Determinants of Incidence and Clearance of High-Risk Human Papillomavirus Infections in Rural Rakai, Uganda

Safaeian, Mahboobeh; Kiddugavu, Mohammed; Gravitt, Patti E.; Gange, Stephen J.; Ssekasanvu, Joseph; Murokora, Dan; Sklar, Marc; Serwadda, David; Wawer, Maria J.; Shah, Keerti V.; Gray, Ron

doi:10.1158/1055-9965.epi-07-2678

Cited by 49 publications

(57 citation statements)

References 36 publications

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“…To our knowledge, our study population has been the oldest in the literature. Similar to other investigators, 7,8,14,15,18,19 increased number of sexual partners was a predictor of HPV acquisition in our study. The risk of incident HPV infection increased significantly in the participants (OR: 5.0, CI: 2.0-12.6) when comparing !2 vs. 1 male partner.…”

supporting

confidence: 92%

“…On the national database, the only incident CIN2 case (though not available for histology review) in passive HPV-negative subjects was HPV negative at baseline when verified by type-specific PCR of the 14 leading HPV types. 10 Of 1,203 women (aged [16][17][18][19][20][21][22][23] accrued in the placebo arm of a multicenter HPV vaccine trial with 6-mo follow-up for 4 yr, the time from HPV acquisition to development of CIN or clearance in HPV-16 (n ¼ 142) and HPV-18 (n ¼ 62) was at 13.9 and 14.9 mo, respectively. 22 In a study from United Kingdom (median age, 18 yr; range 15-19), 11.4% (28/246) high-grade CIN developed in 6-12 mo after first detection of HPV16 during 3-yr follow-up.…”

mentioning

confidence: 99%

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Incidence and outcome of acquisition of human papillomavirus infection in women with normal cytology—A population‐based cohort study from Taiwan

Chao

Chang

Lai

et al. 2009

Intl Journal of Cancer

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Little is known about acquisition of human papillomavirus (HPV) and its outcome among older women with negative HPV testing and normal cytology. A longitudinal 3-yr follow-up of nested-cohort subjects (n 5 8825) from a population-based cervical cancer screening study whose Pap and HPV tests were negative at baseline were conducted. Every active HPVnegative (n 5 413) participant had 12-mo follow-ups of Pap smear and HPV testing. Colposcopy was performed if either HPVpositive or cytology was abnormal. The cytology and histology information of the remaining subjects (passive HPV-negative, n 5 8412) was obtained from national registry database. Median age of participants was 45 yr (range, 30-73 yr). The incidence of new acquisition was 4.2/100 woman-years. The 3-yr cumulative total HPV acquisition rate was 11.1% (95% confidence interval [CI]: 8.1-14.1). Increased number of sexual partners (!2 vs. 1) of the participant was associated with risk of acquisition (odds ratio [OR]: 5.0, 95% CI: 2.0-12.6) by multivariate analysis. Three cases of ! cervical intraepithelial neoplasia (CIN) 2 were identified in 3-yr follow-up in active HPV-negative subjects. HPV genotypes in the dysplastic tissue were actually present at baseline samples after reanalysis. From the passive HPV-negative group, only 1 case progressed to CIN2 probably after HPV acquisition. Negative Pap and HPV tests assured a very low risk of developing ! CIN2 within 3 yr despite incident HPV infection.Human papillomavirus (HPV) is a causative factor of cervical intraepithelial neoplasia (CIN) and subsequent invasive carcinomas.1,2 HPV infection is common in female population, with many women at some age having been infected with HPV.2 It is now widely accepted that persistent HPV infection is a prerequisite for progression into CIN and invasive carcinoma.3,4 The time from acquisition to development of cervical neoplasia is important for selecting an appropriate screening interval. However, the time lag from infection to disease is not easily determined, because a woman whose test is positive in her first sample could have been infected long before that sample is taken. Natural history of HPV infection can be best studied from longitudinal cohort studies starting before sexual debut. 5Several previous studies, mostly targeted on young women, report incident HPV infection in women with negative HPV tests and normal Pap smears. [6][7][8][9] In a Korean study of 171 university students (mean age, 18.4 yr), the acquisition rates of those starting sexual intercourse or had a new sex partner during study were 30 and 29.4% vs. 12.7% of those remained virginal at a median follow-up of 18 mo.6 Winer et al. 7 and Moscicki et al.8 found that incidence and prevalence of HPV infection among young women (mean age, 20.0 and 19.2 yr, respectively) were usually high. However, these young women usually clear incident HPV in a short time without developing high-grade CIN. A Columbian cohort study found that incidence of HPV infection was 6.2 cases/100 woman-years in older women (ag...

