University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA 01655, United States.
Cameroon Baptist Convention Health Services, PO Box 1, Bamenda, North West Region, Cameroon.
Gynecol Oncol. 2018 Jan;148(1):118-125. doi: 10.1016/j.ygyno.2017.11.002. Epub 2017 Nov 16.
The World Health Organization (WHO)'s cervical cancer screening guidelines for limited-resource settings recommend sequential screening followed by same-day treatment under a "screen-and-treat" approach. We aimed to (1) assess feasibility and clinical outcomes of screening HIV-positive and HIV-negative Cameroonian women by pairing visual inspection with acetic acid and Lugol's iodine enhanced by digital cervicography (VIA/VILI-DC) with careHPV, a high-risk human papillomavirus (HR-HPV) nucleic acid test designed for low-resource settings; and (2) determine persistence of HR-HPV infection after one-year follow-up to inform optimal screening, treatment, and follow-up algorithms.
We co-tested 913 previously unscreened women aged ≥30years and applied WHO-recommended treatment for all VIA/VILI-DC-positive women. Baseline prevalence of HR-HPV and HIV were 24% and 42%, respectively.
On initial screen, 44 (5%) women were VIA/VILI-DC-positive, of whom 22 had HR-HPV infection, indicating 50% of women screened false-positive and would have been triaged for unnecessary same-day treatment. VIA/VILI-DC-positive women with HIV infection were three times more likely to be HR-HPV-positive than HIV-negative women (65% vs. 20%). All women positive for either VIA/VILI-DC or HR-HPV (n=245) were invited for repeat co-testing after one year, of which 136 (56%) returned for follow-up. Of 122 women who were HR-HPV-positive on initial screen, 60 (49%) re-tested negative, of whom 6 had received treatment after initial screen, indicating that 44% of initially HR-HPV-positive women spontaneously cleared infection after one year without treatment. Women with HIV were more likely to remain HR-HPV-positive on follow-up than HIV-negative women (61% vs. 22%, p<0.001). Treatment was offered to all VIA/VILI-DC positive women on initial screen, and to all women screening VIA/VILI-DC or HR-HPV positive on follow-up.
We found careHPV co-testing with VIA/VILI-DC to be feasible and valuable in identifying false-positives, but careHPV screening-to-result time was too long to inform same-day treatment.
世界卫生组织（WHO）的宫颈癌筛查指南针对资源有限的地区，建议采用序贯筛查，然后采用“筛查-治疗”方法，对醋酸和卢戈氏碘增强的数字宫颈摄影（VIA/VILI-DC）与针对资源有限地区的高危型人乳头瘤病毒（HR-HPV）核酸检测 careHPV 联合检查，对 HIV 阳性和 HIV 阴性喀麦隆妇女进行筛查。我们旨在：（1）评估通过 VIA/VILI-DC 与 careHPV 联合检查（VIA/VILI-DC 联合 careHPV）对 HIV 阳性和 HIV 阴性喀麦隆妇女进行筛查的可行性和临床结果，该检查可结合视觉检查、醋酸和卢戈氏碘增强的数字宫颈摄影，以及为资源有限地区设计的高危型人乳头瘤病毒（HR-HPV）核酸检测 careHPV；（2）确定在一年随访后 HR-HPV 感染的持续情况，以确定最佳的筛查、治疗和随访方案。
我们对 913 名之前未接受过筛查的年龄≥30 岁的妇女进行了联合检测，并对所有 VIA/VILI-DC 阳性妇女应用了世卫组织推荐的治疗方法。基线时 HR-HPV 和 HIV 的流行率分别为 24%和 42%。
初次筛查时，有 44 名（5%）妇女 VIA/VILI-DC 阳性，其中 22 名妇女 HR-HPV 感染，这表明 50%的筛查妇女为假阳性，将被分诊为不必要的当日治疗。HIV 感染的 VIA/VILI-DC 阳性妇女 HR-HPV 阳性的可能性是 HIV 阴性妇女的三倍（65%比 20%）。所有 VIA/VILI-DC 或 HR-HPV 阳性的妇女（n=245）在一年后再次接受联合检测，其中 136 名（56%）接受了随访。在初次筛查时 HR-HPV 阳性的 122 名妇女中，有 60 名（49%）再次检测结果为阴性，其中 6 名在初次筛查后接受了治疗，这表明 44%的最初 HR-HPV 阳性妇女在未经治疗的情况下，一年后可自发清除感染。与 HIV 阴性妇女相比，HIV 阳性妇女在随访时更有可能持续 HR-HPV 阳性（61%比 22%，p<0.001）。初次筛查时，对所有 VIA/VILI-DC 阳性妇女提供治疗，对所有 VIA/VILI-DC 或 HR-HPV 阳性的妇女在随访时提供治疗。
我们发现 VIA/VILI-DC 联合 careHPV 检测在识别假阳性方面是可行且有价值的，但 careHPV 检测到结果的时间过长，无法及时进行当日治疗。
