HPV Virus Scientific Facts

Utagawa ML, Pereira SM, Makabe S, Maeda MY, Marques JA, Santoro CL, Di Loreto C, Aguiar LS, Pitolli JE, Das Dores GB, Castelo A, Longatto Filho A. Division of Pathology of Adolfo Lutz Institute, 01246-902 Sao Paulo, Brazil.

Liquid-based cytology (LBC) is believed to have better sensitivity than conventional smears (CSs) and offers the possibility to perform molecular assay. The goal of this work was to study the performance of CS and LBC in a high-risk population and to compare the results with the hybrid capture (HC) II for high-risk human papillomavirus (HPV). Samples were collected from selected women with clinical suspicions of low genital tract lesion at Perola Biygnton Hospital (Sao Paulo, Brazil). After CS preparation, the brush was introduced in the endocervix and a new sample was collected and rinsed in the preservative medium of the system. The residual material was used to HC2. From 925 cases, LBC was unsatisfactory in 4 (1.51%) cases and CS was unsatisfactory in 100 cases (10.81%); among theses cases HC2(+) reactions was observed in 54 (54%) CSs and 3 (21.4%) LBCs. Considering cases with atypia of undetermined significance (squamous and glandular), 85 (77.27%) cases from LBC and 44 (86.4%) from CS were positive for HC2 assay for high-risk DNA-HPV. The difference among the methods was not significant (P < 0.38). The diagnosis improvement of LBC in comparison with CS was 86% in satisfactory samples, 92.76% in undetermined atypical lesions (including glandular), 83% in positive low-grade squamous intraepithelial lesions (LSIL(+)), and 86.84% in high-grade SIL(+) (HSIL(+)). HC2(+) reactions were observed in 144 CS cases and 266 LBC cases with abnormalities. Our results have showed that LBC was superior to CS in a high-risk population to detect lesions with high concordance with HC2(+) reactions; CSs also exhibit a high concordance with HC2 assay but with inferior performance to detect lesions.

J Med Virol. 2004 May;73(1):65-70.

Human papillomavirus type specific DNA and RNA persistence--implications for cervical disease progression and monitoring.

Cuschieri KS, Whitley MJ, Cubie HA. Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland. Kate.

In 2000, we monitored the course and persistence of human papillomavirus (HPV) infection in 54 women who were HPV positive and free of any cytological disease using HPV-DNA genotyping with a linear array assay (baseline). The impact of HPV infection on development of cervical cytological abnormality (dyskaryosis) was monitored by repeat HPV genotyping and cytological assessment 2 years later. Detection of mRNA transcripts of known HPV oncogenes E6 and E7 using NASBA methodology and specific molecular beacons for five common HPV types was also performed at both time points. A total of 11/54 (20%) women developed dyskaryosis after 2 years with 31/54 and 23/54 women exhibiting transient and persistent infections respectively, as monitored by DNA genotyping. Women who maintained type-specific persistent HPV infection were significantly more likely to develop dyskaryosis compared to those who exhibited a transient infection (P = 0.001). The presence of HPV mRNA E6/E7 transcripts was less sensitive but more specific for the detection of disease at follow up. Moreover, women who were DNA positive and also positive for mRNA transcripts at baseline were significantly more likely to harbour persistent infection compared to those in whom DNA only was detected at baseline (P = 0.013). This study highlights the importance of detecting persistent type specific HPV infection to identify those women more at risk of developing cervical abnormalities, either by repeated DNA genotyping, or potentially by RNA based techniques that may be more predictive of persistent infection if performed at a single time point. Copyright 2004 Wiley-Liss, Inc.

BMJ. 2004 May 29;328(7451):1293.

Psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: cross sectional questionnaire study.

Maissi E, Marteau TM, Hankins M, Moss S, Legood R, Gray A. Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, London SE1 9RT.