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supporting

confidence: 92%

mentioning

confidence: 99%

Incidence and outcome of acquisition of human papillomavirus infection in women with normal cytology—A population‐based cohort study from Taiwan

Chao

Chang

Lai

et al. 2009

Intl Journal of Cancer

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“…These are somewhat lower than those previously reported for species 9 (143.1/1,000 WMR and 76.5/1,000 WMR) and for species 7 (110.7/1,000 WMR and 94.1/1,000 WMR) (5, 25). These dif- ferences are explained by different study settings, including cohort size, and shorter FU times of 15 to 48 months in those studies (5,19,25). An additional contributing factor is the different age profile.…”

Section: Discussionmentioning

confidence: 98%

“…It was not until recently that data on HPV clearance at the genotype level were available (5,9,19,25). The results indicate that infection with HPV type 16 (HPV16) has the lowest tendency for clearance.…”

mentioning

confidence: 99%

“…Most studies on HPV clearance have addressed high-risk (HR) HPV types collectively and/or have compared clearance between HR and low-risk (LR) HPV types (3,4,12,13,17,18,21,23,24). Earlier data suggest that HR HPV infections usually clear more slowly than LR HPV infections (4,25) and that the likelihood of an infection not clearing increases in parallel with its duration (7, 13).It was not until recently that data on HPV clearance at the genotype level were available (5,9,19,25). The results indicate that infection with HPV type 16 (HPV16) has the lowest tendency for clearance.…”

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confidence: 99%

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Genotype-Specific Clearance of Genital Human Papillomavirus (HPV) Infections among Mothers in the Finnish Family HPV Study

et al. 2010

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The majority of cervical human papillomavirus (HPV) infections in young women are transient, but whether the clearance differs among different HPV genotypes and the different factors predicting genotype-specific clearance are partly unknown. In the Finnish Family HPV Study, 131 of 252 women (mean age, 25.5 years) cleared their infection during the prospective follow-up of 6 years (median, 62.4 months; range, 1.6 to 94.5 months). Cervical scrapings collected at each visit were tested for 24 low-risk and high-risk (HR) HPV types with multiplex HPV genotyping. Poison regression (panel data) was used to estimate predictors for the clearance of species 7 and 9 HPV genotypes. Of all HPV genotypes detected in these women, multiple-type and HPV type 16 (HPV16) infections showed clearance least frequently (46.1% and 50.5%, respectively). The actuarial and crude mean times to first clearance were variable among different genotypes. The actuarial clearance rate (events/person-time at risk) was highest for HPV16 and multiple-type infections, while HPV66 and -82 had the highest crude clearance rate. Independent predictors increasing type-specific clearance of species 7/9 HPV genotypes were older age (incidence rate ratio [IRR] ‫؍‬ 1.1; 95% confidence interval [95% CI], 1.03 to 1.18; P ‫؍‬ 0.002) and baseline oral HR HPV DNA-negative status (IRR ‫؍‬ 2.94; 95% CI, 1.03 to 8.36; P ‫؍‬ 0.042), while a higher number of sexual partners during the follow-up decreased the probability of clearance (IIR ‫؍‬ 0.35; 95% CI, 0.15 to 0.83; P ‫؍‬ 0.018). To conclude, HPV16 and multiple-type infections showed the lowest clearance among young mothers. Increasing age and negative oral HR HPV DNA status at baseline were associated with increased clearance, whereas a higher number of current sexual partners decreased the probability of species 7/9 HPV genotype clearance.Genital human papillomavirus (HPV) infections are transient in most cases (3, 7). Most studies on HPV clearance have addressed high-risk (HR) HPV types collectively and/or have compared clearance between HR and low-risk (LR) HPV types (3,4,12,13,17,18,21,23,24). Earlier data suggest that HR HPV infections usually clear more slowly than LR HPV infections (4,25) and that the likelihood of an infection not clearing increases in parallel with its duration (7, 13).It was not until recently that data on HPV clearance at the genotype level were available (5,9,19,25). The results indicate that infection with HPV type 16 (HPV16) has the lowest tendency for clearance. Accurate data on actual and crude clearance times and clearance rates (CRs) for individual genotypes are needed to understand the natural history of HPV infections.The present study is one of the first to assess the frequency of HPV type-specific clearance as well as the actuarial and crude clearance times and clearance rates for the 24 most common LR and HR HPV genotypes. The study was performed among newly delivered mothers who were followed up for 6 years in the Finnish Family HPV Study. In addition, predictors of species ...

