Prospective follow‐up of 2,065 young unscreened women to study human papillomavirus incidence and clearance

Abstract

Human papillomavirus (HPV) is a necessary factor in the development of cervical intraepithelial neoplasia and cervical cancer. However, HPV is also a very common sexually transmitted virus and many women clear their infection. To study HPV incidence and clearance, 2,065 women, aged 18-29 years, were followed for 12 months and were asked to provide a self-collected cervicovaginal sample and fill-out a questionnaire every 3 months. For HPV DNA detection, the SPF 10 -DEIA LiPA 25 system was used. Incidence rates of any-type high-risk HPV and low-risk HPV were 17.0 per 1,000-person months, and 14.3 per 1,000-person months, respectively. HPV types 16, 52, 51 and 31 had the highest type-specific incidence rates. HPV incidence was increased in singles, and women having a new relationship. A higher number of lifetime sex partners, and a higher frequency of sexual contacts in the past 3 months was associated with an increased HPV incidence. The overall clearance of the newly detected typespecific high-risk HPV infections and low-risk HPV infections was 61.2% and 69.0%, respectively. Having a sexual relationship compared to being single, and a higher sexual age both positively influenced the clearance of any-type high-risk HPV. Among the women infected with HPV 16, the women who had a co-infection had a lower proportion of clearance of HPV 16. In conclusion, in this young Dutch study population, HPV incidence rates are not related to age and comparable to other western countries. Clearance was only independently related to factors associated with sexual behavior, either past or current.It is generally accepted that a persistent human papillomavirus (HPV) infection is the necessary cause of cervical cancer. Acquisition of an HPV infection is therefore the main precursor of the series of events that eventually lead to cervical cancer.1-4 Fortunately, most of the acquired HPV infections are transient and clear spontaneously within 12 months after first detection, and about 90% of the women will have cleared their HPV infection within 24 months. [5][6][7][8][9][10][11][12][13] HPV is a very common sexually transmitted virus, mainly acquired early in sexual life.14,15 Rates of acquiring an HPV infection are high following first sexual intercourse, and with each new sexual partner. 7,16,17 The risk factors associated with acquiring an HPV infection are therefore mainly related to the individuals sexual behavior. 18HPV prevalence, however, is not only influenced by sexual activity but also varies by age and geography, as shown by the International Agency for Research on Cancer (IARC) and others. [19][20][21] Young women have high rates of HPV acquisition, and incidence tends to decline with age. 10,17,22,23 Whether age is also related to the duration of the infection remains controversial. Some studies report that there is no influence of age on the clearance rate of the HPV infection. 10,24,25 Whereas other studies report a lower clearance rate with increasing age, 26,27 or in contrary a faster clearance rate in older women (>4...

Incidence and duration of type-specific human papillomavirus infection in high-risk HPV-naïve women: results from the control arm of a phase II HPV-16/18 vaccine trial

“…The agreement between self-collected and clinician-collected samples for the detection of HPV DNA was reasonably good in this study population, that is, 85% of positive tests were observed when both samples were available, that is, 6, 12 and 18 months. The incidence rate we observed for HR-HPV infections was essentially the same as that seen in a population of Dutch women of comparable age,27 although the latter study observed a higher rate (14.3/1000 women-months, 95% CI 12.8 to 15.9) of LR-HPVs than we did in the present study (6.9 per 1000 women-months).…”

Comparison of Human Papillomavirus Infection and Cervical Cytology in Women Using Copper-Containing and Levonorgestrel-Containing Intrauterine Devices

“…A prospective study of 2,065 women found a 61% spontaneous resolution rate for high-risk HPV infection within a 12-month time period. 22 This is lower than the 70% clearance demonstrated in users of the copper-containing IUD in our study; however, the difference is not statistically significant (P5.17). The 42% (95% CI 25.9-58.1%) of patients who demonstrated high-risk HPV clearance in the levonorgestrel IUD group appears significantly lower than the expected spontaneous regression of 61% (95% CI 55-67%) seen in the mentioned cohort (P5.03).…”

“…22 However, our findings should be taken cautiously, because as a result of the retrospective nature of our research, it is only hypothesis-generating, and larger prospective studies are necessary to confirm our findings.…”

“…Additionally, information about sexual practices and number of sexual partnersknown risk factors for cervical dysplasia and HPV infection 5,26 -was not available. We realize that addition of a control group (patients without IUD) would strengthen our study; however, given the mentioned weaknesses, we believe that a large prospective cohort 22 probably determined the proportion of natural high-risk HPV infection clearance more accurately than our retrospective cohort would.…”

Rates and determinants of incidence and clearance of cervical HPV genotypes among HIV-seropositive women in Pune, India

“…The clearance rates observed in our study was significantly lower than reported in studies (68.3 to 80.7%) among HIV-seronegative women. 4,22–25 However previous studies amongst HIV-seropositive women have reported HPV clearance rates that are comparable 16 , higher 4,8,23,26 and even lower 19 than ours. As reported in earlier studies, we too observed lower clearance rates in women having infection with carcinogenic HPV types especially the alpha-9 species, compared to the clearance rate among carcinogenic HPV types.…”