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1.
N Z Med J ; 137(1596): 43-51, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38843549

RESUMEN

AIM: Cervical cancer is now preventable with human papillomavirus (HPV) vaccination and HPV screening. However, structural health system barriers in rural areas can inhibit screening access. Inequitable access for rural Maori is exacerbated by social determinants and racism. Pro-equity tools, such as self-taken swabs point of care (POC) testing, now exist. This study aimed to investigate whether POC HPV testing and immediate offer of colposcopy by a mobile colposcopy service is possible at a rural community event. METHODS: This case study was a collaboration between a research centre, a women's health bus, a molecular diagnostics company, a Maori health provider and a community charity, and took place prior to the new cervical screening programme introduction at a 2-day community event-a shearathon. Eligible participants were offered a self-taken swab for HPV, which was analysed by POC testing. If high-risk HPV was detected, they were offered an immediate colposcopy. The Maori-centred qualitative component explored women's experiences of the process. RESULTS: Fourteen women undertook a self-test for HPV. High-risk HPV was detected in six women and all were offered immediate colposcopy. Six women were interviewed. All were supportive of the service. Culturally safe staff taking time to put women at ease contributed to acceptability and positive experiences. CONCLUSION: This case study shows that provision of POC HPV testing and colposcopy at a rural community event setting is possible through cross-sector collaboration. This service was acceptable to rural transient workers who face barriers to healthcare in a high-income country.


Asunto(s)
Colposcopía , Infecciones por Papillomavirus , Población Rural , Neoplasias del Cuello Uterino , Humanos , Femenino , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Adulto , Nueva Zelanda , Persona de Mediana Edad , Detección Precoz del Cáncer/métodos , Sistemas de Atención de Punto , Pruebas en el Punto de Atención , Papillomaviridae/aislamiento & purificación , Unidades Móviles de Salud , Nativos de Hawái y Otras Islas del Pacífico , Adulto Joven , Virus del Papiloma Humano
2.
J Med Virol ; 96(6): e29688, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38847316

RESUMEN

To meet the screening goal of WHO's 90-70-90 strategy aimed at eliminating cervical cancer (CC) by 2030, clinical validation of human papillomavirus (HPV) assays is essential to provide accurate and valid results through fulfilling three criteria of the international validation guidelines (IVGs). Previously, the clinical accuracy of the AmpFire® HPV Screening 16/18/HR assay (AmpFire assay) was reported but reproducibility data are lacking. Here, we aim to evaluate the intra- and inter-laboratory reproducibility of the AmpFire assay. The reproducibility of the isothermal AmpFire assay was assessed using 556 cervical cell samples collected from women attending CC screening and biobanked in a Belgian HPV national reference center. This assay detects HPV16, HPV18, and 12 other high-risk HPV (hrHPV) types (31/33/35/39/45/51/52/56/58/59/66/68) in aggregate. Lower 95% confidence interval bound around the assay's reproducibility should exceed 87%, with κ ≥ 0.50. Additionally, a literature review of the assay's clinical performance was performed. The AmpFire assay showed an excellent intralaboratory (96.4%, 95% CI:94.5-97.8%, κ = 0.920) and interlaboratory (95.3%, 95% CI:93.2-96.9%, κ = 0.897) reproducibility. One study demonstrated noninferior sensitivity of a prototype AmpFire assay targeting 15 hrHPV types (including HPV53) to detect CIN2+. However, clinical specificity became similar to the comparator after removing HPV53 from analyses. The low-cost and easy-to-use AmpFire assay presents excellent reproducibility and-after removing HPV53 from the targeted types-fulfills also clinical accuracy requirements. Inclusion of HPV53, which is not recognized as carcinogenic, comprises clinical specificity of screening assays.


Asunto(s)
Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Humanos , Reproducibilidad de los Resultados , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/virología , Femenino , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Papillomaviridae/aislamiento & purificación , Bélgica , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Adulto , Sensibilidad y Especificidad , Persona de Mediana Edad , Técnicas de Diagnóstico Molecular/normas , Técnicas de Diagnóstico Molecular/métodos , Cuello del Útero/virología
4.
CMAJ ; 196(21): E716-E723, 2024 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-38830680

