HPV viral load in self-collected vaginal fluid samples as predictor for presence of cervical intraepithelial neoplasia

Abstract

ObjectiveThis study was performed to evaluate the use of high-risk HPV (hrHPV) viral load in screening tests for cervical cancer to predict persistent infection and presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+).MethodsWe followed women between 30 and 60\u2009years of age who performed self-sampling of vaginal fluid and subsequently a hrHPV test. Women who were hrHPV positive in their screening test repeated the hrHPV test 3–6\u2009months later and were included in the present study.ResultsOur results show that women with a persistent HPV16 infection had higher HPV viral load in their primary screening test than women with transient infections (p\xa0=\u20095.33e-03). This was also true for sum of viral load for all hrHPV types in the primary screening test (p\xa0=\u20093.88e-07). 48% of women with persistent HPV16 infection and CIN2+ had an increase in HPV16 titer in the follow-up test, as compared to only 20% of women with persistent infection but without CIN2+ lesions. For the sum of all hrHPV types, 41% of women with persistent infection and CIN2+ had an increase in titer as compared to 26% of women without CIN2\u2009+\u2009.ConclusionsThe results show that hrHPV viral load in the primary screening HPV test is associated with the presence of CIN2+ and could be used in triaging hrHPV positive women for different follow-up strategies or recall times. Serial testing of hrHPV viral load has the potential to distinguish women with CIN2+ lesions from women with persistent infection but without CIN2+ lesions.