Evaluation of BD Onclarity™ HPV Assay on Self-Collected Vaginal and First-Void Urine Samples as Compared to Clinician-Collected Cervical Samples: A Pilot Study

Oral Treatment with EGCG, Folic Acid, Vitamin B12, and Hyaluronic Acid Improves HPV Clearance and Counteracts Its Persistence: A Clinical Study

Human papillomavirus (HPV) infection represents one of the most common sexually transmitted infections worldwide. However, the lack of effective therapeutic strategies to counteract viral infection and its persistence still makes the management of HPV a medical concern. Persistence is indeed a crucial issue in the context of HPV, as it may increase the risk of viral DNA integration into the host genome, thus exposing patients to tumoral progression. This clinical study aims to evaluate the effectiveness of a dietary supplement containing epigallocatechin gallate (EGCG), folic acid (FA), vitamin B12 (B12), and hyaluronic acid (HA) in improving HPV clearance and HPV-induced cervical lesions, and in counteracting viral persistence. A total of 106 patients who tested positive for HPV DNA were enrolled in this study and were treated daily for 6 months with a tablet containing EGCG (200 mg), FA (400 μg), B12 (1 mg), and HA (50 mg) (Pervistop®, Lo.Li. Pharma, Rome, Italy). A 6-month treatment with such combined molecules demonstrated a viral clearance in 85.8% of enrolled patients, while 92.3% of participants exhibited no more cervical lesions. Furthermore, 71.8% of patients with persistent infection tested negative to HPV DNA test after 6 months of treatment. The obtained data in this large population strongly support previous evidence on the efficacy of such molecules in the management of HPV infection by improving both viral clearance and related cervical lesions, and by targeting viral persistence.

Recent Advances in HPV Detection: From Traditional Methods to Nanotechnology and the Application of Quantum Dots

Cervical cancer, a significant public health concern, demands precise and expeditious detection methods to curb the spread of human papillomavirus (HPV). The early detection of cervical cancer remains a critical challenge in developing reliable and efficient screening tools to meet the demand for controlling cervical cancer. Traditional detection techniques are often cumbersome, costly, and inadequate for on-site HPV testing. Nanotechnology, with its unique electrical, chemical, and optical properties, has emerged as a pivotal component in the development of biosensors for rapid and reliable HPV detection. This article provides a comprehensive review of the advancements in cervical cancer detection, encompassing traditional methods, emerging protocols, and novel quantum dots (QDs)-based approaches for detection. The review examines the application of various nanomaterials in electrochemical and photoelectrochemical biosensors for the diagnosis of cervical cancer, with these innovations offering a significant improvement over conventional approach. Furthermore, we detail the synthesis methods of QDs and their properties, illustrate the substantial enhancement in sensor performance achieved through their applications, and elucidate the improvements and challenges associated with these new protocols while highlighting the potential application prospects of novel QDs technology in HPV detection.

Human papillomavirus self-sampling in Asia: a systematic review

Background

Human papillomavirus (HPV) self-sampling may be an accurate and effective alternative sampling method to conventional cervical cancer screening methods. This systematic review compares the accuracy and acceptance of self-sampling to clinician sampling for HPV testing in Asia.

Methods

The PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched for publications published from the establishment of the database to 2023. The risk of bias was assessed using the QUADAS-2 tool for studies included in this review. All studies evaluating the accuracy and acceptance of HPV self-sampling, and agreement of self- and clinician-collected samples in Asia were included. The accuracy of each study was demonstrated through the sensitivity and specificity in diagnosing cervical intraepithelial neoplasia or cancer, as well as the detection rate of HPV. The agreement between the two sampling methods was assessed based on the detection outcomes of HPV. Acceptance was indicated by women's preferences for HPV self-sampling.

Results

Sixty-seven studies including 117,279 adult, female participants were included in this review. The type of HPV screening, other intervention components, study design, sample size, follow-up period, analysis method, numerical outcomes, results, and limitations were extracted from each study. The sensitivity and specificity of HPV self-sampling in detecting cervical intraepithelial neoplasia were higher than 80% and 70%, consistent with the results of HPV clinician sampling. The consistency between self-sampling and clinician-sampling was high in most studies, and the kappa value was more than 0.7. Women had high acceptance of self-sampling but expressed some concerns.

