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Arthur AW, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Detection and Clearance of Type-Specific and Phylogenetically Related Genital Human Papillomavirus Infections in Young Women in New Heterosexual Relationships. J Infect Dis 2024; 229:691-706. [PMID: 37824429 PMCID: PMC10938200 DOI: 10.1093/infdis/jiad450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Understanding the natural history of human papillomavirus (HPV) infections is essential to cervical cancer prevention planning. We estimated HPV type-specific infection detection and clearance in young women. METHODS The HPV Infection and Transmission among Couples through Heterosexual activity (HITCH) study is a prospective cohort of 502 college-age women who recently initiated a heterosexual relationship. We tested vaginal samples collected at 6 clinical visits over 24 months for 36 HPV types. Using rates and Kaplan-Meier analysis, we estimated time-to-event statistics with 95% confidence intervals (CIs) for detection of incident infections and clearance of incident and present-at-baseline infections (separately). We conducted analyses at the woman- and HPV-levels, with HPV types grouped by phylogenetic relatedness. RESULTS By 24 months, we detected incident infections in 40.4% (CI, 33.4%-48.4%) of women. Incident subgenus 1 (43.4; CI, 33.6-56.4), 2 (47.1; CI, 39.9-55.5), and 3 (46.6; CI, 37.7-57.7) infections cleared at similar rates per 1000 infection-months. We observed similar homogeny in HPV-level clearance rates among present-at-baseline infections. CONCLUSIONS Our analyses provide type-specific infection natural history estimates for cervical cancer prevention planning. HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections persist longer than their low oncogenic risk subgenera 1 and 3 counterparts.
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Affiliation(s)
- Andrew W Arthur
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St.Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - François Coutlée
- Département Clinique de Médecine de Laboratoire, Service de Diagnostique Moléculaire, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
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2
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Soumya D, Meenakshi K, Nagaraja M, Rishi Gowtham R, Umapathi N, Madhavi Latha PM, Padmalatha AM, Prakash P, Kalawat U. Detection of Chlamydia trachomatis and Herpes Simplex Virus-2 Infections Among Clinically Suspected Women with Cervical Cancer or Precancerous Lesions. Indian J Gynecol Oncolog 2023; 21:27. [DOI: 10.1007/s40944-022-00704-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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3
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Arthur AW, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Detection and clearance of type-specific and phylogenetically related genital human papillomavirus infections in young women in new heterosexual relationships. medRxiv 2023:2023.02.24.23286387. [PMID: 36865299 PMCID: PMC9980228 DOI: 10.1101/2023.02.24.23286387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Understanding the natural history of human papillomavirus (HPV) infections is essential to effective cervical cancer prevention planning. We examined these outcomes in-depth among young women. Methods The HPV Infection and Transmission among Couples through Heterosexual Activity (HITCH) study is a prospective cohort of 501 college-age women who recently initiated a heterosexual relationship. We tested vaginal samples collected at six clinical visits over 24 months for 36 HPV types. Using rates and Kaplan-Meier analysis, we estimated time-to-event statistics with 95% confidence intervals (CIs) for detection of incident infections and liberal clearance of incident and present-at-baseline infections (separately). We conducted analyses at the woman- and HPV-levels, with HPV types grouped by phylogenetic relatedness. Results By 24 months, we detected incident infections in 40.4%, CI:33.4-48.4 of women. Incident subgenus 1 (43.4, CI:33.6-56.4), 2 (47.1, CI:39.9-55.5) and 3 (46.6, CI:37.7-57.7) infections cleared at similar rates per 1000 infection-months. We observed similar homogeny in HPV-level clearance rates among present-at-baseline infections. Conclusions Our woman-level analyses of infection detection and clearance agreed with similar studies. However, our HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections take longer to clear than their low oncogenic risk and commensal subgenera 1 and 3 counterparts.