RESUMEN

BACKGROUND: To eliminate cervical cancer in Canada by 2040, defined as an annual age-standardized incidence rate (ASIR) lower than 4.0 per 100 000 women, the Canadian Partnership Against Cancer (CPAC) identified 3 priorities for action: increasing human papillomavirus (HPV) vaccine coverage, implementing HPV-based screening and increasing screening participation, and improving follow-up after abnormal screen results. Our objective was to explore the impact of these priorities on the projected time to elimination of cervical cancer in British Columbia. METHODS: We used OncoSim-Cervical, a microsimulation model led and supported by CPAC and developed by Statistics Canada that simulates HPV transmission and the natural history of cervical cancer for the Canadian population. We updated model parameters to reflect BC's historical participation rates and program design. We simulated the transition to HPV-based screening and developed scenarios to explore the additional impact of achieving 90% vaccination coverage, 95% screening recruitment, 90% ontime screening, and 95% follow-up compliance. We projected cervical cancer incidence, ASIR, and year of elimination for the population of BC for 2023-2050. RESULTS: HPV-based screening at current vaccination, participation, and follow-up rates can eliminate cervical cancer by 2034. Increasing on-time screening and follow-up compliance could achieve this target by 2031. Increasing vaccination coverage has a small impact over this time horizon. INTERPRETATION: With the implementation of HPV-based screening, cervical cancer can be eliminated in BC before 2040. Efforts to increase screening participation and follow-up through this transition could potentially accelerate this timeline, but the transition from cytology- to HPV-based screening is fundamental to achieving this goal.


Asunto(s)
Detección Precoz del Cáncer , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino , Humanos , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/diagnóstico , Colombia Británica/epidemiología , Femenino , Vacunas contra Papillomavirus/administración & dosificación , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/diagnóstico , Incidencia , Adulto , Detección Precoz del Cáncer/estadística & datos numéricos , Persona de Mediana Edad , Tamizaje Masivo , Adulto Joven , Anciano , Erradicación de la Enfermedad
5.
Cancer Epidemiol Biomarkers Prev ; 33(6): 763-765, 2024 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-38826081

RESUMEN

Cervical cancer can be eliminated, and the global community intends to achieve this goal in the next century. For this to successfully occur, concerted efforts to implement and scale-up available, evidence-based strategies including human papillomavirus vaccination, screening and treatment of precancerous lesions, and early detection and treatment for invasive cancers is paramount. While the World Health Organization has offered technical guidance and recommendations on implementation, several questions remain unanswered and require urgent high-quality research to inform policy and practice. We discuss the findings from the Cervical Cancer Screening and Treatment Algorithms pilot study in the context of the evidence synthesis conducted for the second edition of the World Health Organization guidelines for screening and treatment of cervical precancer lesions for cervical cancer prevention. Policymakers at the national level must consider the weight of evidence with country-level resources to make decisions on screening, triage, and treatment approaches. See related article by Sebitloane et al., p. 779.


Asunto(s)
Algoritmos , Detección Precoz del Cáncer , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Humanos , Femenino , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/prevención & control , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Detección Precoz del Cáncer/métodos , Vacunas contra Papillomavirus/uso terapéutico , Vacunas contra Papillomavirus/administración & dosificación , Papillomaviridae/aislamiento & purificación , Proyectos Piloto
6.
HLA ; 103(6): e15509, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38837741

RESUMEN

Loss of heterozygosity (LOH) has been reported to occur in HLA regions in cervical intraepithelial neoplasia (CIN) and cervical cancer. However, the details of how this is related to the progression of CIN have been unclear. In this study, we examined the human papillomavirus (HPV) antigen-presenting capacity of people with CIN and the significance of LOH of HLA class I in the progression of CIN. It was shown that differences in antigen-presenting capacity among each case depended on HLA types, not HPV genotypes. Focusing on the HLA type, there was a positive correlation between antigen-presenting capacity against HPV and the frequency of allelic loss. Furthermore, the lost HLA-B alleles had a higher HPV antigen-presenting capacity than intact alleles. In addition, frequency of LOH of HLA class I was significantly higher in advanced CIN (CIN2-3) than in cervicitis or early-stage CIN (CIN1): around half of CIN2-3 had LOH of any HLA class I. Moreover, the antigen-presenting capacity against E5, which is the HPV proteins that facilitate viral escape from this immune surveillance by suppressing HLA class I expression, had the most significant impact on the LOH in HLA-B. This study suggests that HPV evades immune surveillance mechanisms when host cells lose the capacity for antigen presentation by HLA class I molecules, resulting in long-term infection and progression to advanced lesions.


Asunto(s)
Antígenos de Histocompatibilidad Clase I , Pérdida de Heterocigocidad , Infecciones por Papillomavirus , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Humanos , Displasia del Cuello del Útero/inmunología , Displasia del Cuello del Útero/genética , Displasia del Cuello del Útero/virología , Displasia del Cuello del Útero/patología , Femenino , Neoplasias del Cuello Uterino/inmunología , Neoplasias del Cuello Uterino/genética , Antígenos de Histocompatibilidad Clase I/inmunología , Antígenos de Histocompatibilidad Clase I/genética , Infecciones por Papillomavirus/inmunología , Infecciones por Papillomavirus/genética , Presentación de Antígeno/inmunología , Adulto , Alelos , Papillomaviridae/inmunología , Vigilancia Inmunológica , Persona de Mediana Edad , Genotipo
7.
Int J Equity Health ; 23(1): 112, 2024 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-38822383

