevented by human papilloma virus (HPV) vaccination. Cervarix, the first available HPV vaccine, has been widely administrated to Chinese women, while little was known about its effect on the prevention and control for HPV related diseases in China. The study aims to assess the impact of Cervarix on HPV infection and cervical related diseases in real world.MethodsThis is a prospective, multi-age birth cohort study to investigate the incidence and continuous status of HPV infection, and relevant cervical diseases by exposure status (with Cervarix vaccination history or without any HPV vaccination history). It is planned to recruit 12,118 eligible women at age of 9 to 45 years from vaccination clinics or hospital outpatient clinics, and then follow up them for three years. The standard questionnaire will be used to collect information such as demographic characteristics, menstruation and obstetrical histories, history of sexual behavior, personal behavior history, history of disease and pathogen infection, medication history, and family history at baseline. After three years, the changes of these behaviors will be investigated again, and other related health status information will be retrieved from the electronic health records during the follow-up period. If available physically and legally, the cervical cancer screening will be performed, including type-specific HPV deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) testing and contingent thinprep cytologic test (TCT) and colposcopy. The free cervical cancer screening will be captured and uploaded timely to the Yinzhou Regional Health Information Platform (YRHIP); therefore, the long-term outcomes of participants will be monitored.DiscussionThis prospective cohort study will assess the impact of HPV vaccine on HPV infection and related cervical diseases in women aged 9–45 years, which makes up for the lack of evidence in Chinese women. The results of this study will provide support for understanding the impact of HPV vaccination in China, and make a contribution to increasing HPV vaccination and cervical cancer screening coverage in China.Trial registrationThis study has been retrospectively registered on clinicaltrials.gov (NCT05341284) on April 22, 2022.

A systematic review of economic evaluations of cervical cancer screening methods

ObjectiveThe aims of this systematic review were to (1) identify primary- and model-based economic evaluations of cervical cancer screening methods and to (2) provide a contextual summary of valuation outcomes associated with three types of cervical cancer screening tests: visual inspection with acetic acid, human papillomavirus deoxyribonucleic acid, and Papanicolaou smear.IntroductionCervical cancer screening is an important public health priority with the potential to improve the detection of precancerous lesions in high-risk females for early intervention and disease prevention. Test performance and cost-effectiveness differ based on the specific screening method used across different platforms. There is a need to appraise existing economic evaluations of cervical cancer screening methods.MethodsThis review considered primary-based and model-based full economic evaluations of cervical cancer screening methods. The evaluation methods of interest included cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, cost–benefit analysis, and cost-consequence analysis. We searched Scopus, PubMed, National Health Economic Evaluation Database (NH EED), Cochrane, and the Health Economic Evaluation Database for full economic evaluations of cancer screening methods. No formal date restrictions were applied. Model-based and primary-based full economic evaluations were included. A critical appraisal of included studies was performed by the main investigator, while a second independent reviewer assessed critical appraisal findings for any inconsistencies. Data were extracted using a standardised data extraction tool for economic evaluations. The ultimate outcomes of costs, effectiveness, benefits, and utilities of cervical cancer screening modalities were extracted from included studies, analysed, and summarised.ResultsFrom a total of 671 screened studies, 44 studies met the study inclusion criteria. Forty-three studies were cost-effectiveness analyses, one study reported both cost-utility and cost-effectiveness outcomes, and another study reported cost utilities of cervical cancer screening methods only. Human papillomavirus (HPV) DNA testing was reported as a dominant stand-alone screening test by 14 studies, while five studies reported visual inspection with acetic acid (VIA) as a dominant stand-alone screening test. Primary HPV screening strategies were dominant in 21 studies, while three studies reported cytology-based screening strategies as the dominant screening method.ConclusionsExisting evidence indicates that HPV-based and VIA testing strategies are cost-effective, but this is dependent on setting. Our review suggests the limited cost-effectiveness of cytology-based testing, which may be due in part to the need for specific infrastructures and human resources.Systematic review registrationPROSPERO CRD42020212454.

Diagnostic accuracy of menstrual blood for human papillomavirus detection in cervical cancer screening: a systematic review.

Globally, cervical cancer is the fourth most common cancer among females and a major public health problem in low- and middle-income countries (LMICs). There are several screening tests available for cervical cancer screening; however, due to a lack of organised screening facilities as well as factors such as low participation rates in screening programmes, many women die due to cervical cancer. To reach out to a large number of women, an easy, non-invasive and time-saving screening method is required. Evidence supports that cervical cancer screening with human papillomavirus deoxyribonucleic acid (HPV DNA) testing is the most effective technique for lowering the incidence and mortality associated with cervical cancer when compared to other screening methods. Furthermore, a small number of studies have reported that menstrual blood can be used as an alternative sample for HPV detection for cervical cancer screening. We have done a systematic review of the studies that have reported the diagnostic accuracy of menstrual blood to detect HPV. We found five studies in our literature search. The studies showed the diagnostic accuracy of menstrual blood in terms of sensitivity ranging from 82.8% to 97.7% and specificity ranging from 50.0% to 98.0% in cervical intraepithelial neoplasia or HPV infection detection. This review supports the use of menstrual blood as a screening tool for cervical cancer especially in LMICs where women are reluctant to participate in cervical cancer screening due to issues such as embarrassment and discomfort to test procedures as well as busy schedules. However, further studies are required to compare the diagnostic accuracy of menstrual blood in detecting HPV compared to other self-sampled HPV detection methods. This is one of the methods that can be explored further for use as a cervical cancer screening test.

