EVALUATION OF THE DETECTION OF HUMAN-PAPILLOMAVIRUS GENOTYPES IN CERVICAL SPECIMENS BY HYBRID CAPTURE AS SCREENING FOR PRECANCEROUS LESIONSIN HIV-POSITIVE WOMEN

Given the frequency and persistence of human papillomavirus (HPV) infe ction and associated cytological alterations in HIV-1-positive women, the incidence of uterine cervix neoplasm is likely to increase along w ith patient survival. More appropriate screening programs, which, in a ddition to Pap smears (PS), also include tests to detect and type HPV, are needed for the early identification of precancerous cervical lesi ons. This prospective study involved 168 HIV-positive (group A) and 10 0 HIV-negative women (group B). Cervicovaginal samples were collected for a PS and HPV DNA search. The detected virus was typed as high-inte rmediate oncogenic risk HPV (HR-HPV) and low-risk HPV (LR-HPV) using h ybrid capture (HC) (Murex-Digene) and in-house PCR tests. The HC-detec ted prevalence of HPV was 111/268 (66%:HR 75.6%) in group A and 15/100 (15%:HR 42.9%) in group B (P < 0.0001). Polymerase chain reaction (PC R) was positive in 91% and 48%, respectively. No significant differenc e was observed between drug addicts and heterosexual HIV-l-positive wo men (P = 0.09). HPV was detected in 94% of the 57 HIV-positive women w ith cytological alterations. HR-HPV was found in 41/49 women with low- grade and 7/8 with high-grade squamous intraepithelial lesions (LSIL a nd HSIL, respectively). In women with a negative PS, HPV was detected in 57/111 cases (HR 63%) of group A and in 13/98 of group B (6 cases o f HR). Of the 54 group A women who underwent biopsy, histology reveale d that 41 had LSIL (18 with negative PS, 19 with LSIL, and 4 with HSIL ; HR-HPV in 73% and LR-HPV in 17%), nine had HSIL (5 LSIL and 4 HSIL o n cytology; HR-HPV in 89% and LR-HPV in 11%), and four were negative ( all cytology negative; 3 HR-HPV and 1 LR-HPV). HR-HPV was more frequen t as immunodepression worsened. These results show that cytological ev aluation alone underestimated histological alterations in 23/50 women (42.6%), whereas the combination of Pap smear and HPV detection reduce d this underestimate to 5%. J. Med. Virol. 56:133-137, 1998. (C) 1998 Wiley-Liss, Inc.