Conclusion

Self-sampling for HPV testing can significantly improve cervical cancer screening coverage, especially in areas with limited medical resources or reluctance to accept physician sampling. In most studies, the accuracy and acceptance of HPV self-sampling was comparable to clinician sampling. However, the diagnostic criteria and HPV detection methods still need to be adjusted due to the low sensitivity of HPV self-sampling in some studies in China and India. Targeted health education should be carried out to improve the acceptance of HPV self-sampling in women.

Systematic review registration

https://inplasy.com/?s=INPLASY202520107, INPLASY202520107.

COVID-19 Pandemic Impact on Delays in Diagnosis and Treatment for Cervical Cancer in Montreal, Canada

INTRODUCTION

The COVID-19 pandemic has been responsible for a major reorganization of healthcare systems, with less access for cancer screening. Few data exist on the impact of cervical cancer treatment during the pandemic.

METHODS

The purpose of this study was to compare the cervical cancer stage at diagnosis and the surgical and medical treatment delays before and during the COVID-19 pandemic. This is a retrospective cohort study of all cervical cancers diagnosed at any stages between 1 January 2018 and 28 February 2022 at the Centre Hospitalier de l'Université de Montréal. Stage at diagnosis, time to initial referral, time from diagnosis to treatment before and during the COVID-19 pandemic were compared.

RESULTS

A total of 244 cervical cancers were diagnosed during the study period. No differences were observed between the number of cases diagnosed before and after pandemic (p = 0.237). Most patients and disease characteristics did not differ between the study periods, but the patients were significantly younger (p = 0.007), with higher BMI (p = 0.024) in the pandemic period. The mean time between initial diagnosis and referral was longer during the pandemic by 13 days (p = 0.042). The mean time between diagnosis and MRI and diagnosis and PET CT was not longer during the pandemic (p = 0.481 and p = 0.384). There were no significant differences in the mean time from the initial referring to the first visit at the CHUM (p = 0.895) or in the mean time from diagnosis to treatment (0.668) and duration of treatment (p = 0.181) Conclusion. Minor delays were observed during the COVID-19 pandemic. Cervical cancer patients treated at the CHUM, a tertiary and quaternary Canadian public health center, were globally referred and treated similarly, as those who were treated before pandemic.

Addressing COVID-19 Screening Delays: The Impact of HPV Self-Sampling on Non-Attenders in a Cervical Cancer Screening Program

Background/Objectives: Self-sampling is recognized as a viable alternative to clinician-sampling for HPV primary screening. This study aimed to assess, within an Italian organized cervical cancer screening program, the acceptance and ease of use of self-sampling and the adherence to follow-up. The prevalences of HPV infection, cervical dysplasia, and cancer were contextually evaluated. Methods: Electronic records of 19,327 women, 30-64 years-old, residing within the Bologna Local Health Authority territory, who were offered self-sampling as an alternative to clinician-sampling, were retrospectively reviewed. They had never or irregularly attended and were overdue for a screening invitation due to the COVID-19 pandemic. An opt-in approach was adopted, involving local pharmacies for kit delivery and sample collection. Initially, HPV-positive results led to direct referral to colposcopy; later, cytological triage on clinician-samples was provided. Results: Self-sampling reached over twice as many women (11.5%) compared to historical clinician-sampling alone (<5%), showing high acceptance. Additionally, a high screening completion level was observed, with 79.5% of self-samples returned to pharmacies. A low percentage of self-samples resulted in inadequate results (1.1%), suggesting the method's ease of use. HPV-positivity was 13.1%, higher than the 9.9% recorded in the ordinary screening population in 2019 (p < 0.001), the last year before the pandemic. Compliance to both immediate colposcopy and cytology triage exceeded 90% (p = 0.675). The rate of cervical adenocarcinoma was twice as high as in the routinely screened population in 2019 (0.9‱ versus 0.4‱). Finally, 6% of women opted for clinician appointments. Conclusions: Self-sampling proved to be an easy-to-use and effective tool for reaching non-attenders, who are at high risk of cancer. Cytology triage on clinician-samples did not negatively impact follow-up adherence. It seems appropriate to maintain a clinician-collection option even among non-attenders.

