Type-specific high-risk human papillomavirus viral load as a viable triage indicator for high-grade squamous intraepithelial lesion: a nested case–control study

Abstract

PurposeCurrently, the associations between type-specific high-risk human papillomavirus (HR-HPV) viral loads and cervical lesions are still inconsistent. We aimed to assess the type-specific HR-HPV viral load as a risk triage indicator for development of high-grade squamous intraepithelial lesion or worse (≥HSIL).Patients and methodsA total of 19,446 women who underwent primary screening for cervical cancer using Cervista® HR-HPV and cytology assays were enrolled. The viral loads of 1,396 HR-HPV-positive specimens confirmed by Cervista® assay were detected by BioPerfectus Multiplex Real-Time PCR assay. The correlation between viral loads and cervical lesions was analyzed. The optimal cutoffs of individual HR-HPV viral loads used to predict ≥HSIL were determined from the receiver operating characteristic curve. A logistic regression model was used to analyze the relationship between covariates and the probability of ≥HSIL.ResultsThe viral loads of HPV-16, -31, -33, -52, and -58 were positively correlated with the severity of the cervical lesion, which was significantly elevated in patients with ≥HSIL, whereas those of HPV-18, -45, -56, -59, and other types were not. The optimal cutoffs of the log10-transformed viral loads for HPV-16, -31, -33, -52, and -58 in identifying ≥HSIL were 4.26, 4.46, 4.48, 4.36, and 4.26 copies per 10,000 cells, respectively. Furthermore, multivariate analysis indicated that type-specific viral loads of HPV-16, -31, -33, -52, and -58 exceeding the cutoffs could be independent risk factors for the incidence of ≥HSIL.ConclusionThe BioPerfectus Multiplex Real-Time PCR viral load assay provides viable triage for ≥HSIL when using appropriate cutoff levels.

Human papillomavirus type 16 and 18 viral loads as predictors associated with abnormal cervical cytology among women in Saudi Arabia

“…The distribution of viral loads for HPV 16 and 18 was different: overall, HPV 16 had a higher median viral load (426.9 copies/μL) than HPV 18 (24 copies/μL). A few studies have reported a linear correlation of cervical abnormality and viral load for HPV 16, but linearity was not observed for HPV 18 [23]. In the present study, we found similar results, that is, HPV 16 was mostly correlated with cytology grade, whereas HPV 18 was imbalanced across cytology grade.…”

“…Several previous studies have argued that a linear relationship between the severity of disease and viral load is associated with specific HPV types [15,16,17,18]. One study reported a significant relationship when the HPV types were 16, 31, 33, 52, and 58, while the association was not significant with HPV types 18, 45, 56, and 59 [19]. The results of the present study found no change in the significance of the association when we compared HPV genotypes 16 and 18.…”

Significance of the Viral Load of High-risk Hpv in the Diagnosis and Prediction of Cervical Lesions: A Retrospective Study

“…On the other hand, the present study supports the hypothesis that high HR-HPV viral loads are associated with more advanced cervical lesions. This view is supported by Long et al [19], who showed that the viral load of HPV-16, HPV-58, and HPV-33 was associated with high-grade cervical lesions, as well as by other studies in various populations [13][14][15][16][17][18][19][31][32][33]. Berggrund et al [14] showed that the HR-HPV viral load could indicate the course of the infection, as well as the presence of CIN II, CIN III, and CC.…”

“…Higher HR-HPV viral load in cervical lesions was associated with a higher risk of high-grade cervical lesions. Nevertheless, the HR-HPV DNA load could be used for triage [15].…”

“…The HR-HPV viral load indicates the activity of HPV-DNA in the body [13,14]. Studies showed that the type of HPV infection is closely related to the severity of cervical lesions and treatment prognosis [10][11][12], but there are inconsistent results from the studies on the correlation between the HPV viral load and the severity of cervical lesions [13][14][15][16][17][18][19]. At present, the correlation between the HPV viral load and cervical lesions has not been determined, and the signi cance of the HPV viral load in the detection and treatment of cervical lesions is still controversial [17,19].…”