Human Papillomavirus Same Genotype Persistence and Risk: A Systematic Review.

Objective: The aim of the study was to examine whether high-grade cervical intraepithelial neoplasia (CIN) was more closely associated with human papillomavirus (HPV) same-genotype persistence (SGTP) versus clearance of prior infection with a subsequent infection by a new genotype (genotype switch [GS]), clearance of HPV infection, or acquisition of a new HPV infection after a negative infection status, during a follow-up testing subsequent to abnormal screening results.
Materials and Methods: MEDLINE, Cochrane Library, Health Technology Assessment, and clinicaltrials.gov were searched from January 2000 to July 2019 for prospective controlled trials and observational studies of women and retrospective studies using HPV assays with extended- or full-genotype reporting. The primary outcome was high-grade CIN after at least 2 rounds of testing. Overall quality of evidence for the risk estimate outcomes was assessed. Of the 830 identified abstracts, 66 full-text articles were reviewed, and 7 studies were included in the synthesis. The study protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42018091093).
Results: Continued HPV-positive women falls in 2 equally large groups: SGTP and GS. Sensitivity, positive predictive value, and positive likelihood ratio of SGTP were significantly higher than for GS. Human papillomavirus genotypes may be ranked into 3 tiers (immediate colposcopy, follow-up testing, return to routine screening), according to associated risk of persistence for high-grade CIN and to prevailing clinical action thresholds.
Conclusions: There is moderately high-quality evidence to support the clinical utility of SGTP to improve risk discrimination for high-grade CIN compared with qualitative HPV testing without genotype-specific information.
Competing Interests: D.S.G. and J.C.A. were full-time employees of Becton, Dickinson and Company. M.T.S. has in the past served as a paid advisor to Roche and received honoraria from Roche and BD. J.B. is the principal investigator of studies supported with reagents and limited co-funding to his institution by BD Diagnostics, Agena Bioscience, Genomica SAU, LifeRiver Biotech, and QIAGEN. He has received honoraria for lectures from BD Diagnostics and Hologic. J.B. is appointed member of the National Danish Cervical Screening Committee by the Danish Health Authority and a member of the regional cervical screening steering committee of the Capital Region of Denmark. The other authors have declared they have no conflicts of interest.
(Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASCCP.)