Human papillomavirus type specific risk of progression and remission during long‐term follow‐up of equivocal and low‐grade HPV‐positive cervical smears

Abstract

The prevalence of clinically relevant HPV types and their specific risk for progression and regression in women with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) were studied in a routine screening population. A 4-year cohort of women (n = 820) with ASCUS/LSIL and a positive HPV test in triage were followed for 6-9 years. The progression risks for CIN2+/CIN3+ were determined for single (71.2%) and multiple HPV infections (28.8%). The CIN2+ progression risk for all HPV 16, all HPV 35, single HPV 16 and single HPV 35 infections were 65.3% (95% CI: 59.6-71.0), 64.4% (95% CI: 50.4-78.4), 63.8% (95% CI: 56.2-71.4) and 73.7% (95% CI: 53.9-93.5), respectively. Based on CIN2+ progression risks four main groups were defined; the HPV 16 group, the HPV 31/33/35 group, the HPV 18/45/51/52 group and the HPV 39/56/58/59/66/68 group with progression risks of 65.3% (95% CI: 59.6-71.0), 62.1% (95% CI: 54.8-69.4), 52.6 (95% CI: 45.9-59.3) and 39.5 (95% CI: 33.0-46.0), respectively. In multivariate analyses, women in the age group 40-49 years had an increased risk of CIN2+ progression. As for CIN3+, HPV 16 had a higher progression risk than other HPV risk groups (p < 0.05). In multiple infections only HPV 16 had a significant additive CIN3+ progression risk (p < 0.05) as compared to other HPV risk groups. In summary, HPV types 16 and 35, including the HPV risk group 31/33/35, had a similar CIN2+ progression risk, but only HPV 16 had a higher risk for CIN3+ progression.

Co-infection with trichomonas vaginalis increases the risk of cervical intraepithelial neoplasia grade 2–3 among HPV16 positive female: a large population-based study

“…The virus can be cleared through host immune responses spontaneously, only a small number of infections persisted and progressed to cervical cancer [36]. HPV 16 was found to be the most prevalent hr-HPV type with the highest risk among all hr-HPVs to progress to CIN2-3 and ICC [37]. Studies found that the outcome of HPV infection was closely related to the local micro-environmental of the cervix [27].…”

Comparison of HPV-16 and HPV-18 Genotyping and Cytological Testing as Triage Testing Within Human Papillomavirus–Based Screening in Mexico

“…Moreover, it has been demonstrated that presence of HPV-16 is a major factor for risk of CIN grade 3 or higher. 30,31 A 2016 cohort study 31 found that HPV-16 and HPV-18 are associated with the greatest 3-year risk of CIN grade 3 or higher.…”

“…40 This measurement error could be higher in the group of women whose results were negative in HPV-16/HPV-18 genotyping and normal in LBC who were used for VBA, considering that CIN grade 2 lesions caused by high-risk HPV types other than HPV-16 or HPV-18 are more likely to regress. 30,32,41,42 A 2016 study 31 indicated that the 3-year risk of CIN grade 3 or higher ranged from 1.2% to 4.0% for patients with high-risk HPV who did not have HPV-16 or HPV-18 and had normal cytological findings. This can lead to an underestimation of the true sensitivity and specificity of the analysis if using VBA.…”

A hidden Markov model for population‐level cervical cancer screening data

“…Certain strains of the HPV are known to be the primary causes of cervical cancer, and certain conditions accelerate progression from low-grade lesions caused by HPV to cancer. [32][33][34][35] Exposure to HPV is typically through sexual contact, thus risk of HPV infection is highly correlated with age. Moreover, the dependence on age is nonmonotonic, as the exposure to HPV increases from late teens to mid-twenties and then decreases as women get older, with a possible slight increase in risk in early middle-age.…”