RESUMEN

BACKGROUND: Inequities in access to human papillomavirus (HPV) vaccine are becoming a growing critical issue globally. Few studies investigate the factors determining HPV vaccine uptake disparities when vaccine supply is constrained, especially in low- and middle-income countries. The aim of this study was to investigate inequities of HPV vaccination and related factors under the constrained vaccine supply in China. METHODS: A cross-sectional survey was conducted in a developed eastern coastal province and a developing western one in China between November and December 2022. Employing multistage stratified cluster random sampling, the study collected data from parents of children aged 9-14. Mixed-effects logistic regression models with school units as random effects were used for analysis. RESULTS: From 4,127 eligible parents (as vaccine decision makers for girls), 1,346 (32.6%) intended to vaccinate their daughters against HPV, of which 836 (62.1%) attempted to schedule a vaccination appointment. Only 16.4% succeeded in booking an appointment. More than half of the intended parents expected the imported 9-valent HPV vaccine. There were significant disparities in HPV vaccine awareness, intention, and vaccination behavior across educational, income, geographic, ethnic, gender, and health literacy levels. Vaccine awareness and intentions were higher among parents with higher socioeconomic status; however, girls from lower socioeconomic families were more likely to receive the HPV vaccine and had a higher domestically produced vaccination rate. Significant disparities exist in vaccination intentions and actual vaccination behaviors, primarily due to large supply constraints of the HPV vaccine. CONCLUSIONS: Sustained health education campaigns are needed to raise awareness of the HPV vaccine, improve health literacy, and decrease over-preference for the 9-valent HPV vaccine. A mother's HPV vaccination behavior was positively associated with increased intention and actual vaccination behavior for her daughter. This study advocates for complementary cervical cancer prevention programs targeting both mothers and daughters.


Asunto(s)
Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Vacunas contra Papillomavirus/uso terapéutico , Vacunas contra Papillomavirus/administración & dosificación , China , Femenino , Niño , Estudios Transversales , Adolescente , Masculino , Infecciones por Papillomavirus/prevención & control , Vacunación/estadística & datos numéricos , Vacunación/psicología , Conocimientos, Actitudes y Práctica en Salud , Adulto , Disparidades en Atención de Salud/estadística & datos numéricos , Padres/psicología , Factores Socioeconómicos , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Virus del Papiloma Humano
8.
BMC Infect Dis ; 24(1): 552, 2024 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-38831406

RESUMEN

BACKGROUND: Persistent infections with high-risk human papillomavirus (hrHPV) can cause cervical squamous intraepithelial lesions (SIL) that may progress to cancer. The cervicovaginal microbiome (CVM) correlates with SIL, but the temporal composition of the CVM after hrHPV infections has not been fully clarified. METHODS: To determine the association between the CVM composition and infection outcome, we applied high-resolution microbiome profiling using the circular probe-based RNA sequencing technology on a longitudinal cohort of cervical smears obtained from 141 hrHPV DNA-positive women with normal cytology at first visit, of whom 51 were diagnosed by cytology with SIL six months later. RESULTS: Here we show that women with a microbial community characterized by low diversity and high Lactobacillus crispatus abundance at both visits exhibit low risk to SIL development, while women with a microbial community characterized by high diversity and Lactobacillus depletion at first visit have a higher risk of developing SIL. At the level of individual species, we observed that a high abundance for Gardnerella vaginalis and Atopobium vaginae at both visits associate with SIL outcomes. These species together with Dialister micraerophilus showed a moderate discriminatory power for hrHPV infection progression. CONCLUSIONS: Our results suggest that the CVM can potentially be used as a biomarker for cervical disease and SIL development after hrHPV infection diagnosis with implications on cervical cancer prevention strategies and treatment of SIL.


Asunto(s)
Cuello del Útero , Microbiota , Infecciones por Papillomavirus , Vagina , Humanos , Femenino , Estudios Longitudinales , Vagina/microbiología , Vagina/virología , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/microbiología , Adulto , Cuello del Útero/microbiología , Cuello del Útero/virología , Persona de Mediana Edad , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Papillomaviridae/clasificación , Adulto Joven , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/microbiología , Frotis Vaginal
9.
BMC Public Health ; 24(1): 1485, 2024 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-38831431