The diagnostic accuracy of TCT + HPV-DNA for cervical cancer: systematic review and meta-analysis.

BackgroundThis study sought to systematically analyze the clinical diagnostic value of tumor markers combined with ThinPrep cytologic test (TCT) and human papillomavirus (HPV) deoxyribonucleic acid (DNA) detection for cervical cancer and pre-cancerous lesions. However, there is a lot of controversy in the field of TCT + HPV-DNA. Many people have mixed opinions on the accuracy of TCT + HPV-DNA, and there is no unified opinion. Therefore, it is necessary to further confirm the significance of this combined detection method in the early diagnosis of cervical cancer by applying meta method.MethodsThe Cochrane Library, PubMed, Web of Science, Embase, Chinese Biomedical Literature Database (CBM) databases were searched to retrieve studies. To assess the methodological quality of each study and potential risk of bias, QUADAS-2 Guidelines were used to evaluate the quality of all articles that met the inclusion criteria and data extraction of the included articles were performed, and a meta-analysis was performed of the included studies using Review Manager 5.2 software.ResultsA total of 5 studies were included in the study, and a total of 2,778 patients were included in the study, and there was no significant publication bias observed. The meta-analysis showed that there was a statistical difference in terms of the accuracy of the tumor markers combined with TCT in the detection of cervical cancer. The results were as follows: the pooled sensitivity (SEN) was 0.86 (95% CI: 0.75–0.93); the combined specificity (SPE) was 0.79 (95% CI: 0.57–0.92); the diagnostic performance of combined with thin-layer liquid-based cytology and HPV DNA detection in the diagnosis accuracy of cervical cancer by summary receiver operating characteristic (SROC) curve analysis, result showed excellent diagnostic accuracy, with a combined area under the curve (AUC) of 0.90 (95% CI: 0.87–0.92).DiscussionTumor markers are important for the early diagnosis of cervical cancer. Combining the tumor markers with TCT and HPV DNA detection effectively improved the detection rate.

Validity of Vaginal Self-Collected Samples for Human Papillomavirus Deoxyribonucleic Acid Detection among Women in Rural Delta State, Nigeria

Background: With the emergence of human papillomavirus-based primary screening, the option of vaginal self-collected sample may overcome the barrier of speculum examination. Despite evidence of high acceptability of self-collection, there is need to evaluate the validity of such samples for HPV detection. This research aimed to determine the validity of self-collected vaginal samples for HPV detection among Nigerian women. Methods: A cross-sectional analytic study was conducted among 230 asymptomatic women, selected by multi-stage sampling method in Orhuwhorun community in Udu Local Government Area of Delta State between May to June 2021. Participants were instructed on self-collection (SC) of vaginal samples using Flobam female sample collection kit and a clinician-collected (CC) cervical sample was obtained using a similar swab. Paired specimens were tested for HPV genotyping using 21 HPV GenoArray Diagnostic kits. SPSS vs 25 was used for data analysis. Agreement between the two collection methods was calculated using concordance and discordance rates and Cohen's kappa statistic. A 2 by 2 contingency table was used to calculate sensitivity and specificity of both sampling methods. A p < 0.05 was considered statistically significant. Results: 230 women of mean age 41.08 years (SD ± 8.45) were enrolled and 228 paired SC and CC results were analyzed. Of the 228 samples, 44 (19.3%) and 48 (21.1%) had HPV on clinician-collected and self-collected samples respectively. The HPV detection concordance was 92.9% (95%CI: 89.7–96.3), Kappa value of 0.66 (p < 0. 001), showing substantial agreement. Sensitivity and specificity of SC compared to CC were 86.4% (95%CI: 76.2–96.5) and 94.6% (95%CI: 91.3–97.8) respectively. Odds ratio was 1.15 indicating SC is as good as CC for HPV detection. Conclusions: The excellent validity of SC support its use as an alternative form of HPV screening among Nigerian women hence the government should consider its introduction into the national cervical screening programme.

