Human papillomavirus infection and other risk factors for cervical neoplasia: a case-control study

Biologic characteristics of specific human papillomavirus types predicted from morphology of cervical lesions

Human papillomavirus (HPV) DNA was detected by Southern blot hybridization in cervicovaginal lavage samples from 199 of 329 (60.5%) women attending a municipal hospital colposcopy clinic. Human papillomavirus was identified in 195 of 264 (73.9%) patients with a squamous intraepithelial lesion or cancer on biopsy or Papanicolaou smear (Bethesda system) compared with 11 of 65 (16.9%) without squamous intraepithelial lesion (P < .0001). The most common HPV type identified was HPV 16 (20.6% of positive samples), and 36.7% of isolates contained uncharacterized HPVs. Of women with cervical intraepithelial neoplasia (CIN) grade III or cancer, 23.4% were infected with HPV 16 compared with less than 4% with any other single HPV type. Based on biopsy diagnosis in patients infected with specific HPV types, HPVs 6 and 11 had low oncogenic potential; HPVs 18, 31, 35, and 45 had intermediate oncogenic potential; and HPVs 16 and 33 had high oncogenic potential. Hyperchromatic, unusually enlarged nuclei ("meganuclei"), and/or abnormal mitoses were found significantly more often in lesions infected with HPVs 16, 33, and 35 than in those infected with HPVs 6, 11, 18, 31, and 45, even in low-grade lesions, and may represent a histologic marker for HPVs with significant oncogenic potential. Human papillomavirus capsid protein was detected significantly less often by immunocytochemical staining in CIN I and CIN II lesions infected with HPVs 16 and 33 (8.3%) than in those infected with HPVs 6, 11, 18, and 31 (60%; P = .007), suggesting early abnormalities in cellular differentiation in lesions infected with highly oncogenic HPVs.

Comparison of ViraPap, Southern hybridization, and polymerase chain reaction methods for human papillomavirus identification in an epidemiological investigation of cervical cancer

In order to provide a reliable diagnosis for the presence and type of human papillomavirus (HPV) DNA in a case-control study of cervical cancer in Colombia and Spain, 926 cervical scrapes from female subjects were examined by ViraPap (VP) and Southern hybridization (SH), and 510 of these (263 cases and 247 controls) were also tested by polymerase chain reaction (PCR) using the HPV L1 consensus primers. HPV DNA prevalence was much higher in cases than in controls by each of the three tests. There was complete agreement between the results of the three tests for 64.9% of the 510 specimens; 53.5% were negative and 11.4% were positive (regardless of type) by all tests. An additional 29.0% of the specimens were positive by PCR: 19.4% by PCR alone, 6.7% by PCR and VP, and 2.9% by PCR and SH. SH and/or VP gave positive results for 6.0% of the specimens for which the PCR finding was negative: 2.7% by SH alone, 2.5% by VP alone, and 0.8% by both VP and SH. When specimens which were positive by VP alone or only by SH at low-stringency conditions were excluded, PCR confirmed all but four specimens which were positive by other tests. The concordance between type-specific diagnosis by SH and PCR was 86% when HPVs were typed in both tests. HPV-16 accounted for over 80% of the typed HPVs in each test. The presence of blood in case specimens did not appear to inhibit HPV positivity by VP or by PCR at the dilution tested. Low amounts of cellular DNA of specimens resulted in some underestimation of HPV positivity by VP and SH but not by PCR. Compared with that of PCR, the sensitivities for case specimens were 38% by SH and 50% by VP; the sensitivity for control specimens, although it could not be measured precisely because there were few positive specimens, appeared to be lower than for case specimens. It was concluded that PCR-based tests are best suited for epidemiological investigation of HPVs.

Genital human papillomavirus infection in women

OBJECTIVE

To enhance nurse clinicians' knowledge of genital human papillomavirus infection in women.

DATA SOURCES

Several literature searches using the following terms, dating back to 1986: human papillomavirus (HPV), females, human, cervical neoplasia, risk factors, condylomata acuminata, detection, epidemiology, pathology, psychology, Papanicolaou test, immunosuppression, HIV infection, and AIDS.

STUDY SELECTIONS

Forty-three formal research studies regarding the association of various types of HPV infection with cervical intraepithelial lesions, the putative precursor lesions for cervical neoplasia; the outcomes of diagnostic techniques for HPV types; the outcomes of diagnostic/screening techniques for abnormal cervical cells; the association of risk factors for acquiring HPV infection; or the outcomes of therapy. Some additional references were chosen for their presentation of epidemiologic or surveillance data, others for their scientific discussions on related topics.

DATA EXTRACTION

Data were abstracted according to summary measures of the parameter of interest in the sample studied. In most instances, it was the prevalence of HPV, cervical neoplasia, or frequency of use of screening tests.

DATA SYNTHESIS

Immunosuppressed clients are at particular risk for HPV-mediated cervical neoplasia.

CONCLUSION

Because Papanicolaou tests are an effective screening tool, cervical cancer is easily detectable. The nurse may facilitate treatment. This is an especially important issue for young women, among whom sexual activity is growing--with attendant increases of HPV and HIV infection.