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Affiliation(s)
- Andrew W Arthur
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Pierre-Paul Tellier
- Department of Family Medicine, McGill University, Montréal, Québec, H3S 1Z1, Canada
| | - Francois Coutlée
- Départements de Clinique de Médecine de Laboratoire et de Médecine, Services de Biologie Moléculaire et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, H2X 0C1, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
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Rodrigues R, Sousa C, Vale N. Chlamydia trachomatis as a Current Health Problem: Challenges and Opportunities. Diagnostics (Basel) 2022; 12:1795. [PMID: 35892506 PMCID: PMC9331119 DOI: 10.3390/diagnostics12081795] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Chlamydia is one of the most common sexually transmitted bacterial infections (STIs) worldwide. It is caused by Chlamydia trachomatis (CT), which is an obligate intracellular bacterium. In some cases, it can occur in coinfection with other parasites, increasing the pathologic potential of the infection. The treatment is based on antibiotic prescription; notwithstanding, the infection is mostly asymptomatic, which increases the risk of transmission. Therefore, some countries have implemented Chlamydia Screening Programs in order to detect undiagnosed infections. However, in Portugal, there is no CT screening plan within the National Health Service. There is no awareness in the general healthcare about the true magnitude of this issue because most of the methods used are not Nucleic Acid Amplification Technology-based and, therefore, lack sensitivity, resulting in underreporting infection cases. CT infections are also associated with possible long-term severe injuries. In detail, persistent infection triggers an inflammatory milieu and can be related to severe sequels, such as infertility. This infection could also trigger gynecologic tumors in women, evidencing the urgent need for cost-effective screening programs worldwide in order to detect and treat these individuals adequately. In this review, we have focused on the success of an implemented screening program that has been reported in the literature, the efforts made concerning the vaccine discovery, and what is known regarding CT infection. This review supports the need for further fundamental studies in this area in order to eradicate this infection and we also suggest the implementation of a Chlamydia Screening Program in Portugal.
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Ntuli L, Mtshali A, Mzobe G, Liebenberg LJP, Ngcapu S. Role of Immunity and Vaginal Microbiome in Clearance and Persistence of Human Papillomavirus Infection. Front Cell Infect Microbiol 2022; 12:927131. [PMID: 35873158 PMCID: PMC9301195 DOI: 10.3389/fcimb.2022.927131] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/14/2022] [Indexed: 12/02/2022] Open
Abstract
Cervical cancer disproportionately affects women of reproductive age, with 80% of cases occurring in low- and middle-income countries. Persistent infection with high-risk human papillomavirus (HPV) genotypes has been described as the most common non-systemic biological risk factor for the development of cervical cancer. The mucosal immune system plays a significant role in controlling HPV infection by acting as the first line of host defense at the mucosal surface. However, the virus can evade host immunity using various mechanisms, including inhibition of the antiviral immune response necessary for HPV clearance. Pro-inflammatory cytokines and the vaginal microbiome coordinate cell-mediated immune responses and play a pivotal role in modulating immunity. Recently, diverse vaginal microbiome (associated with bacterial vaginosis) and genital inflammation have emerged as potential drivers of high-risk HPV positivity and disease severity in women. The potential role of these risk factors on HPV recurrence and persistence remains unclear. This article reviews the role of cellular or cytokine response and vaginal microbiome dysbiosis in the clearance, persistence, and recurrence of HPV infection.
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Affiliation(s)
- Lungelo Ntuli
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Andile Mtshali
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Gugulethu Mzobe
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Lenine JP Liebenberg
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Sinaye Ngcapu
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- *Correspondence: Sinaye Ngcapu,
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Prasad SK, Bhat S, Shashank D, C R A, R S, Rachtanapun P, Devegowda D, Santhekadur PK, Sommano SR. Bacteria-Mediated Oncogenesis and the Underlying Molecular Intricacies: What We Know So Far. Front Oncol 2022; 12:836004. [PMID: 35480118 PMCID: PMC9036991 DOI: 10.3389/fonc.2022.836004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/22/2022] [Indexed: 01/10/2023] Open
Abstract
Cancers are known to have multifactorial etiology. Certain bacteria and viruses are proven carcinogens. Lately, there has been in-depth research investigating carcinogenic capabilities of some bacteria. Reports indicate that chronic inflammation and harmful bacterial metabolites to be strong promoters of neoplasticity. Helicobacter pylori-induced gastric adenocarcinoma is the best illustration of the chronic inflammation paradigm of oncogenesis. Chronic inflammation, which produces excessive reactive oxygen species (ROS) is hypothesized to cause cancerous cell proliferation. Other possible bacteria-dependent mechanisms and virulence factors have also been suspected of playing a vital role in the bacteria-induced-cancer(s). Numerous attempts have been made to explore and establish the possible relationship between the two. With the growing concerns on anti-microbial resistance and over-dependence of mankind on antibiotics to treat bacterial infections, it must be deemed critical to understand and identify carcinogenic bacteria, to establish their role in causing cancer.
