High specificity of HPV cell free DNA tests in persons with HIV for the detection of HPV-related cancer.
Academic Article
Overview
abstract
INTRODUCTION: Persons with HIV (PWH) experience high rates of HPV-associated cancers compared to the general population. Plasma HPV cell free DNA (cfDNA) tests are sensitive in patients with known HPV-associated cancers, It is not known if these tests can screen for invasive cancers in populations with high burdens of non-malignant HPV disease such as PWH. It was not known whether HPV infection and/or non-invasive anal high grade squamous intraepithelial lesions (HSIL) alone in this population would result in detectable HPV cfDNA, which would result in a high number of false positives if HPV cfDNA is used to screen for invasive cancers. METHODS: We conducted a prospective study of PWH in two cohorts: 20 without anal HSIL and 20 with anal HSIL. We tested anal and vaginal swabs for HPV infection and HPV genotyped the biopsies of anal HSIL. Finally, we performed HPV cfDNA droplet digital PCR (ddPCR) to test for HPV16/18/33 from plasma samples. RESULTS: In the combined cohorts: The median age was 56, 12.5% were cisgender women, and none had detectable HIV. 84.6% had prevalent anovaginal HPV infection, including 10 participants with HPV16, 13 with HPV18, and 2 with HPV33 infections. Five and two participants had HPV16 and HPV33 detected in anal HSIL, respectively. Despite the high prevalence of HPV infection and anal HSIL, no participant had HPV16/18/33 detectable cfDNA by ddPCR. CONCLUSION: These results provide a strong rationale for investigating the use of HPV cfDNA in a screening setting for suspected HPV-related invasive cancers in PWH.
