Back to Search
Start Over
A comparison of screening tests for detection of high-grade cervical abnormalities in women living with HIV from Cameroon.
- Source :
- Infectious Agents & Cancer; 7/11/2020, Vol. 15 Issue 1, p1-7, 7p, 4 Charts
- Publication Year :
- 2020
-
Abstract
- Background: Women living with human immunodeficiency virus (WLWH), especially those living in low- and middle-income countries (LMIC), are at increased risk of cervical cancer. The optimal cervical-cancer screening strategy for WLWH has not been determined. We therefore conducted a pilot study of screening methods in WLWH living in Limbe, Cameroon. Methods: Five-hundred sixty-six WLWH, aged 25–59 years, were enrolled. After self-collecting a cervicovaginal specimen, they underwent a pelvic exam, during which a provider also collected a cervical specimen and visual inspection after acetic acid (VIA) was performed. Both self- and provider-collected specimens were tested for high-risk HPV by the Xpert HPV Test (Cepheid, Sunnyvale, CA, USA), with the residual of the latter used for liquid-based cytology. Women testing HPV positive on either specimen and/or VIA positive were referred to colposcopy and biopsies. However, because of poor attendence for follow-up colposcopy for the screen positives due to civil strife and technical issues with biopsies, high-grade cytology and/or clinical diagnosis of cancer was used as the primary high-grade cervical abnormality endpoint. Clinical performances for high-grade cervical abnormality of HPV testing and VIA for screening WLWH, and the most carcinogenic HPV genotypes and/or VIA to triage high-risk HPV-positive WLWH, were evaluated. Results: Four-hundred eighty-seven (86.0%) WLWH had results for HPV testing on both specimen, VIA, and cytology and were included in the analysis. Forty-nine (10.1%) had a high-grade cervical abnormality. HPV testing on provider- and self-collected specimens was more sensitive than VIA (95.9 and 91.8% vs. 43.8%, respectively, p < 0.01 for both comparisons) for identifying women with high-grade cervical abnormalities. HPV testing on provider- and self-collected specimens was less specific than VIA (57.5 and 51.6% vs. 89.7%, respectively, p < 0.01 for both comparisons) for identifying women with high-grade cervical abnormalities; HPV testing on provider-collected specimens was more specific than on self-collected specimens (p < 0.01). Among HPV-positive women, HPV16/18/45 detection or VIA positivity had a sensitivity and positive predictive value of 73.5 and 29.0%, respectively, for provider-collected specimens and 68.8 and 22.9%, respectively, for self-collected specimens for high-grade cervical abnormalities. Conclusions: HPV testing was more sensitive but less specific than VIA for detection of high-grade cervical abnormality in WLWH. Improved triage methods for HPV-positive WLWH are needed. Trial registration: NCT04401670 (clinicaltrials.gov); retrospectively registered on May 26, 2020 [ABSTRACT FROM AUTHOR]
- Subjects :
- PAPILLOMAVIRUS disease diagnosis
ACETIC acid
BODY fluid examination
COLPOSCOPY
GYNECOLOGIC examination
HIV-positive persons
PAP test
PAPILLOMAVIRUS diseases
PHYSICAL diagnosis
RISK assessment
WOMEN'S health
CERVIX uteri tumors
PILOT projects
PREDICTIVE tests
SELF diagnosis
EARLY detection of cancer
GENOTYPES
TUMOR grading
DISEASE risk factors
Subjects
Details
- Language :
- English
- ISSN :
- 17509378
- Volume :
- 15
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Infectious Agents & Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 144520838
- Full Text :
- https://doi.org/10.1186/s13027-020-00311-w