HPV testing for triage of HIV-infected women with papanicolaou smears read as atypical squamous cells of uncertain significance

L. Stewart Massad, Michael F. Schneider, D. Heather Watts, Howard Strickler, Sandra Melnick, Joel Palefsky, Kathryn Anastos, Alexandre M. Levine, Howard Minkoff

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Abstract

Purpose: To assess the utility of testing for high-risk human papillomavirus (HPV) DNA as a triage strategy for detecting cervical intraepithelial neoplasia (CIN) grade 2/3 in women with human immunodeficiency virus-1 (HIV-1) infection and cytology read as atypical cells of uncertain significance (ASCUS). Methods: Conventional cervical cytology and cervicovaginal lavage were obtained at 6-month intervals between October 1, 1994, and September 30, 2002, from women enrolled in the Women's Interagency HIV Study, a multicenter cohort studying the natural history of HIV in women. HPV typing was performed by PCR. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 32, 56, 58, 59, and 68 were classified as carrying high oncogenic risk. Women with ASCUS smears were referred for colposcopy. Analyses of the sensitivity of HPV testing were cross-sectional, using colposcopy results within 90 days of first ASCUS result. Results: Of the 270 women evaluated, 7 (3%) had CIN 2, and 3 (1%) had CIN3 or adenocarcinoma in situ. High-risk HPV DNA was found in 81 (30%) of the 270 participants. The sensitivity of high-risk HPV DNA detection for CIN 2/3 was 50% (95% CI 0.19, 0.81), the specificity was 71% (95% CI 0.65, 0.76), the positive predictive value was 6% (95% CI 0.01, 0.11), and the negative predictive value was 97% (95% CI 0.95, 1.00). HPV of any risk type was found in 176 (65%) of the 270 women, including 9 of 10 women with CIN 2/3, for a sensitivity of 90% (95% CI 0.56, 1.00), a specificity of 36% (95% CI 0.30, 0.42), a positive predictive value of 5% (95% CI 0.02, 0.08), and a negative predictive value of 99% (95% CI 0.94, 1.00). Conclusions: For women with HIV and Papanicolaou smears read as ASCUS, DNA testing for high risk HPV may not be sensitive enough for clinical use.

Original languageEnglish (US)
Pages (from-to)147-153
Number of pages7
JournalJournal of Women's Health
Volume13
Issue number2
DOIs
StatePublished - Mar 2004

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Papanicolaou Test
Triage
HIV
Cervical Intraepithelial Neoplasia
Colposcopy
DNA
Cell Biology
Atypical Squamous Cells of the Cervix
Human papillomavirus 18
Human papillomavirus 16
Therapeutic Irrigation
Virus Diseases
Natural History
Multicenter Studies
HIV-1
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Medicine(all)

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HPV testing for triage of HIV-infected women with papanicolaou smears read as atypical squamous cells of uncertain significance. / Massad, L. Stewart; Schneider, Michael F.; Watts, D. Heather; Strickler, Howard; Melnick, Sandra; Palefsky, Joel; Anastos, Kathryn; Levine, Alexandre M.; Minkoff, Howard.

In: Journal of Women's Health, Vol. 13, No. 2, 03.2004, p. 147-153.

Research output: Contribution to journalArticle

Massad, L. Stewart ; Schneider, Michael F. ; Watts, D. Heather ; Strickler, Howard ; Melnick, Sandra ; Palefsky, Joel ; Anastos, Kathryn ; Levine, Alexandre M. ; Minkoff, Howard. / HPV testing for triage of HIV-infected women with papanicolaou smears read as atypical squamous cells of uncertain significance. In: Journal of Women's Health. 2004 ; Vol. 13, No. 2. pp. 147-153.
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abstract = "Purpose: To assess the utility of testing for high-risk human papillomavirus (HPV) DNA as a triage strategy for detecting cervical intraepithelial neoplasia (CIN) grade 2/3 in women with human immunodeficiency virus-1 (HIV-1) infection and cytology read as atypical cells of uncertain significance (ASCUS). Methods: Conventional cervical cytology and cervicovaginal lavage were obtained at 6-month intervals between October 1, 1994, and September 30, 2002, from women enrolled in the Women's Interagency HIV Study, a multicenter cohort studying the natural history of HIV in women. HPV typing was performed by PCR. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 32, 56, 58, 59, and 68 were classified as carrying high oncogenic risk. Women with ASCUS smears were referred for colposcopy. Analyses of the sensitivity of HPV testing were cross-sectional, using colposcopy results within 90 days of first ASCUS result. Results: Of the 270 women evaluated, 7 (3{\%}) had CIN 2, and 3 (1{\%}) had CIN3 or adenocarcinoma in situ. High-risk HPV DNA was found in 81 (30{\%}) of the 270 participants. The sensitivity of high-risk HPV DNA detection for CIN 2/3 was 50{\%} (95{\%} CI 0.19, 0.81), the specificity was 71{\%} (95{\%} CI 0.65, 0.76), the positive predictive value was 6{\%} (95{\%} CI 0.01, 0.11), and the negative predictive value was 97{\%} (95{\%} CI 0.95, 1.00). HPV of any risk type was found in 176 (65{\%}) of the 270 women, including 9 of 10 women with CIN 2/3, for a sensitivity of 90{\%} (95{\%} CI 0.56, 1.00), a specificity of 36{\%} (95{\%} CI 0.30, 0.42), a positive predictive value of 5{\%} (95{\%} CI 0.02, 0.08), and a negative predictive value of 99{\%} (95{\%} CI 0.94, 1.00). Conclusions: For women with HIV and Papanicolaou smears read as ASCUS, DNA testing for high risk HPV may not be sensitive enough for clinical use.",
author = "Massad, {L. Stewart} and Schneider, {Michael F.} and Watts, {D. Heather} and Howard Strickler and Sandra Melnick and Joel Palefsky and Kathryn Anastos and Levine, {Alexandre M.} and Howard Minkoff",
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T1 - HPV testing for triage of HIV-infected women with papanicolaou smears read as atypical squamous cells of uncertain significance