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Affiliation(s)
- Shashanka K Prasad
- Department of Biotechnology and Bioinformatics, Faculty of Life Sciences, Jagadguru Sri Shivarathreeshwara (JSS) Academy of Higher Education and Research (JSSAHER), Mysuru, India
| | - Smitha Bhat
- Department of Biotechnology and Bioinformatics, Faculty of Life Sciences, Jagadguru Sri Shivarathreeshwara (JSS) Academy of Higher Education and Research (JSSAHER), Mysuru, India
| | - Dharini Shashank
- Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, Mandya, India
| | - Akshatha C R
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sindhu R
- Department of Microbiology, Faculty of Life Sciences, Jagadguru Sri Shivarathreeshwara (JSS) Academy of Higher Education and Research (JSSAHER), Mysuru, India
| | - Pornchai Rachtanapun
- School of Agro-Industry, Faculty of Agro-Industry, Chiang Mai University, Chiang Mai, Thailand.,Cluster of Agro Bio-Circular-Green Industry (Agro BCG), Chiang Mai University, Chiang Mai, Thailand
| | - Devananda Devegowda
- Centre of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, India
| | - Prasanna K Santhekadur
- Centre of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, India
| | - Sarana Rose Sommano
- Cluster of Agro Bio-Circular-Green Industry (Agro BCG), Chiang Mai University, Chiang Mai, Thailand.,Department of Plant and Soil Sciences, Faculty of Agriculture, Chiang Mai University, Chiang Mai, Thailand
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Zhang L, Tan W, Yang H, Zhang S, Dai Y. Detection of Host Cell Gene/HPV DNA Methylation Markers: A Promising Triage Approach for Cervical Cancer. Front Oncol 2022; 12:831949. [PMID: 35402283 PMCID: PMC8990922 DOI: 10.3389/fonc.2022.831949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer is the most prevalent gynecologic malignancy, especially in women of low- and middle-income countries (LMICs). With a better understanding of the etiology and pathogenesis of cervical cancer, it has been well accepted that this type of cancer can be prevented and treated via early screening. Due to its higher sensitivity than cytology to identify precursor lesions of cervical cancer, detection of high-risk human papillomavirus (HR-HPV) DNA has been implemented as the primary screening approach. However, a high referral rate for colposcopy after HR-HPV DNA detection due to its low specificity in HR-HPV screening often leads to overtreatment and thus increases the healthcare burden. Emerging evidence has demonstrated that detection of host cell gene and/or HPV DNA methylation represents a promising approach for the early triage of cervical cancer in HR-HPV-positive women owing to its convenience and comparable performance to cytology, particularly in LMICs with limited healthcare resources. While numerous potential markers involving DNA methylation of host cell genes and the HPV genome have been identified thus far, it is crucial to define which genes or panels involving host and/or HPV are feasible and appropriate for large-scale screening and triage. An ideal approach for screening and triage of CIN/ICC requires high sensitivity and adequate specificity and is suitable for self-sampling and inexpensive to allow population-based screening, particularly in LMICs. In this review, we summarize the markers of host cell gene/HR-HPV DNA methylation and discuss their triage performance and feasibility for high-grade precancerous cervical intraepithelial neoplasia or worse (CIN2+ and CIN3+) in HR-HPV-positive women.
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Affiliation(s)
- Lingyi Zhang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China.,Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Wenxi Tan
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Hongmei Yang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China.,Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Songling Zhang
- Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Changchun, China
| | - Yun Dai
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
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Abstract
The risk of HIV acquisition is low on a per-contact basis but increased by transmission co-factors such as other sexually transmitted infections (STIs). Human papillomavirus (HPV) is a prevalent STI that most individuals will acquire HPV in their lifetime. Current HPV vaccines can prevent newly acquired infections, but are largely ineffective against established HPV, complicating worldwide eradication efforts. In addition to being the causative agent of cervical cancer, accumulating evidence suggests that HPV infection and/or accompanying cervical inflammation increase the risk of HIV infection in men and women. The fact that immunological features observed during HPV infection overlap with cellular and molecular pathways known to enhance HIV susceptibility underscore the potential interplay between these two viral infections that fuel their mutual spread. Here we review current insights into how HPV infection and the generation of anti-HPV immunity contribute to higher HIV transmission rates, and the impact of HPV on mucosal inflammation, immune cell trafficking, and epithelial barrier function.
