Self-sampling is associated with increased detection of human papillomavirus DNA in the genital tract of HIV-seropositive women.
BACKGROUND
Analysis of self-collected swab samples from the genital tract could improve accrual and retention of women in studies of human papillomavirus (HPV) infection and precancerous cervical lesions. Self-collected vaginal swab specimens and physician-collected cervical swab specimens were compared for detection and typing of HPV DNA in 158 HIV-seropositive women.


METHODS
Paired samples were collected for 157 participants. Beta-globin was not detected in 6 (3.3%) physician-collected specimens and 8 (4.3%) self-obtained specimens collected from 11 women, leaving 146 paired samples suitable for PCR analysis. HPV DNA was amplified with the HPV primers PGMY09 and PGMY11 and typed using the line blot assay.


RESULTS
HPV DNA was detected more frequently in self-collected samples (95 [65.1%] of 146), compared with physician-collected samples (78 [53.4%] of 146) (P = .04). Self-collected samples contained a greater number of types (mean +/- SD, 1.60 +/- 1.80 types; 95% confidence interval [CI], 1.31-1.90), compared with physician-collected samples (mean +/- SD, 1.25 +/- 1.66 types; 95% CI, 0.98-1.52) (P = .04). A good agreement between sampling methods was achieved for detection of any HPV DNA (kappa = 0.73; 95% CI, 0.58-0.89), high-risk types (kappa = 0.84; 95% CI, 0.68-0.99), and low-risk types (kappa = 0.71; 95% CI, 0.67-0.75). Agreement between sampling methods for detection of HPV DNA was found for 24 (88.8%) of 27 follow-up samples collected from a total of 20 women. A comparison of samples collected at consecutive visits revealed agreements for detection of any HPV DNA, detection of high-risk HPV, and HPV typing results between visits of 88.9% (24 of 27 samples), 81.5% (22 of 27), and 55.5% (15 of 27), respectively, for physician-collected samples, and 96.3% (26 of 27 samples), 92.6% (25 of 27), and 55.5% (15 of 27), respectively, for self-collected samples.


CONCLUSIONS
Analysis of self-collected vaginal swab samples improved the detection rate of HPV, suggesting that such samples might be of greater value than physician-obtained samples in studies of HPV transmission.
Petignat
Patrick
P
Département d'Obstétrique et Gynécologie, Hôpital Notre-Dame du Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Hankins
Catherine
C
Walmsley
Sharon
S
Money
Deborah
D
Provencher
Diane
D
Pourreaux
Karina
K
Kornegay
Janet
J
Rouah
Fabrice
F
Coutlée
François
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications* / Q000821:virology; D006679:HIV Seropositivity / Q000150:complications* / Q000821:virology; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000175:diagnosis*; D012648:Self Care; D014621:Vagina / Q000821:virology; D014626:Vaginal Smears
D004279:DNA, Viral