Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Cancer Med. 2021 Sep;10(17):6078-6088. doi: 10.1002/cam4.4152. Epub 2021 Aug 2.
To evaluate the clinical performance of liquid-based cytology (LBC), HPV tests and visual inspections with acetic acid or Lugol's iodine (VIA/VILI) as primary screening and triage strategies among Chinese women living with HIV (WLHIV).
WLHIV aged 18 years and older were recruited from HIV/AIDS treatment clinic in Yunnan, China from 2019 to 2020. Women were screened with self- and physician-sampling for HPV tests, LBC, and VIA/VILI. Women positive for any HPV or with cytological abnormalities were recalled for colposcopy examination and biopsy when necessary. Clinical performance of primary and triage strategies for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was evaluated.
For primary screening, sensitivity of physician-HPV tests was 100%, 89.5%, and 100% for hybrid capture 2 (HC2), cobas, and Sansure HPV, and specificity was 80.4%, 85.1%, and 72.0%, respectively. Self-HPV test achieved considerable performance with physician-HPV. Sensitivity and specificity were 61.1% and 96.3% for LBC (atypical squamous cells of undetermined significance or worse [ASCUS+]), 40.0% and 77.3% for VIA/VILI. For triaging HPV-positive women, LBC (ASCUS+), HPV-16/18 genotyping, and VIA/VILI-elevated specificity with sensitivity declined 30%-50% compared with HPV screening alone. Restricted HPV genotyping triage (HPV-16/18/31/33/45/52/58) demonstrated the optimal accuracy (89.5% sensitivity, 81.9% specificity), and was similar to HPV-16/18 with reflex LBC (ASCUS+). Combination antiretroviral therapies (cARTs) <2 years were associated with decreased specificity of HC2 (aOR: 1.87, 95% CI: 1.22-3.91) and Sansure HPV (2.48, 1.43-4.29).
Self-HPV with restricted genotyping triage is highly recommended for cervical cancer screening for WLHIV in China. Feasible triage to increase HPV specificity among women with short duration of cART is needed.
评估液基细胞学（LBC）、HPV 检测以及醋酸或卢戈氏碘目视检查（VIA/VILI）作为中国 HIV 感染者（WLHIV）初筛和分流策略的临床性能。
2019 年至 2020 年，从中国云南的 HIV/AIDS 治疗诊所招募了年龄在 18 岁及以上的 WLHIV。对女性进行 HPV 检测、LBC 和 VIA/VILI 的自我和医生采样筛查。对任何 HPV 阳性或细胞学异常的女性进行召回，必要时进行阴道镜检查和活检。评估了初筛和分流策略对检测宫颈上皮内瘤变 2 级或更高级别（CIN2+）的临床性能。
对于初筛，医师 HPV 检测的敏感度分别为 100%、89.5%和 100%，特异度分别为 80.4%、85.1%和 72.0%，用于杂交捕获 2（HC2）、Cobas 和 Sansure HPV。自我 HPV 检测与医生 HPV 检测具有相当的性能，LBC（非典型鳞状细胞不能明确意义或更严重 [ASCUS+]）的敏感度和特异度分别为 61.1%和 96.3%，VIA/VILI 分别为 40.0%和 77.3%。对于 HPV 阳性女性的分流，LBC（ASCUS+）、HPV-16/18 基因分型和 VIA/VILI 升高的特异性降低了 30%-50%，而 HPV 筛查的敏感度降低了 30%-50%。限制 HPV 基因分型分流（HPV-16/18/31/33/45/52/58）显示出最佳的准确性（89.5%的敏感度，81.9%的特异度），与 HPV-16/18 联合阴道镜检查（ASCUS+）相似。联合抗逆转录病毒疗法（cART）<2 年与 HC2（比值比：1.87，95%置信区间：1.22-3.91）和 Sansure HPV（2.48，1.43-4.29）的特异性降低相关。
在中国，建议对 WLHIV 进行 HPV 自我检测联合限制基因分型分流的宫颈癌筛查。需要寻找可行的方法来提高接受 cART 时间较短的女性 HPV 检测的特异性。