Polymerase chain reaction detection of human papillomavirus: quantitation may improve clinical utility

A case-control study compared detection by polymerase chain reaction (PCR) specific for human papillomavirus (HPV) type 16 with restriction enzyme analysis and Southern blot hybridization detection of HPV type 16. Cervicovaginal lavage samples from 64 women with histopathologic evidence of a cervical squamous intraepithelial lesion and 55 samples from cytologically healthy women were studied. Several methods of PCR product analysis, including radioactive and nonradioactive probing, were compared. The sensitivity of HPV detection by PCR when the amplified DNA fragment was visualized on a gel was equivalent to those of detection by restriction enzyme and Southern blot analyses. Hybridization of the PCR product with radioactively or nonradioactively labeled oligonucleotide probes increased the sensitivity of HPV detection by 100-fold. However, an increase in the sensitivity of the assay preferentially identified low levels of the virus in cytologically healthy women. Therefore, the value of HPV detection in identifying women with cervical neoplastic disease was greater, and the odds ratio for the presence of a cervical squamous intraepithelial lesion was higher when the less sensitive modalities were used. These results suggest that quantitation of HPV by PCR may maximize the clinical significance of a positive test result. Further studies will be needed to determine the optimal level of virus detection which has the highest positive predictive value of clinical disease.

Follow-up evaluation of cervicovaginal human papillomavirus infection in adolescents

We performed a second examination for human papillomavirus (HPV) DNA on 51 sexually experienced 13- to 21-year-old (mean = 17.8 years) female patients seen at an urban teaching hospital. Cervicovaginal lavages were performed 6 to 36 months apart (median = 13.3 months) to collect cells for HPV DNA detection and typing by Southern blot hybridization. At the first and second visits, 39.2% (20/51) and 25.5% (13/51) of patients, respectively, were infected with HPV. Collectively, 56.9% (29/51) of patients had at least one positive HPV test result. Although 7.8% (4/51) were infected with HPV at both visits, only one patient had infection with the same HPV type. These findings suggest that although HPV infection is a common sexually transmitted disease, genotype-specific HPV infection detected by Southern blot at two visits was rare.

Loss of heterozygosity on chromosome 17p and mutant p53 in HPV-negative cervical carcinomas

Inactivation of the protein product of the wild-type tumour suppressor gene p53 through complexing of the protein with the E6 oncoprotein of human papillomaviruses (HPV) in HPV-infected cells is thought to be important in the aetiology of cervical carcinoma. Mutations of p53 have also been reported in HPV-negative carcinomas, and we now demonstrate loss of heterozygosity (LOH) of chromosome region 17p13 (in which p53 is located) in such tumours. Immunocytochemical staining with monoclonal antimutant-p53 antibody revealed that the carcinomas with LOH on 17p and completely lacking HPV DNA sequences had mutant p53. Thus the LOH had apparently resulted in the loss of the wild-type allele. Consequently, in both HPV-positive and HPV-negative tumours there is loss of function of wild-type p53, in the former because the protein product of the p53 gene complexes with that of the viral E6 gene, in the latter because the protein is altered, presumably as a result of a direct alteration of the p53 gene but possibly because of other post-translational changes. That this mutant allele of the tumour suppressor gene may sometimes behave like an oncogene is suggested by the presence of more than the expected number of copies of the remaining chromosome 17 homologue in some carcinomas.

Self-administered home cervicovaginal lavage: a novel tool for the clinical-epidemiologic investigation of genital human papillomavirus infections

OBJECTIVE

Our objective was to evaluate a self-administered cervicovaginal irrigation apparatus (MY-PAP, Medtech, Bohemia, N.Y.) for the detection of cervicovaginal human papillomavirus infection.

STUDY DESIGN

Twenty-five women referred to a colposcopy clinic because of a recent abnormal Papanicolaou smear were studied. Human papillomavirus infection test results detected by Southern blot hybridization and polymerase chain reaction from physician-administered and MY-PAP self-administered cervicovaginal lavage were paired for comparison.

RESULTS

Seventeen (68%) patients returned home samples by mail a mean of 13 days after the clinic visit. All clinic samples and 16 of 17 (94%) home samples yielded adequate deoxyribonucleic acid for human papillomavirus infection analyses. Human papillomavirus infection was detected by polymerase chain reaction in 14 of 16 (88%) samples with complete concordance of viral detection in paired samples from the clinic and home. Southern blot detected human papillomavirus infection in 13 of 25 clinic samples (52%) and 7 of 16 home samples (44%), with concordance in 12 of 16 paired samples (75%). Specific viral type was the same in all positive paired samples (6/6). Concordance was high when the initial sample had a strong (2+ to 4+) human papillomavirus infection signal (5/6, 83%) or a negative result (5/6) or when a dysplastic (cervical intraepithelial neoplasia grade 1 to 3) lesion (9/11, 82%) was seen on cervical biopsy.

CONCLUSION

Self-administered lavage represents an extremely promising technique for obtaining cervicovaginal lavage samples for human papillomavirus infection analyses.