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Affiliation(s)
- Romaniya Zayats
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas T. Murooka
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Thomas T. Murooka, ; Lyle R. McKinnon,
| | - Lyle R. McKinnon
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- *Correspondence: Thomas T. Murooka, ; Lyle R. McKinnon,
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Yao X, Chen W, Zhao C, Wei L, Hu Y, Li M, Lin Z, Lin B, Liu X, Hong Y, Li Q, Pan Q, Zhang X, Li M, Zhao Y, Zhang L, Xu H, Hu F, Zhao J, Huang Y, Sheng W, Zheng Y, Hu S, Su Y, Huang S, Pan H, Zhao F, Qiao Y, Wu T, Zhang J, Xia N. Naturally acquired HPV antibodies against subsequent homotypic infection: A large-scale prospective cohort study. Lancet Reg Health West Pac 2021; 13:100196. [PMID: 34527987 PMCID: PMC8403914 DOI: 10.1016/j.lanwpc.2021.100196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/30/2021] [Accepted: 06/06/2021] [Indexed: 11/23/2022]
Abstract
Background Although recent studies have suggested that naturally acquired Human papillomavirus (HPV) antibodies are partly protective against subsequent homotypic infection, the extent of protection remains indecisive. Here, we evaluate the protective effect of neutralizing and IgG antibodies simultaneously. Methods In a cohort of 3634 women aged 18-45 years from the control arm of a phase III trial of the HPV-16/18 bivalent vaccine, participants were tested for neutralizing antibodies by pseudovirion-based neutralization assay (PBNA) and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) at baseline. HPV-16/18 incident and persistent infections were identified using cervical specimens periodically collected during the 5·5 years of follow-up. The protective effects of HPV-16/18 neutralizing and IgG antibodies against homotypic infection were assessed using a Cox proportional hazard model. Findings For the persistent infection (PI) endpoints of HPV-16/18 lasting for over 6/12 months, a prevalence of type-specific neutralizing antibodies was highly protective (6-month PI: hazard ratio (HR) = 0·16, 95% confidence interval (CI): 0·04, 0·65; 12-month PI: HR = 0·23, 95% CI: 0·06, 0·94), whereas a prevalence of IgG antibodies was associated with minor and non-significant protection (6-month PI: HR = 0·66, 95% CI: 0·40, 1·09; 12-month PI: HR = 0·66, 95% CI: 0·36, 1·20). After increasing the cut-off value to the median IgG level, the risk of 6-month PI was significantly lower in seropositive vs seronegative women (HR = 0·38, 95% CI: 0·18, 0·83). Interpretation Naturally acquired antibodies are associated with a substantially reduced risk of subsequent homotypic infection. Funding NSFC; The Fujian Province Health Education Joint Research Project; Xiamen Science and Technology Major Project; CIFMS; and Xiamen Innovax.
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Affiliation(s)
- Xingmei Yao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Wen Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Zhao
- Peking University People's Hospital, Beijing, China
| | - Lihui Wei
- Peking University People's Hospital, Beijing, China
| | - Yuemei Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Mingqiang Li
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Zhijie Lin
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Bizhen Lin
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Xiaohui Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ying Hong
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Qing Li
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Qinjing Pan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xun Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingzhu Li
- Peking University People's Hospital, Beijing, China
| | - Yuqian Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huifang Xu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fangfang Hu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yue Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Wei Sheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ya Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shangying Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingying Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shoujie Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Huirong Pan
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Fanghui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youlin Qiao
- Chinese Academy of Medical Sciences/Peking Union Medical College School of Population Medicine and Public Health, Beijing, China
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China.,The Research Unit of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen, Fujian, China
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Vyankandondera J, Wambua S, Irungu E, Mandaliya K, Temmerman M, Ryan C, Mohamed Y, Vanden Broeck D, Verhelst R, Chersich MF, Luchters S. Type-Specific Human Papillomavirus Prevalence, Incident Cases, Persistence, and Associated Pregnancy Outcomes Among HIV-Infected Women in Kenya. Sex Transm Dis 2019; 46:532-9. [PMID: 31295222 DOI: 10.1097/OLQ.0000000000001029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Persistent infection with high-risk types of human papillomavirus (HPV) is the preeminent factor driving the development of cervical cancer. There are large gaps in knowledge about both the role of pregnancy in the natural history of HPV infection and the impact of HPV on pregnancy outcomes. METHODS This single-site prospective cohort substudy, nested within an international multisite randomized controlled trial, assessed prevalence, incident cases, and persistence of type-specific HPV infection, and the association between persistence of high-risk HPV infection with pregnancy outcomes among HIV-infected pregnant women in Kenya, including HIV transmission to infants. Type-specific HPV was assessed using a line probe assay in pregnancy and again at 3 months after delivery. HIV status of children was determined using polymerase chain reaction at 6 weeks. RESULTS In total, 84.1% (206/245) of women had a high-risk HPV infection at enrollment. Three quarters (157/206) of these infections persisted postpartum. Persistence of HPV16 and/or HPV18 types was observed in more than half (53.4%; 39/73) of women with this infection at enrollment. Almost two-thirds had an incident high-risk HPV infection postpartum, which was not present in pregnancy (62.5%), most commonly HPV52 (19.0%). After adjustments, no association was detected between persistent high-risk HPV and preterm birth. All mothers of the 7 cases of infant HIV infection had persistent high-risk HPV infection (P = 0.044). CONCLUSIONS High levels of high-risk HPV infection and type-specific persistence were documented, heightening the urgency of mass role out of HPV vaccination. The association between HPV persistence and HIV transmission is a novel finding, warranting further study.
