Primary HPV and Molecular Cervical Cancer Screening in US Women Living With Human Immunodeficiency Virus

Background. Primary human papillomavirus (HPV) screening ( PHS ) utilizes oncogenic human papillomavirus (oncHPV) the initial cervical cancer screening method typically, if positive, additional reflex-triage (eg, HPV16/18-genotyping, Pap testing). While US guidelines support PHS usage in the general population, PHS has been little studied in women living with HIV (WLWH). value (PPV), and a 35% colposcopy referral rate (Colpo). “ PHS with reflex HPV16/18-genotyping and Pap testing ” had 84% Se, 16% PPV, 30% Colpo. PHS with only HPV16/18-genotyping had 24% Colpo. “ Concurrent oncHPV and Pap Testing” (Co-Testing) had 91% Se, 12% PPV, 40% Colpo. p16/Ki-67 immunochemistry had the highest PPV, 20%, but 13% specimen inadequacy. Conclusions. PHS with reflex HPV16/18-genotyping had fewer unnecessary colposcopies and (if confirmed) could be a potential alternative to Co-Testing in WLWH. treatment failure/disease recurrence). To minimize the possibility that sampling order might affect the results, with every other participant we alternated whether the first versus the second liquid Pap specimen collected was the one tested in assay. 20 of one vial was Pap and HPV and used to prepare a standard monolayer cervical Pap and then immediately Cobas HPV DNA HPV16/18-genotyping. residual vial (approximately was was requested HPV Screening (PHS) involves use of an oncHPV assay as the initial cervical cancer screening test without reflex HPV16/18 genotyping or Pap tests; PHS-genotype/Pap includes reflex HPV16/18 genotype and Pap testing. p16/Ki- 67 involves dual immunocytological staining for Ki67 (a proliferation marker) and p16 (a cyclin-dependent kinase inhibitor that can accumulate in HPV-positive cells when there is overexpression of the viral oncoprotein E7).