RESUMEN

BACKGROUND: The prevalence of, and risk factors for, genital Human Papillomavirus (HPV) infections within the young adult population are well-established; the same is not known for oral HPV. This observational study aimed to determine oral HPV prevalence and abundance within a UK young adult population, and examine if sexual practices and established risk factors of oropharyngeal squamous cell carcinomas (OPSCCs) (such as smoking and alcohol consumption) influenced HPV prevalence. METHODS: Convenience sampling was used to recruit a small sample of 452 UK-based young adults studying at a higher education (HE) institution to the study; the study was not powered. A highly sensitive real-time PCR HPV screening method was developed for the detection of multiple HPV subtypes from oral swabs. HPV-positive samples were subsequently screened by qPCR for viral subtypes HPV-6, HPV-11, HPV-16, HPV-18. Results were analysed by univariate and multivariate methods and stratified for gender, with lifestyle behaviour data collected via questionnaire. Socio-economic status was not captured within the questionnaire. RESULTS: We found a high oral HPV prevalence of 22.79%, with a dominance of high-risk viral type HPV-16 (prevalence 19.12%; abundance average 1.08 × 105 copies/million cells) detected within healthy young adults. Frequent smoking (p = .05), masturbation (p = .029), and engagement in multiple sexual activities (p = .057), were found to be associated with oral HPV prevalence, and HPV-16 prevalence, whilst behaviours traditionally associated with genital HPV were not. CONCLUSIONS: Our results strengthen the link between sexual practices and oral HPV transmission. We suggest that young adults should be considered high-risk for the contraction of oral HPV, although acknowledge that this sample of HE students may not be representative of the wider population. We show that high-risk HPV-16 is prevalent in the healthy population, as well as dominating within OPSCC; this study is one of the first to determine the dominance of oral HPV-16 prevalence and abundance within this population, presenting a clear need for greater awareness of oral HPV infections, and the risk factors for HPV-positive OPSCC within young adults.


Asunto(s)
Infecciones por Papillomavirus , Conducta Sexual , Humanos , Infecciones por Papillomavirus/epidemiología , Masculino , Femenino , Factores de Riesgo , Prevalencia , Adulto Joven , Reino Unido/epidemiología , Conducta Sexual/estadística & datos numéricos , Adulto , Adolescente , Neoplasias Orofaríngeas/epidemiología , Neoplasias Orofaríngeas/virología , Papillomaviridae/aislamiento & purificación , Papillomaviridae/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Virus del Papiloma Humano
10.
BMC Infect Dis ; 24(1): 558, 2024 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-38834951

RESUMEN

In January 2020, a different cervical cancer screening program started in Germany. Women above the age of 35 are recommended to have a combined HPV and cytology swab every three years. Showing persistent high-risk human papillomavirus (hrHPV), cytologic negative cervical samples at baseline and after 12 months, patients are referred to colposcopy. Entailing considerable additional workload due to the required colposcopies, we analyzed the risk of high-grade cervical intraepithelial neoplasia (CIN 3) in cytologic negative and persistent hrHPV women according to their hrHPV genotypes.Methods In this single center retrospective study, patients with persistent hrHPV, cytology negative cervical samples from our certified Colposcopy Unit in 2020 and 2021 were analyzed. Patient demographics, hrHPV types, biopsy rates and histological reports were collected.Results During the study, 69 patients were enrolled. Most frequent hrHPV genotypes were: hrHPV other 72.5%; HPV 16, 20.3% and HPV 18, 7.2%. Colposcopy showed no or minor changes in 92.7% and major changes in 7.2%. CIN 3 was found in 7 patients (10.1%). Prevalence of CIN 3 by hrHPV genotypes was 27.3% for HPV16, 20.0% for HPV18 and 7.1% for HPVO. A statistically significant dependency between hrHPV and cervical intraepithelial neoplasia was demonstrated (p = 0.048).Conclusion Within this single center study of persistent hrHPV, cytologic negative samples, patients with HPV 16 were more likely to have high-grade disease compared to other hrHPV subtypes. Larger prospective randomized trials are needed to substantiate our results and obtain adjusted cervical cancer screening time intervals according to the hrHPV genotypes.


Asunto(s)
Colposcopía , Genotipo , Papillomaviridae , Infecciones por Papillomavirus , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Humanos , Femenino , Estudios Retrospectivos , Infecciones por Papillomavirus/virología , Adulto , Persona de Mediana Edad , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/patología , Displasia del Cuello del Útero/virología , Displasia del Cuello del Útero/patología , Displasia del Cuello del Útero/epidemiología , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Papillomaviridae/clasificación , Alemania/epidemiología , Anciano , Detección Precoz del Cáncer , Cuello del Útero/virología , Cuello del Útero/patología , Virus del Papiloma Humano
11.
BMC Womens Health ; 24(1): 322, 2024 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-38834999