AU - Massad, L. Stewart

AU - Schneider, Michael F.

AU - Watts, D. Heather

AU - Strickler, Howard

AU - Melnick, Sandra

AU - Palefsky, Joel

AU - Anastos, Kathryn

AU - Levine, Alexandre M.

AU - Minkoff, Howard

PY - 2004/3

Y1 - 2004/3

N2 - Purpose: To assess the utility of testing for high-risk human papillomavirus (HPV) DNA as a triage strategy for detecting cervical intraepithelial neoplasia (CIN) grade 2/3 in women with human immunodeficiency virus-1 (HIV-1) infection and cytology read as atypical cells of uncertain significance (ASCUS). Methods: Conventional cervical cytology and cervicovaginal lavage were obtained at 6-month intervals between October 1, 1994, and September 30, 2002, from women enrolled in the Women's Interagency HIV Study, a multicenter cohort studying the natural history of HIV in women. HPV typing was performed by PCR. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 32, 56, 58, 59, and 68 were classified as carrying high oncogenic risk. Women with ASCUS smears were referred for colposcopy. Analyses of the sensitivity of HPV testing were cross-sectional, using colposcopy results within 90 days of first ASCUS result. Results: Of the 270 women evaluated, 7 (3%) had CIN 2, and 3 (1%) had CIN3 or adenocarcinoma in situ. High-risk HPV DNA was found in 81 (30%) of the 270 participants. The sensitivity of high-risk HPV DNA detection for CIN 2/3 was 50% (95% CI 0.19, 0.81), the specificity was 71% (95% CI 0.65, 0.76), the positive predictive value was 6% (95% CI 0.01, 0.11), and the negative predictive value was 97% (95% CI 0.95, 1.00). HPV of any risk type was found in 176 (65%) of the 270 women, including 9 of 10 women with CIN 2/3, for a sensitivity of 90% (95% CI 0.56, 1.00), a specificity of 36% (95% CI 0.30, 0.42), a positive predictive value of 5% (95% CI 0.02, 0.08), and a negative predictive value of 99% (95% CI 0.94, 1.00). Conclusions: For women with HIV and Papanicolaou smears read as ASCUS, DNA testing for high risk HPV may not be sensitive enough for clinical use.

AB - Purpose: To assess the utility of testing for high-risk human papillomavirus (HPV) DNA as a triage strategy for detecting cervical intraepithelial neoplasia (CIN) grade 2/3 in women with human immunodeficiency virus-1 (HIV-1) infection and cytology read as atypical cells of uncertain significance (ASCUS). Methods: Conventional cervical cytology and cervicovaginal lavage were obtained at 6-month intervals between October 1, 1994, and September 30, 2002, from women enrolled in the Women's Interagency HIV Study, a multicenter cohort studying the natural history of HIV in women. HPV typing was performed by PCR. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 32, 56, 58, 59, and 68 were classified as carrying high oncogenic risk. Women with ASCUS smears were referred for colposcopy. Analyses of the sensitivity of HPV testing were cross-sectional, using colposcopy results within 90 days of first ASCUS result. Results: Of the 270 women evaluated, 7 (3%) had CIN 2, and 3 (1%) had CIN3 or adenocarcinoma in situ. High-risk HPV DNA was found in 81 (30%) of the 270 participants. The sensitivity of high-risk HPV DNA detection for CIN 2/3 was 50% (95% CI 0.19, 0.81), the specificity was 71% (95% CI 0.65, 0.76), the positive predictive value was 6% (95% CI 0.01, 0.11), and the negative predictive value was 97% (95% CI 0.95, 1.00). HPV of any risk type was found in 176 (65%) of the 270 women, including 9 of 10 women with CIN 2/3, for a sensitivity of 90% (95% CI 0.56, 1.00), a specificity of 36% (95% CI 0.30, 0.42), a positive predictive value of 5% (95% CI 0.02, 0.08), and a negative predictive value of 99% (95% CI 0.94, 1.00). Conclusions: For women with HIV and Papanicolaou smears read as ASCUS, DNA testing for high risk HPV may not be sensitive enough for clinical use.

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