Efficacy of Single-Dose Human Papillomavirus Vaccination among Young African Women

BackgroundSingle-dose human papillomavirus (HPV) vaccination, if efficacious, would be tremendously advantageous, simplifying implementation and decreasing costs.MethodsWe performed a randomized, multicenter, double-blind, controlled trial of single-dose nonavalent (HPV 16/18/31/33/45/52/58/6/11 infection) or bivalent (HPV 16/18 infection) HPV vaccination compared with meningococcal vaccination among Kenyan women 15 to 20 years of age. Enrollment and 6-monthly cervical swabs and a month 3 vaginal swab were tested for HPV deoxyribonucleic acid (DNA). Enrollment sera were tested for HPV antibodies. The modified intent-to-treat (mITT) cohort comprised participants who had an HPV antibody-negative result at enrollment and an HPV DNA-negative result at enrollment and month 3. The primary outcome was incident persistent vaccine-type HPV infection by month 18.ResultsBetween December 2018 and June 2021, 2275 women were randomly assigned and followed. A total of 758 participants received the nonavalent HPV vaccine, 760 received the bivalent HPV vaccine, and 757 received the meningococcal vaccine; retention was 98%. Thirty-eight incident persistent infections were detected in the HPV 16/18 mITT cohort: one each among participants assigned to the bivalent and nonavalent groups and 36 among those assigned to the meningococcal group. Nonavalent vaccine efficacy (VE) was 97.5% (95% confidence interval [CI], 81.7 to 99.7%; P≤0.0001), and bivalent VE was 97.5% (95% CI, 81.6 to 99.7%; P≤0.0001). Thirty-three incident persistent infections were detected in the HPV 16/18/31/33/45/52/58 mITT cohort: four in the nonavalent group and 29 in the meningococcal group. Nonavalent VE for HPV 16/18/31/33/45/52/58 was 88.9% (95% CI, 68.5 to 96.1; P<0.0001). The rate of serious adverse events was 4.5% to 5.2% by group.ConclusionsOver the 18-month timeframe we studied, single-dose bivalent and nonavalent HPV vaccines were each highly effective in preventing incident persistent oncogenic HPV infection, similar to multidose regimens. (Funded by the National Institutes of Health, the Bill and Melinda Gates Foundation, and the University of Washington; ClinicalTrials.gov number, NCT03675256.)

Giant anogenital tumor of Buschke\u2013L\xf6wenstein in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome: a case report

BackgroundBuschke–Löwenstein tumor is a giant condyloma acuminata infection that is characterized by degeneration, invasion, and recurrence. It is associated with human papilloma virus infection. It develops around the genital and perineal area, sometimes causing a large budding ulcerated lesion. Although human immunodeficiency virus infection is frequent in Africa, there are few descriptions of Buschke–Löwenstein tumor diagnosis and its management. Screening for other sexually transmitted infections must be systematic among these patients.Case presentationWe report herein the case of a 21-year-old African origin male patient who developed a perineal swelling. Physical examination showed evidence of a huge exophytic tumor made up of budding pinkish vegetations, with serrated crests, a ‘’butterfly wing’’ structure, and a cauliflower-like appearance crowned with centrifugal circinate lesions. Multiple condylomatous lesions of the anal margin were also present. The patient tested positive for human immunodeficiency virus (cluster of differentiation 4 count of 119 cells/mm3) and hepatitis B infections. Real-time polymerase chain reaction revealed human papilloma virus-16 and other high-risk human papilloma virus deoxyribonucleic acid. The diagnosis of Buschke–Löwenstein tumor was made on mass biopsy, and the patient underwent multidisciplinary intervention (surgery, podophyllin application, and antiretroviral therapy). Medium-term evolution was, however, fatal due to opportunistic infection.ConclusionBuschke–Löwenstein tumor is a rare tumor associated with human immunodeficiency virus infection. It is more frequent in male human immunodeficiency virus-positive patients. There is a need to screen for other sexually transmitted infections. In most cases, the treatment is surgical, in association with local therapies. However, recurrences are common.

Performance of visual Inspection With Acetic Acid for Cervical Cancer Screening as Compared to Human papillomavirus Deoxyribonucleic acid Testing Among Women With HIV in Ethiopia: A Comparative Cross-sectional Study.

ObjectivesThe aim of this study was to evaluate the performance of visual inspection with acetic acid compared with Human papillomavirus Deoxyribonucleic acid (HPV DNA) testing among women with HIV in Ethiopia.MethodsA comparative cross-sectional study was conducted to address the aforementioned objective. Data were collected from January to October 2021, to compare the performance of these two screening modalities. Trained clinicians collected cervical specimens and immediately applied acetic acid for visual inspection. The HPV DNA testing was done using Abbott m2000rt/SP by trained laboratory professionals in accredited laboratories. A total of 578 women with HIV aged 25-49 years were included.ResultsTest positivity was 8.9% using visual inspection with acetic acid (VIA) and 23.3% using HPV DNA test. The sensitivity and specificity of the VIA test were 19.2% and 95.1%, respectively. The strength of agreement between the two screening methods was poor (k = .184). The burden of genetic distribution of high risk HPV16 was 6.1%, and HPV18 was 1.1%. Other high risk HPV types (ie non-HPV 16/18 high risk HPV genotypes) were predominant in this study (18.6%).ConclusionThe higher positivity result using HPV DNA testing compared with VIA, and low sensitivity of VIA are indicating that the implementation of HPV DNA testing as the primary screening strategy is likely to reduce cervical cancer cases and deaths of women in the country.