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Qi M, Naranjo AR, Duque AJ, Lorey TS, Schapiro JM, Suh-Burgmann BJ, Rummel M, Salipante SJ, Wentzensen N, Greene DN. Evaluation of Pre-Analytical Variables for Human Papillomavirus Primary Screening from Self-Collected Vaginal Swabs. J Mol Diagn 2024; 26:487-497. [PMID: 38494078 DOI: 10.1016/j.jmoldx.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Human papillomavirus (HPV) primary screening is an effective approach to assessing cervical cancer risk. Self-collected vaginal swabs can expand testing access, but the data defining analytical performance criteria necessary for adoption of self-collected specimens are limited, especially for those occurring outside the clinic, where the swab remains dry during transport. Here, we evaluated the performance of self-collected vaginal swabs for HPV detection using the Cobas 6800. There was insignificant variability between swabs self-collected by the same individual (n = 15 participants collecting 5 swabs per participant), measured by amplification of HPV and human β-globin control DNA. Comparison of self-collected vaginal swab and provider-collected cervical samples (n = 144 pairs) proved highly concordant for HPV detection (total agreement = 90.3%; positive percentage agreement = 84.2%). There was no relationship between the number of dry storage days and amplification of HPV (n = 68; range, 4 to 41 days). Exposure of self-collected dry swabs to extreme summer and winter temperatures did not affect testing outcomes. A second internal control (RNase P) demonstrated that lack of amplification for β-globin from self-collected specimens was consistent with poor, but not absent, cellularity. These data suggest that self-collected vaginal samples enable accurate clinical HPV testing, and that extended ambient dry storage or exposure to extreme temperatures does not influence HPV detection. Furthermore, lack of β-globin amplification in HPV-negative samples accurately identified participants who required recollection.
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Affiliation(s)
- Michelle Qi
- LetsGetChecked Laboratories, Monrovia, California
| | | | - Abigail J Duque
- The Permanente Medical Group, Northern California Kaiser Permanente Regional Reference Laboratory, Oakland, California
| | - Thomas S Lorey
- The Permanente Medical Group, Northern California Kaiser Permanente Regional Reference Laboratory, Oakland, California
| | - Jeffrey M Schapiro
- The Permanente Medical Group, Northern California Kaiser Permanente Regional Reference Laboratory, Oakland, California
| | | | | | - Stephen J Salipante
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Dina N Greene
- LetsGetChecked Laboratories, Monrovia, California; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington.
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Metz CK, Skof AS, Sehouli J, Siedentopf JP, Gebert P, Weiss F, Alba Alejandre I, Heinrich-Rohr M, Weizsaecker K, Henrich W, Kaufmann AM, Rohr I. Assessment of high-risk human papillomavirus infections and associated cervical dysplasia in HIV-positive pregnant women in Germany: a prospective cross-sectional two-centre study. Arch Gynecol Obstet 2022; 308:207-218. [PMID: 36576558 DOI: 10.1007/s00404-022-06890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Invasive cervical cancer (ICC) is associated in nearly 100% with persistent high-risk Human Papillomavirus (HR-HPV) infection. ICC is still one of the leading causes for cancer mortality in women worldwide. The immunosuppressive influence of Human Immunodeficiency Virus (HIV) and the immunocompromised period of pregnancy due to tolerance induction against the hemiallogeneic fetus, are generally risk factors for acquisition and persistence of HR-HPV infections and their progression to precancerous lesions and HPV-associated carcinoma. METHODS Overall, 81 pregnant women living with HIV (WLWH) were included. A medical history questionnaire was used to record clinical and HIV data. Participants received cervicovaginal cytological smear, colposcopy and HPV testing. HPV test was performed using BSGP5+/6+ PCR with Luminex read-out. The HR-HPV genotypes 16, 18, 31, 33, 45, 52, 58 were additionally grouped together as high-high-risk HPV (HHR-HPV) for the purpose of risk-adapted analysis. RESULTS HR-HPV prevalence was 45.7%. Multiple HPV infections were detected in 27.2% of participants, of whom all had at least one HR-HPV genotype included. HR-HPV16 and HR-HPV52 were the most prevalent genotypes and found when high squamous intraepithelial lesion (HSIL) was detected by cytology. HIV viral load of ≥ 50 copies/ml was associated with higher prevalence of HR-HPV infections. Whereas, CD4 T cells < 350/µl showed association with occurrence of multiple HPV infections. Time since HIV diagnosis seemed to impact HPV prevalence. CONCLUSION Pregnant WLWH require particularly attentive and extended HPV-, colposcopical- and cytological screening, whereby clinical and HIV-related risk factors should be taken into account.
