Prevalence of Anal Human Papillomavirus (HPV) and Performance of Cepheid Xpert and Hybrid Capture 2 (hc2) HPV Assays in South African HIV-Infected Women

Am J Clin Pathol. 2017 Aug 1;148(2):148-153. doi: 10.1093/ajcp/aqx050.


Objectives: This study investigated anal high-risk HPV (HR-HPV) prevalence in HIV-infected women using the Cepheid Xpert HPV assay and compares its performance with that of Hybrid Capture-2 (hc2).

Methods: A total of 199 HIV-infected women were recruited from Helen Joseph Hospital, Johannesburg. Stored ThinPrep anal swabs that had previously been tested using hc2 were tested for HPV using Xpert.

Results: The HR-HPV prevalence by Xpert was 40.8% and similar to hc2 (41.8%) with overall agreement of 86.7%; Cohen's kappa 0.73 (95% CI 0.63-0.82). High grade squamous intraepithelial lesions (HSIL) was associated with increasing number of multiple HPV infection (P < .001). Xpert and hc2 were similarly sensitive (77.4% and 77.4%, respectively) and specific (66.1% and 64.8% respectively) for HSIL detection. HPV16 (OR: 14.0, 95% CI: 3.9-48.0, P < .0001), HPV39/68/56/66 (OR: 4.1, 95% CI: 1.4-12, P = .01) and HPV51/59 (OR: 2.8, 95% CI: 1.1-7.6, P = .04) were independently associated with anal HSIL.

Conclusions: Xpert HPV typing is a promising anal screening test in HIV-infected women that performs similarly to hc2.

Keywords: Anal cancer; HPV; Women; Xpert; hc2.

MeSH terms

  • Adult
  • Coinfection / epidemiology*
  • Coinfection / virology*
  • Female
  • HIV Infections / virology*
  • Human Papillomavirus DNA Tests / methods*
  • Humans
  • Middle Aged
  • Molecular Diagnostic Techniques / methods*
  • Papillomaviridae
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / epidemiology*
  • Prevalence
  • Sensitivity and Specificity
  • South Africa
  • Squamous Intraepithelial Lesions of the Cervix / virology