RESUMEN

BACKGROUND: Cervical cancer is one of the leading causes of death in women worldwide. The majority of the cases are found in developing countries. The increasing risk of cervical cancer prevalence and growing danger of death from cervical cancer and the high occurrence of human papillomavirus (HPV) infection in women who are HIV positive give us the ground to study the prevalence and associated risk factors. OBJECTIVE: The study aims to assess the prevalence of cervical cancer screening and associated risk factors among HIV-positive women attending the Adult ART clinic at the University of Gondar Hospital. METHODS: An institution-based cross-sectional study was conducted from March to August 2021, on adult HIV-positive women attending the Adult ART clinic at Gondar University Referral Hospital by phone calling patients per week for six months to complete a total of 2744 HIV-positive patients who were not screened for cervical cancer before. The data were collected using an interviewer-administered questionnaire. Bivariate and multivariable logistic regression analyses were used to determine the presence and the degree of association between dependent and independent variables. In the multivariable logistic analysis, a P-value of < 0.05 and odds ratio with a 95% confidence interval were considered to determine independent predictors for the prevalence of premalignant or malignant cervical lesions among HIV-positive patients. RESULT: This study assessed 915 HIV Positive women who were screened for cervical cancer via visual inspection with acetic acid (VIA) as the primary screening tool and found that 24.48% had positive VIA results. Those with VIA-positive cases pathology examination showed 72.4% had abnormal pathology reports (CIN 1/2/3-51.25%, 17.23% cancer & 3.9% CIS), strengthening the finding in many studies that suggest HIV-positive women have a high rate of premalignant lesions.


Asunto(s)
Infecciones por VIH , Lesiones Precancerosas , Neoplasias del Cuello Uterino , Humanos , Femenino , Etiopía/epidemiología , Estudios Transversales , Adulto , Neoplasias del Cuello Uterino/epidemiología , Prevalencia , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Factores de Riesgo , Persona de Mediana Edad , Lesiones Precancerosas/epidemiología , Detección Precoz del Cáncer , Adulto Joven , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/complicaciones , Hospitales Universitarios , Derivación y Consulta/estadística & datos numéricos
12.
Cancer Med ; 13(11): e7316, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38828559

RESUMEN

OBJECTIVE: To assess the clinical values of extended human papillomavirus (HPV) genotyping in triage of high-risk HPV-positive women, focusing on the trade-off between cervical precancer detections and colposcopy referrals. METHODS: A bivariate random-effects model was used to estimate the diagnostic accuracy of primary HPV screening with following triage strategies to detect cervical precancers: (i) partial genotyping for HPV16/18 combined with cytological testing at atypical squamous cells of undetermined significance threshold (used as the comparator), (ii) genotyping for HPV16/18/58/52, (iii) genotyping for HPV16/18/58/52/33, (iv) genotyping for HPV16/18/58/33/31, (v) genotyping for HPV16/18/58/52/33/31, and (vi) genotyping for HPV16/18/58/52/33/31/39/51. Internal risk benchmarks for clinical management were used to evaluate the risk stratification of each triage strategy. RESULTS: A total of 16,982 women (mean age 46.1 years, range 17-69) were included in this analysis. For CIN3+ detection, triage with HPV16/18/58/33/31 genotyping achieved lower positivity (6.85% vs. 7.35%, p = 0.001), while maintaining similar sensitivity (91.35% vs. 96.42%, p = 0.32) and specificity (94.09% vs. 93.67%, p = 0.56) compared with the comparator strategy. Similar patterns were observed for CIN2+ detection. Women with a positive HPV16/18/58/33/31 genotyping test had high enough risk for CIN3+ for colposcopy referral, while the risk for women with a negative test was below the 1-year return decision threshold according to internal benchmarks. CONCLUSIONS: Our findings suggested extended HPV genotyping is of potential to be used as a triage technique integrated into HPV-based cervical cancer screening, leading to reduced need for colposcopy referral while maintaining similar disease detection and efficient risk stratification.


Asunto(s)
Detección Precoz del Cáncer , Genotipo , Infecciones por Papillomavirus , Triaje , Neoplasias del Cuello Uterino , Humanos , Femenino , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Detección Precoz del Cáncer/métodos , Adulto , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/epidemiología , Persona de Mediana Edad , Triaje/métodos , China/epidemiología , Adolescente , Adulto Joven , Colposcopía , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Displasia del Cuello del Útero/virología , Displasia del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/epidemiología , Anciano , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/aislamiento & purificación , Sensibilidad y Especificidad , Virus del Papiloma Humano
13.
BMJ Open ; 14(6): e080395, 2024 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-38858160

RESUMEN

INTRODUCTION: Multiplathogen home-based self-sampling offers an opportunity to increase access to screening and treatment in endemic settings with high coinfection prevalence of sexually transmitted (HIV, Trichomonas vaginalis (Tv), human papillomavirus (HPV)) and non-sexually transmitted pathogens (Schistosoma haematobium (Sh)). Chronic coinfections may lead to disability (female genital schistosomiasis) and death (cervical cancer). The Zipime-Weka-Schista (Do self-testing sister!) study aims to evaluate the validity, acceptability, uptake, impact and cost-effectiveness of multipathogen self-sampling for genital infections among women in Zambia. METHODS AND ANALYSIS: This is a longitudinal cohort study aiming to enrol 2500 non-pregnant, sexually active and non-menstruating women aged 15-50 years from two districts in Zambia with 2-year follow-up. During home visits, community health workers offer HIV and Tv self-testing and cervicovaginal self-swabs for (1) HPV by GeneXpert and, (2) Sh DNA detection by conventional (PCR)and isothermal (recombinase polymerase assay) molecular methods. Schistosoma ova and circulating anodic antigen are detected in urine. At a clinic follow-up, midwives perform the same procedures and obtain hand-held colposcopic images. High-risk HPV positive women are referred for a two-quadrant cervical biopsy according to age and HIV status. A cost-effectiveness analysis is conducted in parallel. ETHICS AND DISSEMINATION: The University of Zambia Biomedical Research Ethics Committee (UNZABREC) (reference: 1858-2021), the London School of Hygiene and Tropical Medicine (reference: 25258), Ministry of Health and local superintendents approved the study in September 2021.Written informed consent was obtained from all participants prior to enrolment. Identifiable data collected are stored securely and their confidentiality is protected in accordance with the Data Protection Act 1998.


