Dataset Information

Performance of cervical cancer screening and triage strategies among women living with HIV in China.

ABSTRACT:

Objectives

To evaluate the clinical performance of liquid-based cytology (LBC), HPV tests and visual inspections with acetic acid or Lugol's iodine (VIA/VILI) as primary screening and triage strategies among Chinese women living with HIV (WLHIV).

Methods

WLHIV aged 18 years and older were recruited from HIV/AIDS treatment clinic in Yunnan, China from 2019 to 2020. Women were screened with self- and physician-sampling for HPV tests, LBC, and VIA/VILI. Women positive for any HPV or with cytological abnormalities were recalled for colposcopy examination and biopsy when necessary. Clinical performance of primary and triage strategies for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was evaluated.

Results

For primary screening, sensitivity of physician-HPV tests was 100%, 89.5%, and 100% for hybrid capture 2 (HC2), cobas, and Sansure HPV, and specificity was 80.4%, 85.1%, and 72.0%, respectively. Self-HPV test achieved considerable performance with physician-HPV. Sensitivity and specificity were 61.1% and 96.3% for LBC (atypical squamous cells of undetermined significance or worse [ASCUS+]), 40.0% and 77.3% for VIA/VILI. For triaging HPV-positive women, LBC (ASCUS+), HPV-16/18 genotyping, and VIA/VILI-elevated specificity with sensitivity declined 30%-50% compared with HPV screening alone. Restricted HPV genotyping triage (HPV-16/18/31/33/45/52/58) demonstrated the optimal accuracy (89.5% sensitivity, 81.9% specificity), and was similar to HPV-16/18 with reflex LBC (ASCUS+). Combination antiretroviral therapies (cARTs) <2 years were associated with decreased specificity of HC2 (aOR: 1.87, 95% CI: 1.22-3.91) and Sansure HPV (2.48, 1.43-4.29).

Conclusions

Self-HPV with restricted genotyping triage is highly recommended for cervical cancer screening for WLHIV in China. Feasible triage to increase HPV specificity among women with short duration of cART is needed.

SUBMITTER: Duan R

PROVIDER: S-EPMC8419757 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVE:We suggested cervical cancer screening strategies for women living with HIV (WLHIV) by comparing their precancer risks to general population women, and then compared our suggestions with current Centers for Disease Control and Prevention (CDC) guidelines. DESIGN:We compared risks of biopsy-confirmed cervical high-grade squamous intraepithelial neoplasia or worse (bHSIL+), calculated among WLHIV in the Women's Interagency HIV Study, to 'risk benchmarks' for specific management strategies in the general population. METHODS:We applied parametric survival models among 2423 WLHIV with negative or atypical squamous cell of undetermined significance (ASC-US) cytology during 2000-2015. Separately, we synthesized published general population bHSIL+ risks to generate 3-year risk benchmarks for a 3-year return (after negative cytology, i.e. 'rescreening threshold'), a 6-12-month return (after ASC-US), and immediate colposcopy [after low-grade squamous intraepithelial lesion (LSIL)]. RESULTS:Average 3-year bHSIL+ risks among general population women ('risk benchmarks') were 0.69% for a 3-year return (after negative cytology), 8.8% for a 6-12-month return (after ASC-US), and 14.4% for colposcopy (after LSIL). Most CDC guidelines for WLHIV were supported by comparing risks in WLHIV to these benchmarks, including a 3-year return with CD4 greater than 500 cells/?l and after either three negative cytology tests or a negative cytology/oncogenic human papillomavirus cotest (all 3-year risks?1.3%); a 1-year return after negative cytology with either positive oncogenic human papillomavirus cotest (1-year risk?=?1.0%) or CD4 cell count less than 500 cells/?l (1-year risk?=?1.1%); and a 6-12-month return after ASC-US (3-year risk?=?8.2% if CD4 cell count at least 500 cells/?l; 10.4% if CD4 cell count?=?350-499 cells/?l). Other suggestions differed modestly from current guidelines, including colposcopy (vs. 6-12 month return) for WLHIV with ASC-US and CD4 cell count less than 350 cells/?l (3-year risk?=?16.4%) and a lengthened 2-year (vs. 1-year) interval after negative cytology with CD4 cell count at least 500 cells/?l (2-year risk?=?0.98%). CONCLUSIONS:Current cervical cancer screening guidelines for WLHIV are largely appropriate. CD4 cell count may inform risk-tailored strategies.