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11
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Jongen VW, van Santen DK, Alberts CJ, Schim van der Loeff MF. Estimating incidence rates of grouped HPV types: A systematic review and comparison of the impact of different epidemiological assumptions. Papillomavirus Res 2019; 8:100187. [PMID: 31600572 PMCID: PMC6804437 DOI: 10.1016/j.pvr.2019.100187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Some studies on human papillomavirus (HPV) provide not only type-specific incidence rates (IR), but also IRs of HPV groupings (e.g. the nonavalent grouping). We made an inventory of the different approaches used to calculate such IRs and assessed their impact on the estimated IRs of HPV groupings. METHODS We performed a systematic review assessing all approaches used in literature to estimate IRs. Subsequently we applied these approaches to data of a Dutch cohort study on HPV in men who have sex with men (H2M). IRs were estimated for six different HPV groupings. RESULTS The systematic review yielded six different approaches (A-F) for estimating the IRs, varying in exclusion criteria at baseline, and the definitions of an incident event and person-time. Applying these approaches to the H2M dataset (n = 749), we found differences in the number of participants at risk, number of incidents events, person-time, and IR. For example, for the nonavalent grouping, depending on the approach chosen, the IR varied between 3.09 and 6.54 per 100 person-months. CONCLUSION In published studies different epidemiological assumptions are used to estimate IRs of grouped HPV types, leading to widely differing estimates of IRs. IRs between different studies may therefore not be comparable.
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Affiliation(s)
- Vita W Jongen
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Daniëla K van Santen
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Catharina J Alberts
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands; International Agency for Research on Cancer, Lyon, France
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Univ of Amsterdam, Internal Medicine, Amsterdam Infection & Immunity Institute (AIII), Amsterdam, Netherlands.
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12
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Wheeler BS, Rositch AF, Poole C, Taylor SM, Smith JS. Patterns of incident genital human papillomavirus infection in women: A literature review and meta-analysis. Int J STD AIDS 2019; 30:1246-1256. [PMID: 31640474 DOI: 10.1177/0956462418824441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human papillomavirus (HPV) infection acquisition is a necessary step in the development of cervical cancer. No study has systematically quantified the rate of newly acquired HPV infections from the published literature and determined its relationship with age. We performed a systematic review and meta-analysis to describe incident HPV infections in women. Medline® and Thomson Reuters Web of Science via PubMed® databases were searched. A total of 46 of 5136 studies met inclusion criteria and contributed results. We conducted a meta-regression analysis of 13 studies, which reported incidence rate estimates on over 13 high-risk HPV types, to provide pooled stratum-specific incidence rates and rate ratios for key population and study characteristics among 8488 women. Studies with mean age < 30 years had relatively higher HPV incidence rates compared to studies with mean age ≥30 years: relative risk = 3.12; 95% CI: 1.41–6.93. HPV-16 was most frequently detected, followed by HPV-18: relative risk = 0.47; 95% CI: 0.33–0.67, and by HPV-58: relative risk = 0.45; 95% CI: 0.27–0.74. Younger age is a key predictor of genital HPV incidence in women. These data on the relative distribution of incident HPV infections will provide a baseline comparison for monitoring of changes in HPV incidence following the implementation of population-level HPV vaccination.
