Persistence and clearance of high‐risk human papillomavirus and cervical dysplasia at 1 year in women living with human immunodeficiency virus: a prospective cohort study

Abstract

Objective Evaluate 1-year outcomes of cervical cancer screening and treatment using primary high-risk human papillomavirus (HPV) testing in women living with human immunodeficiency virus (HIV).Design Prospective cohort study.Setting HIV treatment centre in Botswana.Population Women living with HIV.Methods Participants underwent cervical cancer screening with high-risk HPV testing and triage evaluation at baseline and 1-year follow up. Excisional treatment was offered as indicated. Histopathology was the reference standard.Main outcome measures Persistence, clearance and incidence of high-risk HPV infection; and persistence, progression, regression, cure and incidence of cervical dysplasia.Results Among 300 women screened at baseline, 237 attended follow up (79%). High-risk HPV positivity significantly decreased from 28% at baseline to 20% at 1 year (P = 0.02). High-risk HPV persistence was 46% and clearance was 54%; incidence was high at 9%. Prevalence of cervical intraepithelial neoplasia Grade 2 (CIN2) or higher was most common in participants with incident high-risk HPV (53%). CIN2 or higher was also common in those with persistent high-risk HPV (32%) and even in those who cleared high-risk HPV (30%). Of the high-risk HPV-positive participants at baseline with <CIN2, 40% progressed to CIN2 or higher at follow up. ConclusionThe high incidence of high-risk HPV and high-grade cervical dysplasia in women living with HIV after one round of high-risk HPV-based screening and treatment raises concern about the rate of progression of high-risk HPV infection to dysplasia. Persistent disease is common. Caution in spacing cervical cancer screening intervals using high-risk HPV testing in women living with HIV is warranted.

Progress and challenges in human papillomavirus and cervical cancer in southern Africa

“…Among 237 WLWH who returned for follow-up, the prevalence of CIN2+ was 9%, similar to the baseline prevalence of 8%. Incident CIN2+ among WLWH who were HR-HPV-negative at baseline was 5.3%, 10 times that in Kelly's study [17 ▪▪ ,30 ▪▪ ]. Although the numbers were small, there was a 40% (8/20) progression from no cervical disease to CIN2+ among WLWH who were HR-HPV positive at baseline [30 ▪▪ ].…”

“…Of those HR-HPV positive without CIN2+ at baseline, incident CIN2+ was 5.8%, whereas only 0.5% baseline HR-HPV-negative women developed incident CIN2+ at 16 months [17 ▪▪ ]. Luckett et al [30 ▪▪ ] reported higher rates of incident CIN2+ at 12–16 months among women who were baseline HR-HPV-negative [30 ▪▪ ]. Among 237 WLWH who returned for follow-up, the prevalence of CIN2+ was 9%, similar to the baseline prevalence of 8%.…”

Comparison of the AmpFire® Multiplex HPV Assay to the Xpert® HPV Assay for detection of human papillomavirus and cervical disease in women with human immunodeficiency virus: A pragmatic performance evaluation

“…20 Rates of concordant results between AmpFire and Roche linear array HPV on anal swabs was similarly high (90%). 17 In a population of women living with HIV, vaginal self-swabs were found to have 89% positive agreement between AmpFire and Xpert, with AmpFire being slightly more likely to diagnose HPV than Xpert. 28 Beyond agreement in HPV results, our ndings demonstrate the accuracy of AmpFire in identifying women with CIN2+, data which few other studies have con rmed.…”

Comparison of the AmpFire® Multiplex HPV Assay to the Xpert® HPV Assay for detection of human papillomavirus and cervical disease in women with human immunodeficiency virus: a pragmatic performance evaluation

“…Vaginal self-swabs had > 95% agreement between AmpFire, both Roche Cobas® 4800 HPV assay, and SeqHPV assay [ 20 ]. Rates of concordant results between AmpFire and Roche linear array HPV on anal swabs was similarly high (90%) [ 17 ]. In a population of women living with HIV, vaginal self-swabs were found to have 89% positive agreement between AmpFire and Xpert, with AmpFire being slightly more likely to diagnose HPV than Xpert [ 28 ].…”

“…While Botswana has excellent laboratory infrastructure to perform laboratory-based HPV testing, implementation of HPV testing at the national level is hindered by the cost of HPV testing [ 16 ]. In our research setting, high-risk HPV genotyping has been performed with the Xpert® HPV Assay and the Abbott RealTime® HPV assay, which both test for the same 14 high-risk HPV genotypes [ 17 ]. While the performance of these tests in a research setting was satisfactory, their cost prohibits national implementation of primary HPV screening, despite demonstration that HPV-based screening is the most effective method to screen our population.…”