A comparison of screening tests for detection of high-grade cervical abnormalities in women living with HIV from Cameroon

Philip E Castle, Rogers Ajeh, Anastase Dzudie, Ernestine Kendowo, Norbert Fuhngwa, Andre Gaetan Simo-Wambo, Denis Nsame, Enow Orock, Tiffany M Hebert, Amanda J Pierz, Daniel Murokora, Kathryn Anastos, Adebola Adedimeji, Philip E Castle, Rogers Ajeh, Anastase Dzudie, Ernestine Kendowo, Norbert Fuhngwa, Andre Gaetan Simo-Wambo, Denis Nsame, Enow Orock, Tiffany M Hebert, Amanda J Pierz, Daniel Murokora, Kathryn Anastos, Adebola Adedimeji

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.

Conflict of interest statement

Competing interestsThis study received Xpert HPV tests from Cepheid (Sunnyvale, CA, USA) at a reduced cost. Dr. Castle has received HPV tests and assays for research from Roche, Becton Dickinson, Cepheid, and Arbor Vita Corporation at a reduced or no cost.

© The Author(s) 2020.

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