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Affiliation(s)
- Bradford S Wheeler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,SALineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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13
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Pamnani SJ, Sudenga SL, Rollison DE, Ingles DJ, Abrahamsen M, Villa LL, Lazcano-Ponce E, Huang Y, Borenstein A, Giuliano AR. Recurrence of Genital Infections With 9 Human Papillomavirus (HPV) Vaccine Types (6, 11, 16, 18, 31, 33, 45, 52, and 58) Among Men in the HPV Infection in Men (HIM) Study. J Infect Dis 2019; 218:1219-1227. [PMID: 29800222 DOI: 10.1093/infdis/jiy300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/21/2018] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this study was to assess genital recurrence of human papillomavirus (HPV) genotypes included in the 9-valent vaccine and to investigate factors associated with recurrence among men in the HPV Infection in Men (HIM) Study. Methods Men were followed every 6 months for a median of 3.7 years. HPV genotypes were detected using Roche linear array. Factors associated with type-specific HPV recurrence (infections occurring after a ≥12-month infection-free period) were assessed. Results In type-specific analyses, 31% of prior prevalent and 20% of prior incident infections recurred. Among prevalent infections, HPV types 52, 45, 16, 58, and 6 and among incident infections, HPV types 58, 52, 18, 16, and 11 had the highest rates of recurrence. New sexual partners (male or female) and frequency of sexual intercourse with female partners were associated with HPV-6, -16, -31, and -58 infection recurrence. In grouped analyses, lifetime and new male sexual partners were associated with recurrence of prior incident infection with any of the 9 HPV types. Conclusions Recurrence of genital HPV infections is relatively common among men and associated with high-risk sexual behavior. Further studies are needed to understand the role of HPV recurrence in the etiology of HPV-associated diseases.
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Affiliation(s)
| | - Staci L Sudenga
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Epidemiology, Vanderbilt University Medical Center, Tennessee
| | - Dana E Rollison
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Nashville, Tennessee
| | - Martha Abrahamsen
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Eduardo Lazcano-Ponce
- School of Medicine, University of São Paulo, Brazil.,Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Yangxin Huang
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa
| | - Amy Borenstein
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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14
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Safaeian M, Castellsagué X, Hildesheim A, Wacholder S, Schiffman MH, Bozonnat MC, Baril L, Rosillon D. Risk of HPV-16/18 Infections and Associated Cervical Abnormalities in Women Seropositive for Naturally Acquired Antibodies: Pooled Analysis Based on Control Arms of Two Large Clinical Trials. J Infect Dis 2019; 218:84-94. [PMID: 29718393 DOI: 10.1093/infdis/jiy112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/11/2018] [Indexed: 11/12/2022] Open
Abstract
Background Studies on the role of antibodies produced after infection with human papillomavirus 18 (HPV-18) and subsequent protection from HPV-18 infection have been conflicting, mainly due to inadequate sample size. Methods We pooled data from the control arms of the Costa Rica Vaccine Trial and the PATRICIA trial. Using Poisson regression we compared the risk of newly detected 1-time HPV-18 infection, HPV-18 1-year persistent infection (12MPI), and HPV-18-associated atypical squamous cells of undetermined significance or greater (ASC-US+) lesions between HPV-18 seropositive and seronegative women. Results High HPV-18 antibodies at enrollment was associated with reduced subsequent HPV-18 detection (P trend = 0.001; relative rate [RR] = 0.69; 95% confidence interval [CI], 0.47-1.01 for the third quartile; RR = 0.63; 95% CI, 0.43-0.94 for the fourth quartile, compared to seronegative). The risk of 12MPI showed a decreasing trend with increasing antibodies (P trend = 0.06; RR = 0.72; 95% CI, 0.29-1.77; RR = 0.42; 95% CI, 0.13-1.32 for the third and fourth quartiles, respectively). Lastly, we observed a significant decreased risk of HPV-18 ASC-US+ with increasing antibody (P trend = 0.01; RR = 0.46; 95% CI, 0.21-0.97 for the fourth quartile). We also observed a significant decreased risk of HPV-16 infection, 12MPI, and ASC-US+ with increasing HPV-16 antibody level. Conclusions High HPV-18 naturally acquired antibodies were associated with partial protection from future HPV-18 infections and associated lesions. Clinical Trials Registration NCT00128661 and NCT001226810.