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Affiliation(s)
- Charlotte K Metz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anna S Skof
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department for Gynecology, Laboratory for Gynaecological Tumor Immunology, HPV Laboratory, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jalid Sehouli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department for Gynecology, Laboratory for Gynaecological Tumor Immunology, HPV Laboratory, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jan-Peter Siedentopf
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Pimrapat Gebert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Fabian Weiss
- Ludwig-Maximilians-University (LMU), University Hospital, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377, Munich, Germany
| | - Irene Alba Alejandre
- Ludwig-Maximilians-University (LMU), University Hospital, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michaela Heinrich-Rohr
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Social Medicine, Epidemiology and Health Economic, Luisenstraße 57, 10117, Berlin, Germany
| | - Katharina Weizsaecker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wolfgang Henrich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas M Kaufmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department for Gynecology, Laboratory for Gynaecological Tumor Immunology, HPV Laboratory, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Irena Rohr
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353, Berlin, Germany.
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Gaester K, Fonseca LAM, Luiz O, Assone T, Fontes AS, Costa F, Duarte AJS, Casseb J. Human papillomavirus infection in oral fluids of HIV-1-positive men: prevalence and risk factors. Sci Rep 2014; 4:6592. [PMID: 25322857 PMCID: PMC5377573 DOI: 10.1038/srep06592] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/12/2014] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus is one of the most common sexually transmitted diseases worldwide. The natural history of oral HPV infection is unclear, and its risk factors have not been explored. Immunocompromised individuals, as exemplified by HIV patients, are at high risk for HPV-related diseases. The mean of this study is to determine the prevalence of HPV in the oral tract of HIV-1-positive male subjects and its association with risk factors. A total of 283 oral wash samples from HIV-1-positive men were tested. The oral fluid samples were used for DNA extraction and conventional PCR amplification; HPV genotyping was performed by hybridization. HPV genotyping revealed that nine samples (3.5%) were positive for HPV DNA; the major high-risk HPV types identified were 51 and 66. Worldwide studies have shown a variable prevalence of oral HPV. The diversity of genotypes and the high prevalence of multiple infections in HIV-infected subjects can be better explained by the effects of HIV-induced immunosuppression. The most important risk factors are unprotected sexual intercourse, but other factors for this infection have been described elsewhere including smoking, age and HIV-positive serostatus. In this study, smoking was the most important risk factor for acquiring oral HPV in HIV-1-infected subjects in Brazil.
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Affiliation(s)
- Karen Gaester
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Luiz A. M. Fonseca
- Department of Preventive Medicine, University of São Paulo Medical School, Brazil
| | - Olinda Luiz
- Department of Preventive Medicine, University of São Paulo Medical School, Brazil
| | - Tatiane Assone
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Adriele Souza Fontes
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Fernando Costa
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Alberto J. S. Duarte
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Jorge Casseb
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
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Visser J, van Baarle D, Hoogeboom BN, Reesink N, Klip H, Schuuring E, Nijhuis E, Pawlita M, Bungener L, de Vries-Idema J, Nijman H, Miedema F, Daemen T, van der Zee A. Enhancement of human papilloma virus type 16 E7 specific T cell responses by local invasive procedures in patients with (pre)malignant cervical neoplasia. Int J Cancer 2006; 118:2529-37. [PMID: 16353143 DOI: 10.1002/ijc.21673] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It has been suggested that local invasive procedures may alter the natural course of (pre)malignant cervical disease. This could be due to partial excision of the lesions, or via induction of cellular immunity against human papillomavirus (HPV) by the local invasive procedures. We studied the influence of local invasive procedures on HPV-16 E7 specific immune responses in patients with different grades of cervical intra-epithelial neoplasia (CIN) and different stages of cervical cancer. Blood was obtained at intake and after invasive procedures from patients with CIN or cervical cancer. Antigen specific T-cell responses were measured by IFN-gamma ELISPOT analysis, after stimulation with recombinant HPV-16 E7 protein. As expected, HPV-16 E7 specific IFN-gamma T cell responses were more frequent in HPV-16 DNA positive patients compared with that in HPV-16 DNA negative patients (39/50 vs. 16/36, (p=0.006, chi2 test). After invasive procedures, a small number of HPV-16 DNA positive CIN patients, but a considerable proportion of HPV-16 DNA positive cervical cancer patients, showed an enhancement of T cell responses against HPV-16 E7. Induction of T cell reactivity was most pronounced in cervical cancer patients who had undergone previous invasive procedures. Both CD4+ and CD8+ T cells showed E7 specific IFN-gamma production upon in-vitro stimulation. Our study shows that invasive procedures may enhance HPV-specific cell-mediated immunity in a considerable number of patients with cervical cancer, but in only a minority of CIN patients. Our data indicate that invasive procedures should be considered as possible confounding factors when analyzing the effectiveness of therapeutic immunization studies, especially, when induction of HPV-specific immune responses is used as intermediate end-point.
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Affiliation(s)
- Jeroen Visser
- Department of Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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