Human papillomavirus testing as an optional screening tool in low-resource settings of Latin America: experience from the Latin American Screening study

Abstract

Hybrid capture II (HC II) test for oncogenic human papillomaviruses (HPV) was carried out in a cohort of 4284 women at their first clinical visit. Overall prevalence of HPV was 17.1%, decreasing with age from 33.9% among women below 20 years to only 11.0% among those older than 41 years. HPV prevalence was significantly higher among current smokers (odds ratio [OR] = 1.31; 95% CI 1.1-1.6), in women with two or more lifetime sexual partners (OR = 1.9; 95% CI 1.6-2.4), and those women with two or more sexual partners during the past 12 months prior to examination (OR = 1.6; 95% CI 1.2-2.2). HPV detection increased in parallel with increasing cytologic abnormality, being highest in women with high-grade squamous intraepithelial lesion (P= 0.001). Specificity of the HPV test in detecting histologically confirmed cervical disease was 85% (95% CI 83.9-86.1). Sensitivity of the HPV test in detecting histologic abnormalities increased in parallel with disease severity, ranging from 51.5% for cervical intraepithelial neoplasia (CIN) 1 to 96.5% for CIN 3 and 100.0% for cancer, with respective decline of positive predictive value. These data suggest that HPV testing with HC II assay might be a viable screening tool among this population with relatively high prevalence of cervical disease.

Safety of screening with Human papillomavirus testing for cervical cancer at three-year intervals in a high-risk population: experience from the LAMS study

“…12 A cohort of over 12,000 women was enrolled from five different regions, the study design, baseline data and tentative results of hrHPV testing and VIA/VILI being reported. 13,14 Based on the completion of the prospective follow-up of over 1000 of these women, 13 the present study reports the acquisition of cytological abnormalities among baseline hrHPV-positive and hrHPV-negative women, derived from this low income, relatively unassisted and previously incompletely studied Latin American population. The main aim was to assess, whether hrHPV testing is a safe enough approach to warrant extension of the screening intervals of those women who test Papanicolaou (Pap)-and hrHPV-negative at baseline.…”

Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) L1 virus‐like‐particle vaccine in Latin American women

“…32 Another large ongoing study, the Latin American Screening Study or LAMS, has enrolled over 12,000 women from low-resource areas of Brazil and Argentina. 20 Together with these exploratory studies using traditional Pap smear, recent experiences Per-protocol included all subjects who received 3 doses of vaccine or placebo and were seronegative and PCR negative for the relevant HPV type(s) at day 1 (and PCR negative for the relevant HPV types at month 7) -case counting began at month 7; unrestricted susceptible included subjects who received at least 1 dose of vaccine or placebo and were seronegative and PCR negative at enrollment for the appropriate vaccinerelated HPV type -case counting began 30 days after enrollment; intention-to-treat included all subjects who received at least 1 dose of vaccine and returned for follow-up -case counting began at day 1. Two subjects under age 16 were included in the analysis; both in the placebo group-neither became a case.-2 Subjects are counted once per row, but could be included in more than 1 row.…”

“…As previously stated, the prevalence of HPV is generally accepted to be between 14 and 17% among women aged 18-65 with normal cervical cytology in Latin America; however, for women under 25 years of age the prevalence is over 30%. [9][10][11][12]20 We report a prevalence of HPV 6/11/16/18 infection at enrollment of 13.9%, although only for the 4 vaccine-related HPV types. When positive results by serology are considered, the prevalence of HPV exposure rises to 32.1%, highlighting the transient nature of most HPV infections.…”

“…The few relatively well-organized screening programs that do exist in Latin America are primarily located in large urban centers. 20 The necessity of developing a primary prevention strategy to decrease the incidence of HPV infection and its consequences is evident in Latin America, as well as the rest of the world. Recent Phase III trials conduced in 17,500 young adult women have demonstrated that a prophylactic quadrivalent (types 6/11/16/18) HPV L1 virus-like particle (VLP) vaccine was highly effective in preventing HPV 6-, 11-, 16-or 18-related cervical, vaginal and vulvar neoplasias (as well as anogenital condylomata) in women who were na€ ıve to the respective vaccine HPV types at enrollment.…”

Cervical Cancer in Latin America and the Caribbean: The Problem and the Way to Solutions

“…In recent years, highly sensitive and reproducible laboratory techniques to detect oncogenic HPVs have been developed and are now being used or considered to replace cervical cytology for primary screening (14). Different methodologies and algorithms have been proposed; several studies are ongoing in LAC, but the overall experience is incipient to impact public health decisions in most countries of the region (15)(16). Recent reports indicate that HPV testing could be more cost-effective than cervical cytology in large health delivery organizations such as those existing in the larger LAC countries, for example, Mexico (17).…”