We determined the utility of an assay for 13 cancerassociated HPV types in primary cervical cancer screening of Zimbabwe women at high risk of HIV infection. HIV antibody status was determined by ELISA of oral mucosal specimens, and HPV DNA in the genital tract was identified by hybridization of cervical scrapes with probe B of Hybrid Capture II. Among the 466 women investigated, the prevalence of HPV, low-grade squamous intraepithelial lesions (LGSIL) and highgrade SIL (HGSIL) were 47.2%, 13.9% and 12%. Fifty-three and one-half percent of the women were HIV-seropositive. As compared with HIV-seronegative women, HIV-infected women had a greater than 2-fold HPV prevalence (64.3% vs. 27.6%), a greater than 7-fold amount of HPV DNA (RLU of 82.6 vs. 10.7) in HPV ؉ women assessed as normal on the reference standard, and a nearly 3-fold greater HGSIL prevalence (17.3% vs. Studies over the past 15 years have established conclusively that infections with certain HPV types are etiologically linked to invasive cervical carcinoma (Bosch et al., 1995). Implementation of Pap smear screening programs has reduced cervical cancer incidence in many of the industrialized countries, but such programs have been difficult to establish and maintain in the developing world. Several investigators have reported that human papillomavirus DNA tests may be an important additional tool for improving screening for cervical cancer and its precursor lesions (Meijer et al., 1992;Cuzick et al., 1995;Schneider et al., 1996;Herrero et al., 1997;Lorincz et al., 1999). However, most of these studies have been conducted in HIV Ϫ women. It is known that HIV-infected women have higher rates of HPV infections, squamous intraepithelial lesions (SIL) and cervical carcinoma (Kreiss et al., 1992;Wright et al., 1994;Vermund et al., 1991). Many populations that have a high prevalence of HIV infections also have a high incidence of cervical cancer (Mandelblatt et al., 1992).According to some investigators, there are significant limitations to cytology screening for the identification of SIL in HIV ϩ women as compared with the general population because of the more frequent occurrence of false negatives in HIV ϩ women. Based on this limitation, it has been suggested that colposcopy should be performed routinely for gynecological screening of HIV-infected women (Maiman et al., 1991;Fink et al., 1994;Del Priore and Lurain, 1995;Korn et al., 1994;Olaitin et al., 1997). Falsenegative Pap smears have been documented most often when the genital tract is infected with other organisms (Maiman et al., 1991). In a previous report (Womack et al., 1999), we presented the results of an evaluation of a test for high-risk HPVs (Hybrid Capture II, probe B) as an alternative to Pap smear in screening for cervical cancer in Zimbabwe, a country with a high incidence of cervical cancer and of HIV infection (Bassett et al., 1995;UNAIDS/WHO, 1997). In a subset (23%) of the subjects in that study, we obtained data on HIV prevalence by means of antibody assays of oral mucosal specimen...

For programs with limited resources but with the capacity for HPV testing, sequential testing involving the use of VIA followed by HPV could yield fewer false positives than the use of VIA alone at a cost of relatively few additional false negatives.

There was a very high prevalence of HPV in cervix and urine of sexually active adolescents. Testing urine for HPV may be useful in epidemiologic investigations and in monitoring of infected women.

Dear Sir,The paradigm shift that has occurred in the last decade attributing most, if not all, cervical cancers to infection with human papillomavirus (HPV) has renewed efforts to control cervical cancer, especially in developing countries where it remains the leading cause of cancer deaths among women. Primary and secondary prevention efforts have begun to focus on detection and control of the virus, specifically HPV DNA testing for screening [1][2][3][4][5][6][7] and HPV vaccine development for prevention. 8 Critical to the success of HPV-based prevention efforts is a comprehensive spectrum of targeted genotypes, given that at least 10 different HPV types have been classified as group 1 human carcinogens. 9 The International Biological Study of Invasive Cervical Cancer (IBSCC) demonstrated that certain HPV genotypes, namely, HPV-16, -18, -31 and -45, accounted for 80% of the sampled invasive cancers from 21 countries. 10,11 Based on these results, vaccine efforts are targeted first to HPV-16, with the hope of reducing the cervical cancer burden by up to 50%, presumably with vaccines targeting HPV-18, -31 and -45 to follow. However, a study in Mozambique found that HPV-35 was the most prevalent genotype, both in all HPV-positive women (16.7 %) and among women with cervical neoplasia (18.4%). 12 It is important to determine if this is a geographically isolated finding or if the relative prevalence of HPV types attributable to cervical cancer development differs in sub-Saharan Africa, where primary prevention offers the greatest promise of control. We report the genotype distribution of HPV from a nested case-control study of women originally enrolled in a visual inspection with acetic acid (VIA) screening study in Harare, Zimbabwe. 13 Study participants were drawn from subjects enrolled in phase II VIA screening study conducted jointly by the University of Zimbabwe in Harare and the JHPIEGO Corporation, a Johns Hopkins University affiliate based in Baltimore, MD, USA. Details of subject recruitment have been described elsewhere. 13 Briefly, subjects enrolled in phase II of the VIA screening study were recruited from October 1996 through August 1997 among women aged 25-55 years attending 15 primary-care clinics in Chitungwiza and the greater Harare area of Zimbabwe. All enrolled women provided verbal informed consent, and the institutional review boards of both participating institutions approved study protocols. Participants were interviewed using a standardized questionnaire to assess demographics. Following the interview, each participant consented to a pelvic exam with collection of cells for Pap smear and HPV DNA testing. VIA screening was performed last. All participants were offered a colposcopic examination of the cervix, and biopsies were collected if indicated, usually on the same day. At the colposcopy visit, consenting women (23%) provided an oral mucosal specimen (OraSure; Epitope, Beaverton, OR) for HIV antibody testing (duplicate testing via commercially available ELISA; Organon Teknica, Durham, NC...