HPV self-sampling for cervical cancer screening in China: A multi-center study

Background

Human papillomavirus (HPV) self-sampling is a new method for collecting cervical isolated cells, but research been carried out in multi-ethnic and multi-regional areas of China is scarce.

Objectives

We aimed to evaluate the accuracy and acceptability of HPV self-sampling and analyze the characteristics of HPV infection.

Study design

Women aged 25-65 years were recruited from 8 provinces in China. Women underwent clinician-sampling and self-sampling and were asked to complete a 65-question questionnaire on their acceptance of HPV self-sampling. The paired samples were analyzed for 23 genotypes of HPV by polymerase chain reaction.

Results

5551 women were recruited, of which 5417 were eligible for analysis. 3163 women have completed and submitted the questionnaire. The top five infection genotypes were HPV 52, 58, 16, 39, and 68. The highest infection rate was in the 25-30 years group. The crude agreement between self-sampling and clinician-sampling was 93.06 %. 43.79 % of women preferred self-sampling over clinician-sampling, and 67.59 % preferred doing self-sampling at the hospital.

Conclusion

HPV self-sampling could be an effective supplement to traditional cervical screening in China. Clinicians' advocacy, timely reminders and guidance for women with abnormal self-sampling results are needed. In addition, new vaccination and cervical screening recommendations might be adjusted to fit populations with different characteristics.

Human Papillomavirus Genotypes Distribution in High-Grade Cervical Lesions and Invasive Cervical Carcinoma in Women Living in Mauritania: Implications for Cervical Cancer Prevention and HPV Prophylactic Vaccination

Cervical cancer related to high-risk human papillomavirus (HR-HPV) is the second female cancer in Mauritania (Northwest Sahelian Africa). We assessed the distribution of HPV genotypes in Mauritanian women with high-grade cervical intraepithelial neoplasia (CIN2/3) or invasive cervical cancer (ICC). A prospective study was conducted in the Centre Hospitalier National, Nouakchott, Mauritania, to collect cervical biopsies among women suspected of CIN2/3 or cancer. HPV DNA detection and genotyping were carried out from formalin-fixed, paraffin-embedded biopsies using multiplex PCR (Human Papillomavirus Genotyping Real-Time PCR Kit, Bioperfectus Technologies Co., Taizhou, China). Fifty biopsies were included from women (mean age: 56.7 years) suffering from CIN2/3 (28.0%) and ICC (72.0%) which corresponded to 32 (64.0%) squamous cell carcinomas (SCC) and 4 (8.0%) adenocarcinomas (ADC). HPV DNA detection was successful in 47 (94.0%) samples. The most prevalent HR-HPV genotypes were HPV-45 (40.4%), HPV-16 (38.3%), HPV-39 and HPV-52 (23.4%), HPV-33 (17.0%), HPV-18 (14.9%), HPV-35 (4.2%), and HPV-56 (2.1%). The majority (93.6%) of HPV-positive biopsies contained at least one HPV type covered by the 9-valent Gardasil-9® vaccine, and 40.9% were infected by multiple vaccine HPV genotypes. To eradicate cervical cancer in Mauritania, prophylactic HPV vaccination must be combined with primary molecular screening of cervical HR-HPV infection.

Variables that impact HPV test accuracy during vaginal self collection workflow for cervical cancer screening

Vaginal self collection (SC) is safe and effective for human papillomavirus (HPV) testing and can increase cervical cancer screening coverage for underserved women. To better understand the impact of SC methodology on HPV test outcomes, empirical testing was conducted using different swab collection workflows. Deposition of the collection swab into resuspension buffer resulted in a 2.4-cycle reduction in threshold detection of human beta-hemoglobin during PCR when compared to "swirl-and-toss". In addition, reducing the swab resuspension volume from 10 mL to 3 mL resulted in a 2.6-cycle reduction in threshold detection of human beta-globin. A systematic literature search (01/01/2020 to 08/02/2023) of Ovid Medline and Embase, followed by data extraction and analysis, was conducted to further assess the impact of resuspension volume on performance following SC. HPV test performance for SC, relative to clinician collection (CC), was calculated for detection of cervical pre-cancer. Data were stratified by the resuspension volume ratio of SC to CC being either ≥ 1.0 or < 1.0. SC with a volume ratio of ≥ 1.0 and < 1.0 had a relative ≥ CIN2 sensitivity of 92.0 % (95 % CI: 88.0, 96.0) and 97.0 % (95 % CI: 94.0, 100), respectively. Taken together, these results suggest that SC conditions can be modified to optimize sample recovery and performance, as part of cervical cancer screening.

