Risk of first cervical HPV infection and pre-cancerous lesions after onset of sexual activity: analysis of women in the control arm of the randomized, controlled PATRICIA trial

Abstract

BackgroundMore information is needed about time between sexual initiation and human papillomavirus (HPV) infection and development of cervical precancer.MethodsThe objectives were to investigate the time between first sexual activity and detection of first cervical HPV infection or development of first cervical intraepithelial neoplasia (CIN), and associated factors in women from the double-blind, multinational, 4-year PATRICIA trial. PATRICIA enroled women aged 15-25 years with no more than 6 lifetime sexual partners. Women were randomized 1:1 to the HPV-16/18 AS04-adjuvanted vaccine or to control, but only women from the control arm who began sexual intercourse during the study or within 6 months before enrolment, and had no HPV infection detected before the recorded date of their first sexual intercourse, were included in the present analysis. The time between onset of sexual activity and detection of the first cervical HPV infection or development of the first CIN lesion was analyzed using Kaplan-Meier and univariate and multivariable Cox proportional-hazards models.ResultsA total of 9337 women were enroled in the control arm of PATRICIA of whom 982 fulfilled the required inclusion criteria for analysis. A cumulative total of 28%, 44%, and 62% of the subjects had HPV infection within 12, 24, and 48 months, respectively. The overall incidence rate was 27.08 per 100 person-years. The most common oncogenic types associated with 6-month persistent infection were HPV-16 (incidence rate: 2.74 per 100 person-years), HPV-51 (2.70), HPV-52 (1.66), HPV-66 (1.14), and HPV-18 (1.09). Increased infection risk was associated with more lifetime sexual partners, being single, Chlamydia trachomatis history, and duration of hormone use. CIN1+ and CIN2+ lesions were most commonly associated with HPV-16, with an overall incidence rate of 1.87 and 1.07 per 100 person-years, respectively. Previous cervical HPV infection was most strongly associated with CIN development.ConclusionsMore than 25% of women were infected with HPV within 1 year of beginning sexual activity. Without underestimating the value of vaccination at older ages, our findings emphasize its importance before sexual initiation.Trial registrationclinicaltrials.gov: NCT00122681.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0551-y) contains supplementary material, which is available to authorized users.

MMP-9/RECK Imbalance: A Mechanism Associated with High-Grade Cervical Lesions and Genital Infection by Human Papillomavirus and Chlamydia trachomatis

“…Our data are in agreement with the literature, once sexual precocity is known to increase susceptibility to the first HPV infection, as well as exposure to the carcinogenic effects of HPV, which is associated with higher risk of CIN3 (35,36,40). On the other hand, CIN1 is associated to recent acquisition of HPV infection, regardless of the age of first sexual intercourse (36).…”

“…In addition to genital infections, behavior and physiologic characteristics such as smoking, parity, oral contraceptives, alcohol, and age at first sexual intercourse have been described as factors that influence acquisition of HPV and development of neoplastic lesion (35)(36)(37)(38). In this context, we found a higher frequency of smoking patients in the study group when compared with the control group.…”

The main predictors of human papillomavirus infection in couples

“…Для оценки сексуальной активности мы проана-лизировали количество половых партнеров, считаю-щееся одним из ключевых факторов заражения ВПЧ [1,3,11]. Результаты представлены на рис.…”

“…1). Наличие хронических соматических заболева-ний, как правило, сопровождается девиациями им-мунной реактивности организма и может изменять иммунный ответ на антигены вирусной ДНК, облег-чая репликацию и способствуя развитию ПВИ [5,11,15]. В связи с этим мы провели ретроспективный анализ указанных в анамнезе соматических заболе-ваний половых партнеров в постоянных парах, ин-фицированных ВПЧ (табл.…”

“…За период наблюдения женщины имели до шести половых партнеров, а инфицирование ПВИ происходило относительно быстро после пер-вого полового контакта, и самые ранние случаи за-ражения онкогенными типами ВПЧ были зафикси-рованы в течение 2-3 нед от момента начала сексу-альной жизни, а при продолжении контактов веро-ятность инфицирования увеличивалась. В общей сложности 28, 44 и 62% испытуемых женщин име-ли инфекцию, вызванную высокоонкогенными ти-пами ВПЧ, в течение 12, 24 и 48 мес соответственно, а первые проявления ЦИН среди сексуально актив-ных женщин определялись уже через 6 мес [11]. До-казательства влияния мужского фактора и в разви-тии цервикальной неоплазии, в том числе рака шей-ки матки, приводят и другие авторы [1,2,9].…”