Xpert human papillomavirus test is a promising cervical cancer screening test for HIV-seropositive women

Mbulawa, Zizipho Z. A.; Wilkin, Timothy; Goeieman, Bridgette; Swarts, Avril; Williams, Sophie; Levin, Simon; Faesen, Mark; Smith, Jennifer S.; Chibwesha, Carla J.; Williamson, Anna‐Lise; Firnhaber, Cynthia

doi:10.1016/j.pvr.2016.02.004

Cited by 20 publications

(20 citation statements)

References 26 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current study demonstrated the high HPV/HIV co-infection of 24.4%, with high hr-HPV prevalence across almost all age groups and more multiple hr-HPV infection in HIV-positive women than compared to HIV-negative women. These findings are consistent with previous studies reporting higher prevalence of HPV [9, 27, 30, 35] and higher frequency of infection with multiple HPV types among HIV infected women [30, 32, 36]. A number of risk factors for HPV infection among women have been demonstrated in previous studies, including having more than one partner, early sexual initiation, age and marital status.…”

Section: Discussionsupporting

confidence: 92%

Prevalence of and Associated Risk Factors for High Risk Human Papillomavirus among Sexually Active Women, Swaziland

et al. 2017

View full text Add to dashboard Cite

BackgroundHigh risk human papillomavirus (hr-HPV) infection and the dual burden of HIV remains a huge challenge in some low-income countries (LICs) such as Swaziland with limited or no data. We estimated the prevalence and investigated determinants of hr-HPV, including HIV infection among sexually active women in Swaziland.MethodsA total of 655 women aged between 15 and 49 years from five health facilities were randomly enrolled using a cross-sectional study design. Cervical cells were tested for hr-HPV types using GeneXpert HPV Assays.ResultsThe overall weighted hr-HPV prevalence was 46.2% (95%CI: 42.8–49.5). Of hr-HPV infected women, 12.4% (95%CI: 8.6–17.5) were HPV16-positive, 13.8% (95%CI:12.0–15.8) were positive for HPV18/45, 26.7% (95%CI: 24.2–29.3) for HPV31/33/35/52/58, 7.6% (95%CI: 7.6–11.9) for HPV51/59 and 11.0%, (95%CI: 7.9–15.3) for HPV39/56/66/68. Prevalence of hr-HPV decreased with increasing age. Overall HIV prevalence remained high (42.7%; 95%CI: 35.7–46.2). HIV infection was associated with hr-HPV infection (Adjusted OR = 4.9, 95%CI: 3.043–7.8, p<0.001). Overall hr-HPV/HIV co-infection was 24.4% (95%CI: 20.3–29.1) which was significantly higher among younger age groups (p<0.001). Prevalence of multiple group hr-HPV infection was significantly higher in HIV-positive versus -negative women (27.7% and 12.7% respectively, p<0.001). The presence, absence or unknown of history of STI with HIV did not appear to modify the relationship with hr-HPV (OR = 4.2, 95%CI: 2.6–7.1, OR = 4.6, 95%CI: 2.8–7.7, p<0.001, p<0.001 and OR = 4.1, 95%CI: 1.3–13.4, p<0.021 respectively).ConclusionThe prevalence of hr-HPV infection was high and significantly associated with HIV among sexually active women. Furthermore, the study has provided essential information about the HIV link with hr-HPV infections which may explain the high prevalence among HIV infected women. This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among youth and HIV infected people.

show abstract

Section: Discussionsupporting

confidence: 92%

Prevalence of and Associated Risk Factors for High Risk Human Papillomavirus among Sexually Active Women, Swaziland