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Treatment patterns of aging Americans with differentiated thyroid cancer

Park

Roman

Sosa

2009

Cancer

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BACKGROUND:The incidence of differentiated thyroid cancer (DTC) increases with age. Total thyroidectomy, often followed by radioactive iodine (RAI), is recommended for patients who have tumors that measure !1 cm in greatest dimension. In the current study, the authors assessed the use of thyroidectomy and RAI among elderly patients with DTC and the effects on survival. METHODS: Adults aged !45 years with DTC !1 cm in the Surveillance, Epidemiology, and End Results database from 1988 to 2003 were included. Bivariate and multivariate analyses were used to measure associations between demographic, clinical, and pathologic characteristics and the likelihood of receiving treatment according to current practice guidelines. RESULTS: Of 8899 patients who were identified, 26% were ages 65 years to 79 years, and 5% were aged !80 years. Compared with younger patients, patients aged ! 65 years were more likely to have larger tumors, stage IV disease, extrathyroid extension, and nonpapillary histology. Elderly patients were less likely to undergo total thyroidectomy (74% vs 80%; P < .001) or to receive RAI (47% vs 54%; P < .001). These trends were most pronounced among those aged !80 years. Among the patients who did not undergo surgery, elderly patients did not report higher rates of contraindications to surgery. In multivariate analysis, the groups ages 65 years to 79 years and aged !80 years were associated with lower rates of total thyroidectomy (odds ratio, 0.77 and 0.43, respectively; P < .001) and RAI (odds ratio, 0.85 [P < .01] and 0.39 [P < .001], respectively). Among elderly patients, predictors of worse survival included no surgery (hazard ratio, 5.51; P < .001) and no RAI (hazard ratio, 1.36; P < .001). CONCLUSIONS: Elderly patients with DTC received less aggressive surgical and RAI treatment than younger patients despite having more advanced disease and the improved survival associated with these treatments among elderly patients. Long-term outcomes should be measured to determine the impact of this apparent discrepancy in care. Cancer 2010;116:20-30.

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Determinants of Incidence and Clearance of High-Risk Human Papillomavirus Infections in Rural Rakai, Uganda

Cited by 49 publications

References 36 publications

Incidence and outcome of acquisition of human papillomavirus infection in women with normal cytology—A population‐based cohort study from Taiwan

Incidence and outcome of acquisition of human papillomavirus infection in women with normal cytology—A population‐based cohort study from Taiwan

Genotype-Specific Clearance of Genital Human Papillomavirus (HPV) Infections among Mothers in the Finnish Family HPV Study

Treatment patterns of aging Americans with differentiated thyroid cancer

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