Asunto(s)
Análisis Costo-Beneficio , Infecciones por VIH , Tamizaje Masivo , Infecciones por Papillomavirus , Humanos , Femenino , Zambia/epidemiología , Estudios Longitudinales , Adulto , Adolescente , Adulto Joven , Persona de Mediana Edad , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Tamizaje Masivo/métodos , Tamizaje Masivo/economía , Coinfección/diagnóstico , Autoevaluación , Animales , Esquistosomiasis Urinaria/diagnóstico , Esquistosomiasis Urinaria/epidemiología , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis/aislamiento & purificación , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Virus del Papiloma Humano
14.
BMC Public Health ; 24(1): 1548, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38849788

RESUMEN

BACKGROUND: Human Papillomavirus (HPV) infection is a significant public health concern globally, especially in low- and middle-income countries. In Africa, including Nigeria, HPV prevalence is high, contributing to a substantial burden of cervical cancer. Despite challenges, massive HPV vaccination campaigns in Africa show promise for preventing cervical cancer cases. In Benue State, Nigeria, limited research exists on several aspects of HPV knowledge and attitudes towards HPV among secondary school students. This study aims to bridge this gap by assessing HPV knowledge, prevention practices, willingness to uptake HPV vaccination, and associated attitudes and behaviors among secondary school students in the state. METHODS: The cross-sectional study was conducted among adolescents aged 10-19 years in six secondary schools in three local government areas (LGAs) in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, with a final sample size of 591 students. The selected schools represent both junior and senior secondary school levels and span across the three senatorial districts of the state. Data were collected using a self-administered questionnaire covering sociodemographic characteristics, HPV knowledge, prevention practices, and willingness for HPV vaccination. Statistical analyses included univariate analyses and tests of association, with significance set at p < 0.05 or 0.001 depending on the level of the stringency of the evidence required. Data were analyzed using SPSS version 25. RESULTS: Only 35.4% of the participants were males, and 86.8% were between the ages of 10 and 16. Only 24.7% acknowledged that HPV can be transmitted during sexual intercourse, and 36.2% recognized that HPV can be transmitted via skin-to-skin contact. 48.1% noted that HPV can cause cervical cancer. Half (50.9%) acknowledged that early sexual debut increases the risk of acquiring HPV, while only 28.1% recognized vaccination as a preventive strategy against HPV infection. Only 35% correctly stated the best time for the HPV vaccine. In assessing the practice of HPV prevention, 14.9% are in a sexual relationship and 10.3% admitted to not using condoms during sexual intercourse. Also, 11.8% have had STIs, and 27.2% have previously undergone HIV screening. Various bivariate analyses showed some varying behavioral differences and correlates of HPV infection among young adolescents in Benue State, Nigeria. CONCLUSIONS: This study provides valuable insights into HPV knowledge, prevention practices, and willingness to uptake HPV vaccination among secondary school students in Benue State, Nigeria. The significance of the differences and correlates was discussed using themes. The research has unpacked complex relationships that could have public health implications for researchers and policymakers. Moreover, ten actionable policy recommendations were prescribed. Several interventions and areas for further study were proposed.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Nigeria/epidemiología , Adolescente , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/epidemiología , Femenino , Estudios Transversales , Masculino , Adulto Joven , Niño , Vacunas contra Papillomavirus/administración & dosificación , Encuestas y Cuestionarios , Conducta del Adolescente/psicología , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Conducta Sexual/psicología
15.
BMC Womens Health ; 24(1): 332, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38849836