et al. 2017

View full text Add to dashboard Cite

show abstract

“…HPV-based tests have high sensitivity for CIN2+/CIN3+ in both HIV-negative women and WLHIV, but specificity to distinguish CIN2+ is lower in WLHIV compared to HIV-negative women [30][31][32][33][34]. HPV-based tests targeting up to 14 HR types, including HC2, careHPV, and GeneXpert, have all shown high sensitivity but low specificity for CIN2+/CIN3+ in WLHIV [4][5][6]31,35,36], due to the high prevalence of HPV infection among these women. In a metaanalysis of 20 studies evaluating the association between HR-HPV prevalence and the specificity of HPV DNA testing (HC2) to distinguish CIN2+, HC2 specificity decreased by 8.4% (95% CI 8.02%-8.81%) for each 10% increase in HR-HPV prevalence [7].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of cervical cancer screening and screening–triage strategies among women living with HIV-1 in Burkina Faso and South Africa: A cohort study

et al. 2021

View full text Add to dashboard Cite

Background Cervical cancer screening strategies using visual inspection or cytology may have suboptimal diagnostic accuracy for detection of precancer in women living with HIV (WLHIV). The optimal screen and screen–triage strategy, age to initiate, and frequency of screening for WLHIV remain unclear. This study evaluated the sensitivity, specificity, and positive predictive value of different cervical cancer strategies in WLHIV in Africa. Methods and findings WLHIV aged 25–50 years attending HIV treatment centres in Burkina Faso (BF) and South Africa (SA) from 5 December 2011 to 30 October 2012 were enrolled in a prospective evaluation study of visual inspection using acetic acid (VIA) or visual inspection using Lugol’s iodine (VILI), high-risk human papillomavirus DNA test (Hybrid Capture 2 [HC2] or careHPV), and cytology for histology-verified high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) at baseline and endline, a median 16 months later. Among 1,238 women (BF: 615; SA: 623), median age was 36 and 34 years (p < 0.001), 28.6% and 49.6% ever had prior cervical cancer screening (p < 0.001), and 69.9% and 64.2% were taking ART at enrolment (p = 0.045) in BF and SA, respectively. CIN2+ prevalence was 5.8% and 22.4% in BF and SA (p < 0.001), respectively. VIA had low sensitivity for CIN2+ (44.7%, 95% confidence interval [CI] 36.9%–52.7%) and CIN3+ (56.1%, 95% CI 43.3%–68.3%) in both countries, with specificity for ≤CIN1 of 78.7% (95% CI 76.0%–81.3%). HC2 had sensitivity of 88.8% (95% CI 82.9%–93.2%) for CIN2+ and 86.4% (95% CI 75.7%–93.6%) for CIN3+. Specificity for ≤CIN1 was 55.4% (95% CI 52.2%–58.6%), and screen positivity was 51.3%. Specificity was higher with a restricted genotype (HPV16/18/31/33/35/45/52/58) approach (73.5%, 95% CI 70.6%–76.2%), with lower screen positivity (33.7%), although there was lower sensitivity for CIN3+ (77.3%, 95% CI 65.3%–86.7%). In BF, HC2 was more sensitive for CIN2+/CIN3+ compared to VIA/VILI (relative sensitivity for CIN2+ = 1.72, 95% CI 1.28–2.32; CIN3+: 1.18, 95% CI 0.94–1.49). Triage of HC2-positive women with VIA/VILI reduced the number of colposcopy referrals, but with loss in sensitivity for CIN2+ (58.1%) but not for CIN3+ (84.6%). In SA, cytology high-grade squamous intraepithelial lesion or greater (HSIL+) had best combination of sensitivity (CIN2+: 70.1%, 95% CI 61.3%–77.9%; CIN3+: 80.8%, 95% CI 67.5%–90.4%) and specificity (81.6%, 95% CI 77.6%–85.1%). HC2 had similar sensitivity for CIN3+ (83.0%, 95% CI 70.2%–91.9%) but lower specificity compared to HSIL+ (42.7%, 95% CI 38.4%–47.1%; relative specificity = 0.57, 95% CI 0.52–0.63), resulting in almost twice as many referrals. Compared to HC2, triage of HC2-positive women with HSIL+ resulted in a 40% reduction in colposcopy referrals but was associated with some loss in sensitivity. CIN2+ incidence over a median 16 months was highest among VIA baseline screen-negative women (2.2%, 95% CI 1.3%–3.7%) and women who were baseline double-negative with HC2 and VIA (2.1%, 95% CI 1.3%–3.5%) and lowest among HC2 baseline screen-negative women (0.5%, 95% CI 0.1%–1.8%). Limitations of our study are that WLHIV included in the study may not reflect a contemporary cohort of WLHIV initiating ART in the universal ART era and that we did not evaluate HPV tests available in study settings today. Conclusions In this cohort study among WLHIV in Africa, a human papillomavirus (HPV) test targeting 14 high-risk (HR) types had higher sensitivity to detect CIN2+ compared to visual inspection but had low specificity, although a restricted genotype approach targeting 8 HR types decreased the number of unnecessary colposcopy referrals. Cytology HSIL+ had optimal performance for CIN2+/CIN3+ detection in SA. Triage of HPV-positive women with HSIL+ maintained high specificity but with some loss in sensitivity compared to HC2 alone.

