Role of HPV Genotype, Multiple Infections, and Viral Load on the Risk of High-Grade Cervical Neoplasia.
Journal
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
ISSN: 1538-7755
Titre abrégé: Cancer Epidemiol Biomarkers Prev
Pays: United States
ID NLM: 9200608
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
13
03
2019
revised:
08
06
2019
accepted:
28
08
2019
pubmed:
7
9
2019
medline:
22
9
2020
entrez:
7
9
2019
Statut:
ppublish
Résumé
Human papillomavirus (HPV) testing provides a much more sensitive method of detection for high-grade lesions than cytology, but specificity is low. Here, we explore the extent to which full HPV genotyping, viral load, and multiplicity of types can be used to improve specificity. A population-based sample of 47,120 women undergoing cervical screening was tested for 13 high-risk HPV genotypes. Positive predictive values (PPV) for cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+; High-risk HPV was detected in 15.4% of women. A hierarchy of HPV genotypes based on sequentially maximizing PPVs for CIN3+ found HPV16>33>31 to be the most predictive, followed sequentially by HPV18>35>58>45>52>59>51>39>56>68. After adjusting for higher ranked genotypes, the inclusion of multiple HPV infections added little to risk prediction. High viral loads for HPV18, 35, 52, and 58 carried more risk than low viral loads for HPV16, 31, and 33. High viral load for HPV16 was significantly more associated with CIN3+ than low viral load. HPV genotype and viral load, but not multiplicity of HPV infections, are important predictors of CIN2+ and CIN3+. The ability to identify women at higher risk of CIN2+ and CIN3+ based on both HPV genotype and viral load could be important for individualizing triage plans, particularly as HPV becomes the primary screening test.
Sections du résumé
BACKGROUND
Human papillomavirus (HPV) testing provides a much more sensitive method of detection for high-grade lesions than cytology, but specificity is low. Here, we explore the extent to which full HPV genotyping, viral load, and multiplicity of types can be used to improve specificity.
METHODS
A population-based sample of 47,120 women undergoing cervical screening was tested for 13 high-risk HPV genotypes. Positive predictive values (PPV) for cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+;
RESULTS
High-risk HPV was detected in 15.4% of women. A hierarchy of HPV genotypes based on sequentially maximizing PPVs for CIN3+ found HPV16>33>31 to be the most predictive, followed sequentially by HPV18>35>58>45>52>59>51>39>56>68. After adjusting for higher ranked genotypes, the inclusion of multiple HPV infections added little to risk prediction. High viral loads for HPV18, 35, 52, and 58 carried more risk than low viral loads for HPV16, 31, and 33. High viral load for HPV16 was significantly more associated with CIN3+ than low viral load.
CONCLUSIONS
HPV genotype and viral load, but not multiplicity of HPV infections, are important predictors of CIN2+ and CIN3+.
IMPACT
The ability to identify women at higher risk of CIN2+ and CIN3+ based on both HPV genotype and viral load could be important for individualizing triage plans, particularly as HPV becomes the primary screening test.
Identifiants
pubmed: 31488417
pii: 1055-9965.EPI-19-0239
doi: 10.1158/1055-9965.EPI-19-0239
pmc: PMC8394698
mid: NIHMS1730809
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1816-1824Subventions
Organisme : NIAID NIH HHS
ID : U19 AI113187
Pays : United States
Investigateurs
Nancy E Joste
(NE)
Walter Kinney
(W)
Cosette M Wheeler
(CM)
William C Hunt
(WC)
Ruth M McDonald
(RM)
Michael Robertson
(M)
Alan Waxman
(A)
Steven Jenison
(S)
Julia C Gage
(JC)
Philip E Castle
(PE)
Vicki Benard
(V)
Debbie Saslow
(D)
Jane J Kim
(JJ)
Mark H Stoler
(MH)
Jack Cuzick
(J)
Giovanna Rossi Pressley
(GR)
Kevin English
(K)
Informations de copyright
©2019 American Association for Cancer Research.
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