Detection of human papillomavirus DNA in urine specimens from human immunodeficiency virus-positive women

Abstract

Human immunodeficiency virus (HIV)-positive women may represent one of the fastest-growing populations at risk for acquiring cervical cancer and thus require frequent screening. The purpose of the present studies was to validate a PCR-based urine assay by comparing detection and genotyping of human papillomavirus (HPV) DNA in urine samples and matching cervical swab specimens of HIV-positive women. Despite a difference in amplifiability, the prevalence of any HPV genotype (58% for the cervical swab specimens and 48% for the urine specimens) was not significantly different in this population. The levels of concordance were 70, 71, and 78% for detection of any HPV type, any high-risk HPV type, or any low-risk HPV type in the two specimen types, respectively. While instances of discordant detection were greater for the cervical swab specimens than for the urine specimens, this was not statistically significant. The distributions of HPV genotypes were similar in the cervix and the urine for the majority of types examined. Importantly, detection of HPV DNA in urine was associated with an abnormal Papanicolaou smear to the same extent that detection of HPV DNA in a cervical swab specimen was. These data provide preliminary support for the proposal to use urine testing as a primary or secondary screening tool for cervical cancer in HIV-positive women or as an epidemiological tool. Additional studies with larger sample sizes must be conducted in order to further verify these findings.

FIG. 1.

Prevalence of any HPV type, any high-risk HPV type, any low-risk HPV DNA type, or the presence of a multiple infection in urine or cervix for entire study population of 101 HIV-positive women. The amplifiability of HPV DNA from urine and cervical swab specimens is also compared in the first column. White bars, urine samples; thatched bars, cervical swab samples. Significant differences are denoted by an asterisk (P < 0.05).

FIG. 2.

Detection of any HPV DNA type or any high-risk HPV DNA type in urine and cervix of women with normal Pap smears (WNL; n = 53), ASCUS (n = 17), or abnormal Pap smears (n = 27). White bars, any HPV DNA type in urine; bars with vertical stripes, any HPV DNA type in the cervix; bars with horizontal stripes, any high-risk HPV DNA type in urine; bars with angled thatching, any high-risk HPV DNA type in the cervix. The percentage of urine or cervical swab samples positive for HPV DNA is indicated above each bar for each Pap smear classification.