Human papillomavirus sequencing reveals its usefulness for the management of HIV ‐infected women at risk for developing cervical cancer

Aim Next‐generation sequencing (NGS) is able to describe the composition of human papillomaviruses (HPVs) as percent (%) reads rather than positive/negative results. Therefore, we used this unique approach to assess the prevalence of cervical HPVs of HIV infected (HIV+) in order to understand the determinants of being infected with higher % reads of high risk (HR)‐HPVs and cervical abnormalities of atypical squamous cells of unknown significance or higher (ASCUS+). Methods Study included 66 women characterized for relevant risk factors/cytology. Receiver‐operating curve curve was used to derive the optimal % read cut point to identify ASCUS+ in relation to any HR‐HPV genotype or other specific HPV genotypes. The determinants of ASCUS+ and HR‐HPVs were tested using logistic regression. Results Women with >20% reads of any HR‐HPV or >12% any HR‐HPV other than HPV 16/18 were 5.7 and 12.6 times more likely to be diagnosed with ASCUS+, respectively. Lower CD4 count was a significant determinant of >20% reads of HR‐HPV (odds ratio [OR] = 4.1) or >12% any HR‐HPV other than HPV 16/18 (OR = 4.5). Conclusion We envision that the NGS‐based HPV detection will be more accurate for screening and management of HIV+ at risk for developing cervical cancer (CC). We raise concerns regarding the limitations of 16/18‐based HPV testing for triage and the efficacy of current HPV vaccines for preventing CC in HIV+.