Use of HPV testing for cervical screening in vaccinated women—Insights from the SHEVa (Scottish HPV Prevalence in Vaccinated Women) study

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The management of cervical disease is changing worldwide as a result of HPV vaccination and the increasing use of HPV testing for cervical screening. However, the impact of vaccination on the performance of HPV based screening strategies is unknown. The SHEVa (Scottish HPV Prevalence in Vaccinated women) projects are designed to gain insight into the impact of vaccination on the performance of clinically validated HPV assays. Samples collated from women attending for first cervical smear who had been vaccinated as part of a national “catch-up” programme were tested with three clinically validated HPV assays (2 DNA and 1 RNA). Overall HR-HPV and type specific positivity was assessed in total population and according to underlying cytology and compared to a demographically equivalent group of unvaccinated women. HPV prevalence was significantly lower in vaccinated women and was influenced by assay-type, reducing by 23-25% for the DNA based assays and 32% for the RNA assay (p= 0.0008). All assays showed over 75% reduction of HPV16 and/or 18 (p< 0.0001) whereas the prevalence of non 16/18 HR-HPV was not significantly different in vaccinated vs unvaccinated women. In women with low grade abnormalities, the proportion associated with non 16/18 HR-HPV was significantly higher in vaccinated women (p< 0.0001). Clinically validated HPV assays are affected differentially when applied to vaccinated women, dependent on assay chemistry. The increased proportion of non HPV16/18 infections may have implications for clinical performance, consequently, longitudinal studies linking HPV status to disease outcomes in vaccinated women are warranted.

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Cervical cancer screening increasingly is based on the detection of high-risk human papillomavirus (hrHPV), including types 16 and 18, the prevalence of which is declining in areas with HPV vaccination. Almost nothing is known, however, about how HPV vaccination could impact cervical screening. Drawing on samples in the Scottish HPV Archive, the authors of the present study show that HPV 16 and/or 18 infection is significantly reduced among vaccinated women. Similar reductions were not observed for non-16/18 hrHPV. Moreover, the proportion of non-16/18 hrHPV associated with low-grade cervical abnormalities was increased in vaccinated women, potentially affecting HPV assay performance.

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