Evaluation of Triage Options After HPV Testing for Cervical Cancer Screening Among HIV-infected Women

HIV Infections Clinical Trial

— AIMA-CC  

Official title:

Evaluation of Screening Algorithms Based on Self-collection and HPV Testing With Partial Genotyping for the Prevention of Cervical Cancer Among HIV-infected Women in Low-income Countries

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03789513
• Other study ID #: ANRS12375 AIMA-CC
• Status: Recruiting
• Phase: N/A
• Start date: March 1, 2019
• Est. completion date: September 2022

Study information

• Verified date: February 2022
• Source: ANRS, Emerging Infectious Diseases
• Contact: Pierre Debeaudrap, PhD
• Phone: (0) 1 76 53 34 53
• Email: pierre.debeaudrap[@]ird.fr
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Cervical cancer is the most common cause of cancer and a leading cause of death among HIV-infected women living in resource-limited settings. Although screening for premalignant lesions is an effective way of reducing cervical cancer incidence, its uptake in low-resource settings to date is low. The use of HPV testing for primary screening is currently recommended by many guidelines - including the WHO guidelines for cervical cancer screening in resource-limited settings - because of its greater sensitivity and ease of use compared to other options. However, these WHO guidelines have both highlighted the need to conduct more research on appropriate HPV-based algorithms among HIV-infected women, as immunodeficiency may affect the screening performance. Indeed, HPV infections in HIV-infected women are very common, so there is a need for additional triage to identify women most at risk and there remains considerable uncertainty on the optimal option for such triage. Most of the evidence available comes from HIV-negative populations living in high-resource settings and is not necessarily relevant for low-resource contexts where the epidemiological background is different, women access late to screening and may not have follow up visits, where financial constraints are important and health service resources limited.

Hence, the proposed project aims to provide evidence on the effectiveness and feasibility of HPV-based screening algorithms among HIV-infected women in low-resource settings.

This multicenter cross-sectional study will include 3,000 HIV-infected women (30-49 years old) receiving HAART and followed in Abidjan (Ivory Coast), Bobo-Dioulasso (Burkina Faso) and Phnom Penh (Cambodia).

After self-collection of cervico-vaginal samples, each participant will have an HPV test with partial genotyping primary using the Xpert HPV assay, a real-time PCR assay that provides the possibility of identifying 14 HR-HPV types within one hour. The Xpert HPV test has been chosen because of the wide availability of the Genexpert platform in HIV care centers from resource-limited settings. Furthermore, it can specifically detect HPV-16, 18 and 45, the most carcinogenic HPV types in both HIV-negative and HIV-positive women, separately from other high-risk HPV types. VIA will be another triage option either alone or combined to HPV DNA genotyping.

In addition, participants treated for cervical lesion will be followed over 12 months to assess the risk of post-treatment lesions (CIN2+/HSIL) and to identify associated risk-factors.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 3000
• Est. completion date: September 2022
• Est. primary completion date: September 1, 2022
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 30 Years to 49 Years

Eligibility

Inclusion Criteria:

• Women

• HIV-1 infection

• Age 30 to 49 years

• In care for HIV infection, receiving or initiating antiretroviral therapy

• Written informed consent given

Exclusion Criteria:

• HIV-2 infection

• Ongoing pregnancy (evidenced by self-report or clinical examination)

• Previous total hysterectomy

• Severe concomitant disease that, according to the investigators, may contraindicate or compromise participation to the study

• History of cervical cancer screening with treatment for precancerous lesions within the last 12 months

Differed inclusion

• Ongoing heavy menstruation

• Immediate post-partum (<12 weeks post delivery)

• Sign of ongoing genital infection (e.g. mucopurulante discharge)

Related Conditions & MeSH terms

• Communicable Diseases
• HIV Infections
• HPV - Anogenital Human Papilloma Virus Infection
• Infections
• Papilloma
• Papillomavirus Infections
• Uterine Cervical Neoplasms

Intervention

Diagnostic Test:
• HPV test with partial genotyping and VIA triage
HPV testing with the GenXpert platform VIA Biopsies of VIA+ lesions or random Treatment with thermal ablation of women with precancerous lesions

Locations

Country	Name	City	State
Burkina Faso	HIV day care center	Bobo-Dioulasso
Cambodia	Calmette Hospital	Phnom Penh
Côte D'Ivoire	CEPREF	Abidjan

Sponsors (6)

Lead Sponsor	Collaborator
ANRS, Emerging Infectious Diseases	Institut de Recherche pour le Developpement, International Agency for Research on Cancer, Programme PAC-CI, Site ANRS-MIE de Côte d'Ivoire, University Hospital, Geneva, University of Bordeaux

Countries where clinical trial is conducted

Burkina Faso,  Cambodia,  Côte D'Ivoire, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Sensitivity of the triage options	Sensitivity of the triage options to detect CIN2+ and CIN3+ lesions with histology as the reference standard	Day 0
Primary	Specificity of the triage options	Specificity of the triage options to detect CIN2+ and CIN3+ lesions with histology as the reference standard	Day 0
Secondary	Positive and negative predictive value (PPV and NPV) of the triage options	PPV and NPV of the triage options to detect CIN2+ and CIN3+ lesions with histology as the reference standard	Day 0
Secondary	Positive and negative diagnostic likelihood ratio (DLR) of the triage options	Positive and negative DLR of the triage options to detect CIN2+ and CIN3+ lesions with histology as the reference standard	Day 0
Secondary	Acceptability and feasibility	Acceptability and feasibility of the self-sampling, of the different triage options and of the treatment cervical lesions	Day 0 and Week 1
Secondary	Prevalence of CIN2+ lesions	Prevalence of CIN2 lesions, overall and by sub-groups defined by age categories, current CD4-cell count, nadir CD4-cell count and treatment history	Day 0
Secondary	Prevalence of CIN3+ lesions	Prevalence of CIN3 lesions overall and by sub-groups defined by age categories, current CD4-cell count, nadir CD4-cell count and treatment history	Day 0
Secondary	Prevalence of cervical cancer	Prevalence of cervical cancer overall and by sub-groups defined by age categories, current CD4-cell count, nadir CD4-cell count and treatment history	Day 0
Secondary	Adverse events	Rate and nature of adverse events and protocol violations	Day 0 and Week 1 up to 24 weeks
Secondary	Proportion of the women eligible to HPV screening who were actually screened and treated (if required)	Proportion of the women eligible for the study who were actually screened, treated (if required)	Day 0
Secondary	Evaluation of the micro-costing	Evaluation of the micro-costing of the various components of the screening strategies	Day 0 up to Week 26
Secondary	Evaluation of post-treatment HPV clearance	Evaluation of the HPV clearance at M6 and M12 after thermal-ablation	Week 24 and 48 post treatment
Secondary	Evaluation of post-treatment cervical lesion	Evaluation of the proportion of CIN2 and CIN3 at M12 after treatment	Week 48 post treatment