Counteracting HPV Cervical and Anal Infection through Dietary Supplementation of EGCG, Folic Acid, Vitamin B12 and Hyaluronic Acid: Clinical Case Reports

Background: Human papilloma virus (HPV) infection and the management of its persistence is still a great medical challenge. Recently, scientific evidence has supported the potential therapeutic effects of four combined natural molecules-epigallocatechin gallate (EGCG), folic acid, vitamin B12 and hyaluronic acid (HA)-in counteracting HPV DNA positivity and related cytological lesions. Methods: Each patient of these five clinical cases had persistent HPV positivity in the anogenital site and assumed a dietary supplement based on a combination of 200 mg of EGCG, 50 mg of HA, 1 mg of vitamin B12 and 400 mcg of folic acid (Pervistop®, Farmares s.r.l., Rome, Italy) at a dosage of 1 or 2 caps/day for 6 or 3 months, respectively, depending on clinical history. Results: After treatment, all the patients reported a negative HPV DNA test and improved cytological lesions, thus demonstrating the ability of these combined molecules to counteract both anal and cervical HPV infection and related manifestations. Conclusions: Overall, these data corroborate previous evidence about the effectiveness of such natural molecules in the management of HPV infection and its persistence. Naturally, further studies with a larger population and long-term follow-up will contribute to reinforce the positive effects of this dietary supplement in counteracting HPV infection.

Quantification of HPV16 E7 Oncoproteins in Urine Specimens from Women with Cervical Intraepithelial Neoplasia

We present the validity of using an ultrasensitive enzyme-linked immunosorbent assay (ELISA) for quantifying high-risk human papillomavirus (HPV) 16 E7 oncoproteins in urine specimens as a noninvasive method of analyzing the oncogenic activity of HPV. Some reports claim that the oncogenic activity of HPV is a more relevant clinical indicator than the presence of HPV DNA for estimating malignant potential. In the present study, urine containing HPV16 and related types were selected by uniplex E6/E7 polymerase chain reaction and classified according to the pathologic diagnosis of cervical intraepithelial neoplasia (CIN) in cervical biopsy specimens. Our ultrasensitive ELISA was able to detect attomole levels of HPV16 E7 oncoproteins, and it detected HPV16-positive SiHa cells at >500 cells/mL without detecting HPV18-positive cells. Our ELISA results showed E7 oncoproteins in 80% (4/5) of urine specimens from women with HPV16-positive CIN1, 71% (5/7) of urine specimens from CIN2 patients, and 38% (3/8) of urine specimens from CIN3 patients. Some urine specimens with undetectable E7 oncoproteins were thought to be negative for live HPV 16-positive cells or in an inactivated state of infection. These results provide the basis for assessing oncogenic activity by quantifying E7 oncoproteins in patient urine.

Polyhexamethylene Biguanide Reduces High-Risk Human Papilloma Virus Viral Load in Cervical Cell Samples Derived from ThinPrep Pap Test

Human papilloma virus (HPV) infection and its progression still represent a great medical challenge worldwide. Clinical evidence has demonstrated the beneficial effects of polyhexamethylene biguanide (PHMB) on HPV clinical manifestations; however, evidence of the effect of this molecule on HPV viral load is still lacking. In this in vitro study, 13 ThinPrep Papanicolaou (Pap) tests were treated with a PHMB solution (0.10 g/100 mL) for 2 h. We observed no cytological changes but a significant reduction in the viral load of high-risk (HR) HPV after PHMB treatment, also revealing a dose-dependent antiviral effect. In addition, by stratifying the obtained results according to HR-HPV genotype, we observed a significant reduction in the viral load of HPV 16, P2 (56, 59, 66), 31, and P3 (35, 39, 68) and a strong decrease in the viral load of HPV 45, 52, and P1 (33, 58). Overall, 85% of the analyzed cervical cell samples exhibited an improvement in HPV viral load after PHMB exposure, while only 15% remain unchanged. For the first time, the data from this pilot study support the activity of PHMB on a specific phase of the HPV viral lifecycle, the one regarding the newly generated virions, reducing viral load and thus blocking the infection of other cervical cells.

