{"doi":"10.17615/226z-2519","title":"Primary HPV and Molecular Cervical Cancer Screening in US Women Living With Human Immunodeficiency Virus","abstract":"Background: Primary human papillomavirus (HPV) screening (PHS) utilizes oncogenic human papillomavirus (oncHPV) testing as the initial cervical cancer screening method and typically, if positive, additional reflex-triage (eg, HPV16/18-genotyping, Pap testing). While US guidelines support PHS usage in the general population, PHS has been little studied in women living with HIV (WLWH). Methods: We enrolled n = 865 WLWH (323 from the Women's Interagency HIV Study [WIHS] and 542 from WIHS-affiliated colposcopy clinics). All participants underwent Pap and oncHPV testing, including HPV16/18-genotyping. WIHS WLWH who tested oncHPV[+] or had cytologic atypical squamous cells of undetermined significance or worse (ASC-US+) underwent colposcopy, as did a random 21% of WLWH who were oncHPV[-]/Pap[-] (controls). Most participants additionally underwent p16/Ki-67 immunocytochemistry. Results: Mean age was 46 years, median CD4 was 592 cells/μL, 95% used antiretroviral therapy. Seventy WLWH had histologically-determined cervical intraepithelial neoplasia grade 2 or greater (CIN-2+), of which 33 were defined as precancer (ie, [i] CIN-3+ or [ii] CIN-2 if concurrent with cytologic high grade squamous intraepithelial lesions [HSILs]). PHS had 87% sensitivity (Se) for precancer, 9% positive predictive value (PPV), and a 35% colposcopy referral rate (Colpo). \"PHS with reflex HPV16/18-genotyping and Pap testing\"had 84% Se, 16% PPV, 30% Colpo. PHS with only HPV16/18-genotyping had 24% Colpo. \"Concurrent oncHPV and Pap Testing\"(Co-Testing) had 91% Se, 12% PPV, 40% Colpo. p16/Ki-67 immunochemistry had the highest PPV, 20%, but 13% specimen inadequacy. Conclusions: PHS with reflex HPV16/18-genotyping had fewer unnecessary colposcopies and (if confirmed) could be a potential alternative to Co-Testing in WLWH.","journal":"UNC Libraries","year":2023,"id":415828,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8404,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":384170,"name":"Christine Colie","orcid":null,"position":1,"is_corresponding":false},{"id":591356,"name":"A.A. 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Keller","orcid":"0000-0003-0417-4000","position":11,"is_corresponding":false},{"id":858026,"name":"Howard D. Strickler","orcid":"0000-0001-6397-7466","position":12,"is_corresponding":false},{"id":334762,"name":"Catalina Ramirez","orcid":"0000-0002-0872-0307","position":13,"is_corresponding":false},{"id":265771,"name":"Joel M. Palefsky","orcid":"0000-0002-5097-3818","position":14,"is_corresponding":false},{"id":315093,"name":"Gypsyamber DʼSouza","orcid":"0000-0002-0575-7948","position":15,"is_corresponding":false},{"id":384171,"name":"Jason Leider","orcid":null,"position":16,"is_corresponding":false},{"id":382870,"name":"Rodney Wright","orcid":"0000-0001-7922-3503","position":17,"is_corresponding":false},{"id":382868,"name":"Howard Minkoff","orcid":"0000-0002-7800-7195","position":18,"is_corresponding":false},{"id":340367,"name":"Lisa Rahangdale","orcid":"0000-0002-4444-7969","position":19,"is_corresponding":false},{"id":291036,"name":"Robert D. Burk","orcid":"0000-0002-8376-8458","position":20,"is_corresponding":false},{"id":591317,"name":"K. Anastos","orcid":null,"position":21,"is_corresponding":false},{"id":304399,"name":"Mark H. Einstein","orcid":"0000-0001-7422-0338","position":22,"is_corresponding":false},{"id":611005,"name":"Xianhong Xie","orcid":"0000-0002-4278-1023","position":23,"is_corresponding":false},{"id":597010,"name":"M. Fischl","orcid":null,"position":24,"is_corresponding":false},{"id":382867,"name":"Lisa Flowers","orcid":"0000-0003-0484-2742","position":25,"is_corresponding":false},{"id":356486,"name":"Jessica Atrio","orcid":"0000-0002-3505-643X","position":26,"is_corresponding":false},{"id":237732,"name":"Philip E. Castle","orcid":"0000-0003-1082-6554","position":27,"is_corresponding":false},{"id":1198294,"name":"N.A. 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