RESUMEN

OBJECTIVES: This study aims to analyze factors associated with positive surgical margins following cold knife conization (CKC) in patients with cervical high-grade squamous intraepithelial lesion (HSIL) and to develop a machine-learning-based risk prediction model. METHOD: We conducted a retrospective analysis of 3,343 patients who underwent CKC for HSIL at our institution. Logistic regression was employed to examine the relationship between demographic and pathological characteristics and the occurrence of positive surgical margins. Various machine learning methods were then applied to construct and evaluate the performance of the risk prediction model. RESULTS: The overall rate of positive surgical margins was 12.9%. Independent risk factors identified included glandular involvement (OR = 1.716, 95% CI: 1.345-2.189), transformation zone III (OR = 2.838, 95% CI: 2.258-3.568), HPV16/18 infection (OR = 2.863, 95% CI: 2.247-3.648), multiple HR-HPV infections (OR = 1.930, 95% CI: 1.537-2.425), TCT ≥ ASC-H (OR = 3.251, 95% CI: 2.584-4.091), and lesions covering ≥ 3 quadrants (OR = 3.264, 95% CI: 2.593-4.110). Logistic regression demonstrated the best prediction performance, with an accuracy of 74.7%, sensitivity of 76.7%, specificity of 74.4%, and AUC of 0.826. CONCLUSION: Independent risk factors for positive margins after CKC include HPV16/18 infection, multiple HR-HPV infections, glandular involvement, extensive lesion coverage, high TCT grades, and involvement of transformation zone III. The logistic regression model provides a robust and clinically valuable tool for predicting the risk of positive margins, guiding clinical decisions and patient management post-CKC.


Asunto(s)
Conización , Aprendizaje Automático , Márgenes de Escisión , Neoplasias del Cuello Uterino , Humanos , Femenino , Estudios Retrospectivos , Adulto , Conización/métodos , Persona de Mediana Edad , Neoplasias del Cuello Uterino/cirugía , Neoplasias del Cuello Uterino/patología , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/cirugía , Factores de Riesgo , Lesiones Intraepiteliales Escamosas de Cuello Uterino/cirugía , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología , Displasia del Cuello del Útero/cirugía , Displasia del Cuello del Útero/patología , Infecciones por Papillomavirus/complicaciones , Anciano , Modelos Logísticos , Criocirugía/métodos , Adulto Joven
16.
Clin Epigenetics ; 16(1): 77, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38849868

RESUMEN

OBJECTIVE: The major challenge in routine endocervical curettage (ECC) among Human Papillomavirus (HPV) 16/18-positive patients is that only a small fraction benefit. Nevertheless, current reported models often overestimate the validity and necessity of ECC, making it difficult to improve benefits for patients. This research hypothesized that assessing paired boxed gene 1 methylation levels (PAX1m) and clinical characteristics could enhance the predictive accuracy of detecting additional high-grade squamous intraepithelial lesions or worse (HSIL +) through ECC that were not identified by colposcopy-directed biopsy (CDB). METHODS: Data from 134 women with HPV16/18 positivity undergoing CDB and ECC between April 2018 and April 2022 were collected and analyzed. Quantitative methylation-specific polymerase chain reaction (qMSP) was utilized to measure PAX1m, expressed as ΔCp. Univariate and multivariate regression analyses were conducted to screen variables and select predictive factors. A nomogram was constructed using multivariate logistic regression to predict additional HSIL + detected by ECC. The discrimination, calibration, and clinical utility of the nomogram were evaluated using receiver operating characteristic curves (ROC) and the calibration plot. RESULTS: Age (odds ratio [OR], 5.654; 95% confidence interval [CI], 1.131-37.700), cytology (OR, 24.978; 95% CI, 3.085-540.236), and PAX1 methylation levels by grade (PAX1m grade) (OR, 7.801; 95% CI, 1.548-44.828) were independent predictive factors for additional detection of HSIL + by ECC. In HPV16/18-positive women, the likelihood of additional detection of HSIL + through ECC increased with the severity of cytological abnormalities, peaking at 43.8% for high-grade cytological lesions. Moreover, when cytological findings indicated low-grade lesions, PAX1 methylation levels were positively correlated with the additional detection of HSIL + by ECC (P value < 0.001). A nomogram prediction model was developed (area under curve (AUC) = 0.946; 95% CI, 0.901-0.991), demonstrating high sensitivity (90.9%) and specificity (90.5%) at the optimal cutoff point of 107. Calibration analysis confirmed the model's strong agreement between predicted and observed probabilities. CONCLUSION: The clinical nomogram presented promising predictive performance for the additional detection of HSIL + through ECC among women with HPV16/18 infection. PAX1 methylation level could serve as a valuable tool in guiding individualized clinical decisions regarding ECC for patients with HPV 16/18 infection, particularly in cases of low-grade cytological findings.


Asunto(s)
Colposcopía , Metilación de ADN , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Nomogramas , Factores de Transcripción Paired Box , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Humanos , Femenino , Factores de Transcripción Paired Box/genética , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/aislamiento & purificación , Adulto , Metilación de ADN/genética , Persona de Mediana Edad , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/aislamiento & purificación , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/genética , Infecciones por Papillomavirus/virología , Neoplasias del Cuello Uterino/genética , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/patología , Legrado/métodos , Curva ROC , Displasia del Cuello del Útero/virología , Displasia del Cuello del Útero/genética , Displasia del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/patología , Cuello del Útero/patología , Cuello del Útero/virología
18.
BMC Public Health ; 24(1): 1506, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38840086

RESUMEN

BACKGROUND: Human papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol. METHODS: The study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18-26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4-6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention. DISCUSSION: Recruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden. TRIAL REGISTRATION: NCT05057312.


