The impact of HPV type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme: a two centre observational study

Objective To determine if HPV immunisation has affected the prevalence of HPV genotypes and colposcopic features of CIN in young women referred for colposcopy. Design A two-centre observational study including vaccinated and unvaccinated women. Setting Colposcopy clinics serving two health regions in Scotland, UK. Population 361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening. Methods Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16,18,31,33 and 45. Demographic data, cytology and histology results and colposcopic features were recorded. Chi squared analysis was conducted to identify associations between vaccine status, HPV genotypes and colposcopic features. Main outcome measures Colposcopic features, HPV genotypes, mRNA expression and cervical histology. Results The prevalence of HPV 16 was significantly lower in the vaccinated (8.6%) compared with the unvaccinated (46.7%) group (p=0.001). The number of cases of cervical intraepithelial neoplasia 2 or more (CIN2+) was significantly lower in vaccinated women (p=0.006).HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+ from 74% (unvaccinated) to 66.7% (vaccinated). Conclusions In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in vaccinated women is at the lower acceptable level of the UK national cervical screening programme guidelines

Use of the gLite-WMS in CMS for production and analysis

The CMS experiment at LHC started using the Resource Broker (by the EDG and LCG projects) to submit Monte Carlo production and analysis jobs to distributed computing resources of the WLCG infrastructure over 6 years ago. Since 2006 the gLite Workload Management System (WMS) and Logging \& Bookkeeping (LB) are used. The interaction with the gLite-WMS/LB happens through the CMS production and analysis frameworks, respectively ProdAgent and CRAB, through a common component, BOSSLite. The important improvements recently made in the gLite-WMS/LB as well as in the CMS tools and the intrinsic independence of different WMS/LB instances allow CMS to reach the stability and scalability needed for LHC operations. In particular the use of a multi-threaded approach in BOSSLite allowed to increase the scalability of the systems significantly. In this work we present the operational set up of CMS production and analysis based on the gLite-WMS and the performances obtained in the past data challenges and in the daily Monte Carlo productions and user analysis usage in the experiment

Prevalence and outcomes of HIV-1 diagnostic challenges during universal birth testing – an urban South African observational cohort

IINTRODUCTION : HIV-1 polymerase chain reaction (PCR) testing at birth aims to facilitate earlier initiation of antiretroviral therapy (ART) for HIV-infected neonates. Data from two years of universal birth testing implementation in a high-burden South African urban setting are presented to demonstrate the prevalence and outcomes of diagnostic challenges in this context. METHODS : HIV-exposed neonates born at Rahima Moosa Mother and Child Hospital between 5 June 2014 and 31 August 2016 were routinely screened at birth for HIV-1 on whole blood samples using the COBAS® AmpliPrep/COBAS® TaqMan (CAP/CTM) HIV-1 Qualitative Test, version 2.0 (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Virological results were interpreted according to standard operating procedures with the South African National Health Laboratory Service. All neonates with non-negative results were actively followed-up and categorized according to HIV infection status as positive, negative, uncertain and lost to follow-up (LTFU). RESULTS : 104 (1.8%) of 5743 HIV-exposed neonates received a non-negative birth PCR result, for which laboratory data were available for 102 (98%) cases – 78 (76%) tested positive and 24 (24%) indeterminate. HIV infection status was confirmed positive in 83 (81%) infants, negative in 8 (8%), uncertain in 5 (5%) and LTFU in 6 (6%) cases. The positive predictive value (excluding cases of uncertain diagnosis and inadequate testing) following a non-negative HIV-1 PCR screening test at birth was 0.91 (83/91; 95% confidence interval: 0.85–0.96). Neonates testing positive at birth had significantly higher viral load (VL) results than those testing indeterminate at birth of 4.5 and 3.0 log copies/ml (p = 0.0007), respectively. Similarly, mothers of neonates with positive as compared to indeterminate birth test results had higher VLs of 4.5 and 2.7 log copies/ml (p = 0.0013), respectively. Half of neonates with an indeterminate birth test were shown to be HIV-infected on subsequent confirmatory testing, with time to final diagnosis 30 days longer for these neonates (p < 0.0001). CONCLUSION : Indeterminate HIV-1 PCR results accounted for a quarter of non-negative results at birth and were associated with a high risk of infection in comparison to the risk of in utero transmission. Indeterminate birth results with positive HIV PCR results on repeat testing were associated with later final diagnosis. The HIV-1 status remains uncertain in a minority of cases because of repeatedly indeterminate results, highlighting the need for more sensitive and specific virological tests.The National Institutes of Health U01 HD080441, PEPfAR/USAID and UNICEF.http://www.jiasociety.orgam2017Medical Virolog