Advanced technologies towards improved HPV diagnostics

Persistent infection with high-risk types of human papillomaviruses (HPV) is a major cause of cervical cancer, and an important factor in other malignancies, for example, head and neck cancer. Despite recent progress in screening and vaccination, the incidence and mortality are still relatively high, especially in low-income countries. The mortality and financial burden associated with the treatment could be decreased if a simple, rapid, and inexpensive technology for HPV testing becomes available, targeting individuals for further monitoring with increased risk of developing cancer. Commercial HPV tests available in the market are often relatively expensive, time-consuming, and require sophisticated instrumentation, which limits their more widespread utilization. To address these challenges, novel technologies are being implemented also for HPV diagnostics that include for example, isothermal amplification techniques, lateral flow assays, CRISPR-Cas-based systems, as well as microfluidics, paperfluidics and lab-on-a-chip devices, ideal for point-of-care testing in decentralized settings. In this review, we first evaluate current commercial HPV tests, followed by a description of advanced technologies, explanation of their principles, critical evaluation of their strengths and weaknesses, and suggestions for their possible implementation into medical diagnostics.

Preliminary Results of Feasibility and Acceptability of Self-Collection for Cervical Screening in Italian Women

BACKGROUND

Given the diagnostic accuracy of HPV-DNA tests in terms of self-collected samples, in order to implement self-sampling in cervical screening programs, the standardization of the pre-analytical phase, including decisions concerning the choice of medium, the volume of elution, and storage conditions, are necessary, in addition to understanding the potential factors involved in acceptability by women. On this basis, we carried out a cross-sectional study to assess (i) the stability of dry vaginal self-collected samples stored at room temperature for up to 4 weeks after elution in 2 mL of eNat® (Copan) medium, and (ii) the acceptability of self-collection in enrolled women.

METHODS

185 women were enrolled in the LILT (Italian League Against Tumors) regional project. A self-sampling kit, including a dry FLOQSwab® (Copan), instructions for use, and a satisfaction questionnaire, were supplied for each woman and sent by mail to the laboratory. The HPV-DNA test was carried out using the Anyplex™ II HPV HR (Seegene) kit. To evaluate the specimen's stability, 185 dry vaginal swabs were eluted in eNat®, a lyses-based molecular medium and tested for HPV detection at two different time points (<6 days and 1 month after elution). The Cohen's Kappa coefficients and McNemar test were used to assess the agreement of HPV-DNA at different times.

RESULTS

We found high agreement in terms of HPV-DNA results among the samples tested at two different time points (Cohen K = 0.98; p < 0.0001). Moreover, most of the women found it easy to use self-collection devices and the pictorial instructions clear to understand. Approximately half of the enrolled women declared preferring self-sampling to clinician-collected methods.

CONCLUSION

Our results display the high reliability and accuracy of HPV-DNA tests using dry vaginal self-collection FLOQSwabs® devices eluted in 2 mL of molecular medium. The analysis of the questionnaire showed a high acceptability of self-collection among women, although a high percentage preferred standard collection devices. Overall, our preliminary results support the adoption of self-collection in screening programs, even though further analyses should be performed to optimize and standardize protocols for HPV tests on self-samples, and educational campaigns are needed to adequately inform and increase responsiveness in a target population.

The Editorial of the Special Issue "Diagnosis of Lower Genital Tract Disease"

A range of conditions involving the vulvovaginal and anal area, and those associated with human papillomavirus (HPV) infection, which can manifest as benign, pre-neoplastic, or neoplastic lesions, can be grouped into lower genital tract diseases [...].