Hybrid capture as a tool for cervical lesions screening in HIV-infected women: insights from a Brazilian cohort

Braz J Infect Dis. 2018 Jan-Feb;22(1):16-23. doi: 10.1016/j.bjid.2017.10.007. Epub 2017 Dec 6.

Abstract

Introduction: Cervical cancer remains an important burden for HIV-infected women in the era of combination antiretroviral therapy. Recommendations for cervical screening in these women diverge and may include high-risk HPV (HRHPV) testing. We aimed to evaluate the clinical usefulness of a single HRHPV testing for cervical screening of HIV-infected women.

Methods: 723 HIV-infected women from a Brazilian prospective cohort were included between 1996 and 2012. Inclusion criteria were: normal cervical cytology at baseline and having a HRHPV-test at baseline. We calculated incidence rates of any squamous intraepithelial lesion (SIL) and high grade SIL+ (HSIL+) and negative predictive values (NPV) within 12 and 36 months. Hazard Ratios were obtained using Cox proportional hazards regression models.

Results: Incidence rate for both outcomes was low (9.9 cases per 100 PY [95% CI 8.8-11.0] for any SIL and 1.3 cases per 100 PY [95% IC 0.9-1.8] for HSIL+). Women with a HRHPV positive status at baseline had 1.7-fold (95% CI 1.3-2.2) and 3.2-fold (95% CI 1.5-7.1) increased risk of presenting any SIL and HSIL+, respectively, during follow-up. Negative-HRHPV test presented high NPV for both periods and outcomes (any SIL: 92.4% [95% CI 89.7-94.6] for 12 months and 80.9% [95% CI 77.2-84.3] for 36 months; and HSIL+: 99.8% [95% CI 98.9-100.0] for 12 months and 99.0 [95% CI 97.6-99.7] for 36 months).

Conclusions: Incidence of any and high grade cytological abnormality was significantly higher among HIV-infected women with positive-HRHPV test. A single negative-HRHPV test helped reassure follow-up free of cytological abnormalities through three years of follow-up in HIV-infected women with negative cytology.

Keywords: Cohort; HIV; HPV; Incidence; Women.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Brazil
  • CD4 Lymphocyte Count
  • Early Diagnosis
  • Female
  • HIV Infections / complications*
  • Humans
  • Mass Screening / methods*
  • Multivariate Analysis
  • Papillomavirus Infections / complications*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Reference Values
  • Reproducibility of Results
  • Risk Assessment / methods*
  • Risk Factors
  • Squamous Intraepithelial Lesions of the Cervix / diagnosis*
  • Squamous Intraepithelial Lesions of the Cervix / pathology
  • Squamous Intraepithelial Lesions of the Cervix / virology*
  • Time Factors
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / virology
  • Viral Load