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The use of molecular markers for cervical screening of women living with HIV in South Africa
To determine the performance of molecular screening strategies for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in comparison with cytology screening in women living with HIV. DESIGN: Post-hoc analysis using data from a South African study cohort. METHODS: Cytology and hu...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791588/ https://www.ncbi.nlm.nih.gov/pubmed/31385866 http://dx.doi.org/10.1097/QAD.0000000000002325 |
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author | Kremer, Wieke W. van Zummeren, Marjolein Breytenbach, Erika Richter, Karin L. Steenbergen, Renske D.M. Meijer, Chris J.L.M. Dreyer, Greta |
author_facet | Kremer, Wieke W. van Zummeren, Marjolein Breytenbach, Erika Richter, Karin L. Steenbergen, Renske D.M. Meijer, Chris J.L.M. Dreyer, Greta |
author_sort | Kremer, Wieke W. |
collection | PubMed |
description | To determine the performance of molecular screening strategies for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in comparison with cytology screening in women living with HIV. DESIGN: Post-hoc analysis using data from a South African study cohort. METHODS: Cytology and human papillomavirus (HPV)-based strategies were evaluated, including single test and FAM19A4/miR124-2 methylation triage strategies. Participants underwent cytology screening and a colposcopy-directed biopsy. Valid results on cytology, HPV status, 16/18 genotyping and histology were available for 318 women. Detection of HPV and FAM19A4/miR124-2 hypermethylation was performed on DNA from cervical scrapes. Histological diagnosis of CIN3+ was used as outcome. RESULTS: Cytology provided highest specificity (91.6%), but lowest sensitivity (59.3%), whereas a single HPV test provided highest sensitivity (83.1%), but lowest specificity (66.4%). Combining cytology with methylation did not improve the performance compared with cytology alone: a slight increase in sensitivity was seen, at the cost of a decrease in specificity. Triage of high-risk HPV positive women with methylation increased specificity (76.1%) compared with a single HPV or cytology test, while maintaining acceptable sensitivity (72.9%). Similar performance was observed for HPV16/18 with methylation triage (sensitivity 79.7%, specificity 74.8%). The number of women needed to refer to detect one CIN3+ ranged from 1.5 (cytology) to 2.6 (single HPV test). CONCLUSION: Molecular screening strategies using HPV, with or without HPV16/18 genotyping, and FAM19A4/miR124-2 methylation have higher sensitivity with an acceptable loss in specificity compared with current cytology screening and are efficient for the detection of CIN3+ in South African women living with HIV. |
format | Online Article Text |
id | pubmed-6791588 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-67915882019-11-18 The use of molecular markers for cervical screening of women living with HIV in South Africa Kremer, Wieke W. van Zummeren, Marjolein Breytenbach, Erika Richter, Karin L. Steenbergen, Renske D.M. Meijer, Chris J.L.M. Dreyer, Greta AIDS Clinical Science To determine the performance of molecular screening strategies for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in comparison with cytology screening in women living with HIV. DESIGN: Post-hoc analysis using data from a South African study cohort. METHODS: Cytology and human papillomavirus (HPV)-based strategies were evaluated, including single test and FAM19A4/miR124-2 methylation triage strategies. Participants underwent cytology screening and a colposcopy-directed biopsy. Valid results on cytology, HPV status, 16/18 genotyping and histology were available for 318 women. Detection of HPV and FAM19A4/miR124-2 hypermethylation was performed on DNA from cervical scrapes. Histological diagnosis of CIN3+ was used as outcome. RESULTS: Cytology provided highest specificity (91.6%), but lowest sensitivity (59.3%), whereas a single HPV test provided highest sensitivity (83.1%), but lowest specificity (66.4%). Combining cytology with methylation did not improve the performance compared with cytology alone: a slight increase in sensitivity was seen, at the cost of a decrease in specificity. Triage of high-risk HPV positive women with methylation increased specificity (76.1%) compared with a single HPV or cytology test, while maintaining acceptable sensitivity (72.9%). Similar performance was observed for HPV16/18 with methylation triage (sensitivity 79.7%, specificity 74.8%). The number of women needed to refer to detect one CIN3+ ranged from 1.5 (cytology) to 2.6 (single HPV test). CONCLUSION: Molecular screening strategies using HPV, with or without HPV16/18 genotyping, and FAM19A4/miR124-2 methylation have higher sensitivity with an acceptable loss in specificity compared with current cytology screening and are efficient for the detection of CIN3+ in South African women living with HIV. Lippincott Williams & Wilkins 2019-11-01 2019-08-02 /pmc/articles/PMC6791588/ /pubmed/31385866 http://dx.doi.org/10.1097/QAD.0000000000002325 Text en Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | Clinical Science Kremer, Wieke W. van Zummeren, Marjolein Breytenbach, Erika Richter, Karin L. Steenbergen, Renske D.M. Meijer, Chris J.L.M. Dreyer, Greta The use of molecular markers for cervical screening of women living with HIV in South Africa |
title | The use of molecular markers for cervical screening of women living with HIV in South Africa |
title_full | The use of molecular markers for cervical screening of women living with HIV in South Africa |
title_fullStr | The use of molecular markers for cervical screening of women living with HIV in South Africa |
title_full_unstemmed | The use of molecular markers for cervical screening of women living with HIV in South Africa |
title_short | The use of molecular markers for cervical screening of women living with HIV in South Africa |
title_sort | use of molecular markers for cervical screening of women living with hiv in south africa |
topic | Clinical Science |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791588/ https://www.ncbi.nlm.nih.gov/pubmed/31385866 http://dx.doi.org/10.1097/QAD.0000000000002325 |
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