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Affiliation(s)
- Mahboobeh Safaeian
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Xavier Castellsagué
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain.,Centros de Investigación Biomédica en Red, Epidemiología y Salud Pública, Madrid, Spain
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sholom Wacholder
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark H Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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15
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Rosillon D, Baril L, Del Rosario-Raymundo MR, Wheeler CM, Skinner SR, Garland SM, Salmeron J, Lazcano-Ponce E, Vallejos CS, Stoney T, Ter Harmsel B, Lim TYK, Quek SC, Minkina G, McNeil SA, Bouchard C, Fong KL, Money D, Ilancheran A, Savicheva A, Cruickshank M, Chatterjee A, Fiander A, Martens M, Bozonnat MC, Struyf F, Dubin G, Castellsagué X. Risk of newly detected infections and cervical abnormalities in adult women seropositive or seronegative for naturally acquired HPV-16/18 antibodies. Cancer Med 2019; 8:4938-4953. [PMID: 31273942 PMCID: PMC6712465 DOI: 10.1002/cam4.1879] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infections with human papillomavirus (HPV) types 16 and 18 account for ~70% of invasive cervical cancers but the degree of protection from naturally acquired anti-HPV antibodies is uncertain. We examined the risk of HPV infections as defined by HPV DNA detection and cervical abnormalities among women >25 years in the Human Papilloma VIrus Vaccine Immunogenicity ANd Efficacy trial's (VIVIANE, NCT00294047) control arm. METHODS Serum anti-HPV-16/18 antibodies were determined at baseline and every 12 months in baseline DNA-negative women (N = 2687 for HPV-16 and 2705 for HPV-18) by enzyme-linked immunosorbent assay (ELISA) from blood samples. HPV infections were identified by polymerase chain reaction (PCR) every 6-months, and cervical abnormalities were confirmed by cytology every 12 months. Data were collected over a 7-year period. The association between the risk of type-specific infection and cervical abnormalities and serostatus was assessed using Cox proportional hazard models. RESULTS Risk of newly detected HPV-16-associated 6-month persistent infections (PI) (hazard ratio [HR] = 0.56 [95%CI:0.32; 0.99]) and atypical squamous cells of undetermined significance (ASC-US+) (HR = 0.28 [0.12; 0.67]) were significantly lower in baseline seropositive vs baseline seronegative women. HPV-16-associated incident infections (HR = 0.81 [0.56; 1.16]) and 12-month PI (HR = 0.53 [0.24; 1.16]) showed the same trend. A similar trend of lower risk was observed in HPV-18-seropositive vs -seronegative women (HR = 0.95 [0.59; 1.51] for IIs, HR = 0.43 [0.16; 1.13] for 6-month PIs, HR = 0.31 [0.07; 1.36] for 12-month PIs, and HR = 0.61 [0.23; 1.61] for ASC-US+). CONCLUSIONS Naturally acquired anti-HPV-16 antibodies were associated with a decreased risk of subsequent infection and cervical abnormalities in women >25 years. This possible protection was lower than that previously reported in 15- to 25-year-old women.
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Affiliation(s)
| | | | | | | | - Susan Rachel Skinner
- Vaccines Trials Group, Telethon Kids Institute, Perth, Western Australia, Australia.,Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Suzanne Marie Garland
- The Royal Women's Hospital, The Royal Children's Hospital, Murdoch Childrens Research Institute, University of Melbourne, Parkville, Victoria, Australia
| | | | | | | | - Tanya Stoney
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Bram Ter Harmsel
- Department of Gynecology, Roosevelt Kliniek, Leiden, Delft, The Netherlands
| | | | - Swee Chong Quek
- ASC Clinic for Women, Gleneagles Hospital, Singapore City, Singapore
| | | | - Shelly Ann McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Celine Bouchard
- Clinique de Recherche en Santé des Femmes, Québec City, Québec, Canada
| | - Kah Leng Fong
- Singapore General Hospital, Singapore City, Singapore
| | - Deborah Money
- The Women's Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arunachalam Ilancheran
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Alevtina Savicheva
- Laboratory of Microbiology, DO Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia
| | - Margaret Cruickshank
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, NHS Grampian, Scotland, UK
| | - Archana Chatterjee
- Department of Pediatrics, University of South Dakota Sanford School of Medicine/Sanford Children's Specialty Clinic, Sioux Falls, South Dakota
| | - Alison Fiander
- Leading Safe Choices Programme, Royal College of Obstetricians and Gynaecologists, London, UK
| | | | | | | | | | - Xavier Castellsagué
- Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain
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16
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Thomson NA, Howe L, Weidgraaf K, Thomas DG, Young V, Ward VK, Munday JS. Felis catus papillomavirus type 2 virus-like particle vaccine is safe and immunogenic but does not reduce FcaPV-2 viral loads in adult cats. Vet Immunol Immunopathol 2019; 213:109888. [PMID: 31307673 DOI: 10.1016/j.vetimm.2019.109888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/04/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
