Assessing the diagnostic value of Xpert HPV - Authors' reply.
Assessing the diagnostic value of Xpert HPV - Authors' reply.
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评估 Xpert HPV 的诊断价值 - 作者的回复。
DOI：
10.1016/s2214-109x(20)30296-5
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Denny,Lynette
中科院分区：
文献类型：
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作者：
Kuhn,Louise;Saidu,Rakiya;Denny,Lynette
We thank Siamak Sabour for drawing attention to the importance of the public health relevance of diagnostic accuracy for cervical cancer screening tests. Indeed Dr Sabor is correct in pointing to some reluctance from practitioners to implement human papillomavirus (HPV)-based screenand-treat, despite the high sensitivity of HPV testing, because of its relatively low specificity, especially in women living with HIV. In our Article, 1 Xpert HPV, similar to other HPV tests, has excellent sensitivity, but specificity is suboptimal, particularly in women living with HIV.The primary aim of our study was to show that using existing output from the Xpert HPV assay, the balance between sensitivity and specificity can be improved. With these adjustments, this assay is ideal for HPV-based screen-and-treat, even in populations with a high population of women living with HIV. Xpert HPV provides aggregate HPV typing of the 14 highrisk HPV types in five fluorescent channels: HPV 16 (channel 1), HPV 18 and 45 (channel 2), HPV 31, 33, 35, 52, and 58 (channel 3), HPV 51 and 59 (channel 4), and HPV 39, 56, 66, and 68 (channel 5). The assay is a real-time PCR and cycle threshold values are reported for each channel, the resulting output provides the classification as positive or negative based on the established cycle threshold cut-offs. Our study showed that selecting more stringent cycle threshold cut-offs on the three channels detecting HPV types 16, 18, 45, 31, 33, 35, 52, 58 (ie, allowing the assay to be slightly less sensitive) leads to levels of specificity acceptable for the screen-and-treat approach, even for women living with HIV. In our study, if we set the cut-offs of the assay so that the sensitivity is 80%, we attained a specificity of 94· 1% in women without HIV and a
