No woman left behind: achieving cervical cancer elimination among women living with HIV

Sharma, Kirthana; Machalek, Dorothy A; Toh, Zheng Quan; Amenu, Demisew; Muchengeti, Mazvita; Ndlovu, Andrew; Mremi, Alex; Vallely, Andrew; Denny, Lynette; Rees, Helen; Garland, Suzanne M.

doi:10.1016/s2352-3018(23)00082-6

Cited by 10 publications

(7 citation statements)

References 62 publications

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“…4,5 Other factors that may increase the risk of developing CC include smoking, multiple sexual partners, young age at first pregnancy, human immunodeficiency virus infection, and immunosuppression. 6,7 During the past few decades, CC incidence and mortality rates have declined, largely because of the highly effective measures of primary (HPV vaccine) and secondary (screening by a regular Papanicolaou smear test, also termed Pap test) prevention. 8,9 However, although HPV testing has a high level of sensitivity, it identifies many 'transient' infections, which can cause patients excessive anxiety and psychological stress and increase the economic burden of medical care.…”

Section: Introductionmentioning

confidence: 99%

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Biomarker cystatin B expression correlates with pathogenesis in cervical cancer

Ye,

Duan,

Guan

et al. 2024

J Int Med Res

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Objective Cervical cancer (CC) is one of the most common gynecologic malignancies worldwide. Although rapid improvements have been made regarding its prevention and treatment, little is known about disease pathogenesis and the clinical relevance of reliable biomarkers. The present study evaluated the expression of cystatin B (CSTB) as a potential biomarker of CC. Methods Tissue microarray analysis and immunohistochemical staining were performed to detect CSTB expression, while CSTB mRNA and protein expression levels of freshly isolated CC tissue were measured by quantitative real-time PCR and western blot, respectively. Bioinformatics were used to analyze the CSTB co-expression network and functional enrichments. Results We observed high CSTB mRNA and protein expression levels in CC tissues, which was confirmed by tissue microarray in a comparison with paired adjacent non-cancerous cervical tissue samples. CSTB gene enrichments and associations with co-expressed genes were also observed. Further analysis showed that elevated CSTB expression was associated with pathological progress in CC. Conclusion Our data demonstrate that CSTB has the potential to be used as a tissue biomarker with clinical value in patients with CC, which may aid the development of intervention strategies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomarker cystatin B expression correlates with pathogenesis in cervical cancer

Ye,

Duan,

Guan

et al. 2024

J Int Med Res

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“…13 This limited use is partly due to the cost and logistical challenges of incorporating HPV testing within existing “screen & treat” programs in LMICs. 14,15 To increase the feasibility of HPV-based cervical cancer screening in LMICs, affordable, easy-to-use, and point-of-care HPV assays are needed in both facility and community-based screening programs. In addition, the assays ideally need to be able to perform HPV risk stratification through genotyping to inform triaging or management of HPV-positive individuals, based on the carcinogenic risk of each of the high-risk HPV types.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi

Mungo,

Guliam,

Chinula

et al. 2024

Preprint

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BackgroundThe World Health Organization (WHO) recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries (LMICs) account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi.MethodsWe utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis - cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to <CIN2.Results315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses. Of these, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50-0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens.ConclusionIn this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.

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“…Use of HPV testing for primary screening in LMICs is limited, however, with less than 5 African countries recommending HPV testing as a primary screening method [13]. This limited use is partly due to the cost and logistical challenges of incorporating HPV testing within existing "screen & treat" programs in LMICs [14,15]. To increase the feasibility of HPV-based cervical cancer screening in LMICs, affordable, easy-to-use, and pointof-care HPV assays are needed in both facility and community-based screening programs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi

Mungo,

Guliam,

Chinula

et al. 2024

Infect Agents Cancer

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Background The World Health Organization recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi. Methods We utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis—cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to <CIN2. Results 315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses, of which 279 and 36 were HPV positive and HPV negative, respectively, on Xpert self-collection. Of the 315, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Of the 245 with normal pathology, 213 (87%) and 188 (77%) were HPV-positive on Xpert and ScreenFire self-collected specimens, respectively. Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50–0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens. Conclusion In this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.

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No woman left behind: achieving cervical cancer elimination among women living with HIV

Cited by 10 publications

References 62 publications

Biomarker cystatin B expression correlates with pathogenesis in cervical cancer

Biomarker cystatin B expression correlates with pathogenesis in cervical cancer

Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi

Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi

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