Asunto(s)
Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Texas , Adulto Joven , Vacunas contra Papillomavirus/administración & dosificación , Infecciones por Papillomavirus/prevención & control , Adolescente , Adulto , Femenino , Masculino , Promoción de la Salud/métodos , Vacunación/estadística & datos numéricos
19.
Virol J ; 21(1): 129, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38840267

RESUMEN

BACKGROUND: Global human activities were significantly impacted by the emergence of the coronavirus disease 2019 (COVID-19) pandemic caused by the 2019 novel coronavirus. This study aimed to investigate the prevalence and genotype distribution of HPV infection in Central Fujian Province during the pandemic. METHODS: Cervical samples were collected from 21,612 outpatients and 12,664 females who underwent physical examinations and HPV screening at the People's Hospital of Fujian Province in Fuzhou from April 2020 to April 2023. HPV detection and genotyping were conducted using PCR hybridization. RESULTS: The overall HPV infection rate was 16.1% during the COVID-19 pandemic, with the outpatient group exhibiting a greater infection rate (19.0%) than did the healthy group (12.3%). The top five high-risk HPV (HR-HPV) genotypes in both groups were HPV52, HPV53, HPV58, HPV16, and HPV51. Additionally, HPV81 and HPV43 were the two most common low-risk HPV (LR-HPV) genotypes in the patient group, while HPV81 and HPV42 were the two most common LR-HPV genotypes in the healthy group. The highest prevalence of HPV infection was observed in individuals aged ≤ 24 years (28.4%, 95% CI 25.9-30.9), followed by those aged ≥ 55 years (23.6%, 95% CI 21.6-24.7) and other age groups. The prevalence decreased from 23.0% (95% CI 22.4-23.7) in 2018-2019 to 13.8% (95% CI 12.0-15.5) in 2023. CONCLUSION: This study provides valuable insights into the prevalence and genotypes of HPV infection in the female population of Central Fujian Province from 2020 to 2023. The findings indicate that the prevalence of HPV infection in Central Fujian Province remains relatively low compared to the national average. Furthermore, the prevalence of HPV decreased during the COVID-19 pandemic; however, as the pandemic waned, there was potential for an increase in HPV infection rates. Therefore, it is crucial to strengthen HPV screening and vaccination strategies to prevent the potential spread of HPV.


Asunto(s)
COVID-19 , Genotipo , Papillomaviridae , Infecciones por Papillomavirus , Humanos , Femenino , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , China/epidemiología , Adulto , Prevalencia , COVID-19/epidemiología , COVID-19/virología , Persona de Mediana Edad , Adulto Joven , Papillomaviridae/genética , Papillomaviridae/clasificación , Papillomaviridae/aislamiento & purificación , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , SARS-CoV-2/clasificación , Adolescente , Anciano , Cuello del Útero/virología , Virus del Papiloma Humano
20.
Virol J ; 21(1): 133, 2024 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-38844960

RESUMEN

BACKGROUND: Early diagnosis and treatment of HPV persistent infection and cervical intraepithelial neoplasia, which have yet to be thoroughly characterized in Guangxi, Southwestern China, are the key preventative measures for the development of cervical cancer in women, particularly in HIV-infected women. METHODS: A retrospective study of 181 patients with HPV infection or cervical intraepithelial neoplasia who received surgical excision of lesions and were prospectively enrolled at the Fourth People's Hospital of Nanning between January 2018 and February 2023 was performed. HPV-infected patients were divided into two subgroups: HIV-infected and HIV/HPV-coinfected patients and compare differences between these groups. RESULTS: HPV16, 18, 52, and 58 were the most prevalent HPV genotypes. High-risk HPV was significantly co-infected with multiple genotypes (P = 0.0332). HIV-infected women were predisposed to HPV infection (P < 0.0001), and the development of cervical cancer at a young age (P = 0.0336) compared to HIV-uninfected women and the loop electrosurgical excision procedure (P = 0.0480) is preferred for the treatment. CONCLUSIONS: HIV infection may increase HPV prevalence and lead to cervical cancer development at a young age. The loop electrosurgical excision procedure is an efficient evaluation and treatment strategy for HIV-infected women suffering from cervical intraepithelial neoplasia.


Asunto(s)
Coinfección , Infecciones por VIH , Infecciones por Papillomavirus , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Humanos , Femenino , Infecciones por VIH/complicaciones , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/virología , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Displasia del Cuello del Útero/virología , Displasia del Cuello del Útero/cirugía , Displasia del Cuello del Útero/complicaciones , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/cirugía , Coinfección/virología , China/epidemiología , Genotipo , Prevalencia , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Infección Persistente/virología , Adulto Joven
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