Screening for oncogenic human papillomaviruses in atypical and low-grade cervical pathology in human immunodeficiency virus-positive women

R. Li Vigni PhD^1,2, U.A Bianchi MD², G. Carosi MD³, M. Lomini MD², S. Pecorelli MD²

AIM: Convincing evidence has been accumulated that infection with oncogenic human papillomavirus (HPV) types is the most important risk factor for cervical neoplasms also in women infected with human immunodeficiency virus type-1 (HIV+). Frequently, long-term follow-up of HIV+ women with borderline changes is difficult to achieve. Thus, the see-and-treat management paradigm is appealing in private practice. We performed this study to evaluate in a 40 months survey the prognostic value of high-risk HPV DNA testing by Hybrid CaptureII (HC)(Digene Diagnostics) and indirect in-situ polymerase chain reaction (PCR-ISH). METHODS: From September 1997 throughout January 2001, 379 women HIV+ were enrolled at the University of Brescia, Italy. The patients were followed-up by cytology at 6 months intervals and referred for biopsy in cases of persistent or increasing abnormalities. All women had a HC test at 0, 12, 24, 36 months and a colposcopic-directed biopsy at the enrollement and the endpoint. RESULTS: At baseline, cytological diagnoses were 48 low-grade SILs (13% LSIL), 99 ASCUS (26%) and 182 smears (48%) within normal limits. The rate of biopsy-confirmed CIN was 77% in the category of ASCUS/LSIL and 12% in the normal. The overall HPV high-risk positivity detected was 60% by HC and 70% by PCR-ISH. After 1 year, 199 HIV-patients were lost, in the remaining 130 women, the HPV high-risk positivity was 52% by HC and 6 showed a cyto-histological progression. In the 110 patients followed-up at 24 months the overall HPV positivity was 58% by HC and 13 showed a cyto-histological progression to high-grade neoplasia. At the end of follow-up, 15 of 105 women had biopsy-confirmed CIN3. These samples have been always positive by PCR-ISH whereas 10 and 11 specimens were HC-positive at the enrollement and the endpoint. CONCLUSIONS: Timely discovery and treatment of progressive lesions confers a substantial improvement in curative potential and cost savings in HIV+ women. PCR-ISH can substantially increase the detection rate of incoming CIN with an acceptable positive predictive value. Furthermore, PCR-ISH offers high patient satisfaction, and decreases the risk of loss of follow-up before the completion of evaluation and treatment of CIN.

For more information, contact livigni@pasteur.fr

Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Viral Oncogenesis.

http://www.cancerprev.org/Journal/Issues/26/101/996/4357