show abstract

“…In this study, we investigate the hrHPV prevalence and type distribution in HIV-positive and HIV-negative women in rural Zimbabwe. Initial hrHPV screening from self-collected cervicovaginal specimens was performed by the Xpert HPV test (Cepheid, Sunnyvale, CA), on the GeneXpert instrument and further typed using the Seegene Anyplex II HPV HR Detection kit (Seegene, Seoul, South Korea) (Einstein et al, 2014; Mbulawa et al, 2016; Cornall et al, 2017; Hesselink et al, 2016; Ostrbenk et al, 2018). Prior studies have demonstrated comparable sensitivity, specificity, and positive predictive value for detection of hrHPV and Cervical Intraepithelial Neoplasia (CIN) 2+ when Xpert HPV is compared to other platforms (Einstein et al, 2014; Cuschieri et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

hrHPV prevalence and type distribution in rural Zimbabwe: A community-based self-collection study using near-point-of-care GeneXpert HPV testing

Fitzpatrick

Mandishora

Katzenstein

et al. 2019

International Journal of Infectious Diseases

View full text Add to dashboard Cite

Objectives: High-risk human papilloma viruses (hrHPV) are the causative agents of cervical cancer, the leading cause of cancer deaths among Zimbabwean women. The objective of this study was to describe the hrHPV types found in Zimbabwe for consideration in cervical cancer screening and vaccination efforts. Design and methods: To determine hrHPV prevalence and type distribution in Zimbabwe we implemented a community-based cross-sectional study of self-collected cervicovaginal samples with hrHPV screening using near-point-of-care Cepheid GeneXpert HPV. Results: The hrHPV prevalence was 17% (112/643); 33% (41/123) vs. 14% (71/520) among HIV-1-positive and -negative participants, respectively ( p = 2.3E-07). Typing via Xpert HPV showed very good overall agreement (77.2%, kappa = 0.698) with the Seegene Anyplex II HPV HR Detection kit. The most common types were HPV16, HPV18, HPV35, HPV52, HPV58, HPV68, HPV18, and HPV51, each of which appeared in 14–20% of infections. 37% (28/76) of women with positive cytology results (ASCUS+) had a type not included in the basic vaccine and 25% (19/76) had a type not currently in the nine-valent vaccine. Conclusions: hrHPV type distribution includes less common high-risk types in rural Zimbabwe. The distribution and carcinogenicity of hrHPV type distribution should be considered during screening assay design, program development, as well as vaccine distribution and design.

show abstract

Xpert human papillomavirus test is a promising cervical cancer screening test for HIV-seropositive women

Cited by 20 publications

References 26 publications

Prevalence of and Associated Risk Factors for High Risk Human Papillomavirus among Sexually Active Women, Swaziland

Prevalence of and Associated Risk Factors for High Risk Human Papillomavirus among Sexually Active Women, Swaziland

Diagnostic accuracy of cervical cancer screening and screening–triage strategies among women living with HIV-1 in Burkina Faso and South Africa: A cohort study

hrHPV prevalence and type distribution in rural Zimbabwe: A community-based self-collection study using near-point-of-care GeneXpert HPV testing

Contact Info

Product

Resources

About