High-Risk Human Papillomavirus Positive-Negative-Positive Infection Pattern Revealed Infection Below the Screening...

Area of Science:

• Gynecology
• Virology
• Oncology

Background:

• Cervical cancer screening relies on detecting high-risk human papillomavirus (HR-HPV).
• The Hybrid Capture 2 (HC2) assay is a common screening tool for HR-HPV.
• Understanding HPV infection dynamics, including transient or low-titer infections, is crucial for accurate diagnosis and management.

Purpose of the Study:

• To characterize HR-HPV infections in women with a specific positive-negative-positive (PNP) screening pattern.
• To investigate the performance of a sensitive genotyping assay in detecting HPV in samples that were negative by HC2 assay but showed a PNP pattern.

Main Methods:

• Identified women with PNP HR-HPV results using the HC2 assay (2015-2021).
• Analyzed cervical smears from these women using a sensitive reverse line blot genotyping assay to detect 32 HPV genotypes.
• Compared genotyping results with HC2 assay results to understand discrepancies.

Main Results:

• A PNP HR-HPV infection pattern was identified in 29 out of 10,512 women (0.27%).
• A sensitive genotyping assay detected HPV in 93% of HC2-negative samples within the PNP group.
• Infections were linked to prior cervical treatments or represented persistent/transient low-titer infections, not latent HPV.

Conclusions:

• The PNP HR-HPV screening pattern is rare.
• HC2 assay negativity is often due to HPV detection below the assay's cutoff, indicating subclinical infections.
• The study did not find evidence of HPV latency, but rather low-titer, subclinical HPV infections.