OBJECTIVE: To describe the psychological impact on women of being tested for human papillomavirus (HPV) when smear test results are borderline or mildly dyskaryotic. DESIGN: Cross sectional questionnaire study. SETTING: Two centres participating in an English pilot study of HPV testing in women with borderline or mildly dyskaryotic smear test results. PARTICIPANTS: Women receiving borderline or mildly dyskaryotic smear test results tested for HPV and found to be HPV positive (n = 536) or HPV negative (n = 331); and women not tested for HPV with borderline or mildly dyskaryotic smear results (n = 143) or normal smear results (n = 366). MAIN OUTCOME MEASURES: State anxiety, distress, and concern about test result, assessed within four weeks of receipt of results. RESULTS: Women with borderline or mildly dyskaryotic smear results who were HPV positive were more anxious, distressed, and concerned than the other three groups. Three variables independently predicted anxiety in HPV positive women: younger age (beta = -0.11, P = 0.03), higher perceived risk of cervical cancer (beta = 0.17, P < 0.001), and reporting that they did not understand the meaning of test results (beta = 0.17, P = 0.001). Testing HPV negative was not reassuring: among women with abnormal smear test results, those who were HPV negative were no less anxious than those who were not tested for HPV. CONCLUSIONS: Informing women more effectively about the meaning of borderline or mildly dyskaryotic smear test results and HPV status, in particular about the absolute risks of cervical cancer and the prevalence of HPV infection, may avoid some anxiety for those who are HPV positive while achieving some reassurance for those who test HPV negative.

Publication Types:
• Multicenter Study

Int J Circumpolar Health. 2004;63 Suppl 2:199-201.

Human papillomavirus and cervical dysplasia in Nunavut: prelude to a screening strategy.

Healey SM, Aronson K, Mao Y, Franco EL. Health Protection Unit, Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada.

OBJECTIVES: To determine the prevalence of oncogenic human papillomavirus' (HPV) in Nunavut and to assess the association between HPV and squamous intraepithelial lesions (SIL) as a prelude to planning a better screening strategy. STUDY DESIGN: A cross-sectional study was conducted on the Pap-screened populations in 19 communities in Nunavut, Canada. SIL was determined using Liquid-based cytology, and HPV testing was done using the Hybrid Capture II assay. RESULTS: Prevalence of oncogenic HPVs in 1,290 women ages 13-79 was 26% and of Cervical Dysplasia was 7.2%. Over 90% of women with SIL had positive HPV tests. Over 75% of women who were HPV positive but SIL negative were under 30 years of age. CONCLUSION: Consideration should be given to using liquid-based cytology for Pap testing. Also consider concurrent HPV testing in those over 30 years old and reflex testing of HPV in those under 30 years old with a positive HPV test.

Diagn Cytopathol. 2004 Nov;31(5):358-61.

ASC-US and HPV testing in women aged 40 years and over.

Bruner KS, Davey DD. Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.

High-risk human papillomavirus (HPV) DNA triage is commonly performed for cervical cytology specimens interpreted as atypical squamous cells of undetermined significance (ASC-US), but little is known about testing results in women > or =40 yr of age. The extent to which clinical follow-up after HPV testing reflects the most recent management guidelines is unknown also. Data from 108 patients > or =40 yr of age with concurrent (93 patients) or recent (15 patients) ASC-US interpretations and HPV testing were reviewed. Twenty-five (23.1%) of these patients were positive for high-risk HPV. The HPV(+) rate was higher in women with a current interpretation of ASC-US (26.9%) compared with those with a previous ASC-US result (0%). Many patients were not managed exactly according to the "2001 Consensus Guidelines for the Management of Women with Cervical Cytologic Abnormalities." The majority (52.6%) of women with HPV(+) ASC-US did not receive colposcopy in our institution, and 41.3% of women with HPV(-) ASC-US received follow-up testing within 8 mo. These results show the potential for inadequate evaluation of women with HPV(+) ASC-US, as well as unnecessary early repeat cytology in HPV(-) ASC-US patients. Therefore, additional clinician education and reminders to correlate cytology and HPV test results may be warranted to optimize patient care.

Publication Types:
• Evaluation Studies

HPV Virus Scientific Facts - HPV Screening Links

CTF Full Text Review: Screening for Human Papillomavirus Infection - Read a large article about the effectiveness of early detection and screening.

HPV Screening Test for Cervical Cancer - Learn basic facts concerning screening for HPV and other gynecological disorders.