HPV detection and measurement of HPV-16, telomerase, and survivin transcripts in colposcopy clinic patients

Aims-To determine whether the detection of high risk human papillomavirus ( HPV) types is more predictive for high grade CIN than the current cervical smear test, and whether the production and measurement of HPV type 16 (HPV- 16) and cellular survivin and telomerase transcripts can be used to discrim inate between cervical HPV infections that self cure and those that induce high grade lesions. Methods-Three hundred and fifty four cervical smear samples from women atte nding the colposcopy clinic were tested by the polymerase chain reaction (P CR) for the presence of HPV. Transcripts for HPV-16 E6, E6*I, E6*II, E7, an d L1 as well as cellular survivin, telomerase RNA component, and telomerase reverse transcriptase were measured fluorogenic probe (Taqman) assays. Results-Referral smear grades of severe or moderate showed greater positive predictive values for CIN 2/3 than did the detection of high or moderate r isk HPV types. HPV-16 transcripts from E6, E6*I, E6*II, and E7 showed high predictive values for CIN 2/3, but low sensitivity. The telomerase RNA comp onent was detected in 53 of 57 samples and telomerase reverse transcriptase was only detected in one sample, whereas survivin transcripts were detecte d in 40% of samples. Conclusions-The detection of HPV-16 or cellular survivin or telomerase tran scripts did not accurately predict the grade of CIN in the samples. The det ection of HPV risk types correlated well with the grade of GIN; however, th e referral grade smear was the most accurate predictor of the severity of t he lesion. Of the 35 different HPV types detected, 18 are not included in t he HPV hybrid capture II commercial test kit. The use of such kits would ha ve missed HPV infection in 4.3% of clinic patients with CIN 2/3 lesions and 15.4% with CIN 0/1.