Felis catus papillomavirus type 2 (FcaPV-2) commonly infects the skin of domestic cats and has been associated with the development of skin cancer. In the present study, a FcaPV-2 virus-like particle (VLP) vaccine was produced and assessed for vaccine safety, immunogenicity, and impact on FcaPV-2 viral load. This is the first report of the use of a papillomavirus VLP vaccine in domestic cats. The FcaPV-2 VLP vaccine was given to ten adult cats that were naturally infected with FcaPV-2, and a further ten naturally infected cats were sham vaccinated as a control group. The rationale for vaccinating cats already infected with the virus was to induce neutralizing antibody titers that could prevent reinfection of new areas of skin and reduce the overall viral load, as has been demonstrated in other species. Reducing the overall FcaPV-2 viral load could reduce the risk for subsequent PV-associated cancer. The vaccine in this study was well-tolerated, as none of the cats developed any signs of local reaction or systemic illness. In the treatment group, the geometric mean anti-papillomavirus endpoint antibody titers increased significantly following vaccination from 606 (95% CI 192-1913) to 4223 (2023-8814), a 7.0-fold increase, although the individual antibody response varied depending on the level of pre-existing antibodies. Despite the immunogenicity of the vaccine, there was no significant change in FcaPV-2 viral load in the treatment group compared to the control group, over the 24 week follow-up period. A possible reason is that FcaPV-2 was already widespread in the basal skin layer of these adult cats and so preventing further cells from becoming infected had no impact on the overall viral load. Therefore, these results do not support the use of a FcaPV-2 VLP vaccine to reduce the risk for PV-associated cancer in cats in which FcaPV-2 infection is already well established. However, these results justify future studies in which the vaccine is administered to younger cats prior to FcaPV-2 infection becoming fully established.
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Affiliation(s)
- Neroli A Thomson
- School of Veterinary Science, Massey University, Palmerston North 4472, New Zealand.
| | - Laryssa Howe
- School of Veterinary Science, Massey University, Palmerston North 4472, New Zealand
| | - Karin Weidgraaf
- School of Agriculture and Environment, Massey University, Palmerston North 4472, New Zealand
| | - David G Thomas
- School of Agriculture and Environment, Massey University, Palmerston North 4472, New Zealand
| | - Vivienne Young
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Vernon K Ward
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
| | - John S Munday
- School of Veterinary Science, Massey University, Palmerston North 4472, New Zealand
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17
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Aldhous MC, Bhatia R, Pollock R, Vragkos D, Cuschieri K, Cubie HA, Norman JE, Stock SJ. HPV infection and pre-term birth: a data-linkage study using Scottish Health Data. Wellcome Open Res 2019; 4:48. [PMID: 30984880 PMCID: PMC6436145 DOI: 10.12688/wellcomeopenres.15140.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background: We aimed to investigate whether infection with high-risk (HR) types of human papilloma virus (HPV) or HPV-associated cervical disease were associated with preterm birth (<37 weeks gestation). In a sub-group of younger women who were eligible for the HPV vaccine, we aimed to determine whether prior vaccination against the specific HPV-types, HPV-16 and -18 modified preterm birth risk. Methods: This was a data-linkage study, which linked HPV-associated viral and pathological information (from the Scottish HPV Archive) from women aged 16-45 years to routinely collected NHS maternity- and hospital-admission records from 1999-2015. Pregnancy outcomes from 5,598 women with term live birth (≥37 weeks gestation, n=4,942), preterm birth (<37 weeks gestation, n=386) or early miscarriage (<13 weeks gestation, n=270). Of these, data from HPV vaccine-eligible women (n=3,611, aged 16-25 years) were available, of whom 588 had been vaccinated. HPV-associated disease status was defined as: HR HPV-positive no disease, low-grade abnormalities or high-grade disease. Results: High-grade HPV-associated cervical disease was associated with preterm birth (odds ratio=1.843 [95% confidence interval 1.101-3.083], p=0.020) in adjusted binary logistic regression analysis, in all women, but there were no associations with HR HPV-infection alone or with low-grade abnormalities. No associations between any HPV parameter and preterm birth were seen in vaccine-eligible women, nor was there any effect of prior vaccination. Conclusions: HPV-associated high-grade cervical disease was associated with preterm birth, but there were no associations with HR HPV-infection or low-grade cervical disease. Thus HPV-infection alone (in the absence of cervical disease) does not appear to be an independent risk factor for preterm birth. For women who have undergone treatment for CIN and become pregnant, these results demonstrate the need to monitor for signs of preterm birth.
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Affiliation(s)
- Marian C. Aldhous
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ramya Bhatia
- HPV Research Group, Division of Pathology, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Roz Pollock
- Electronic Data Research and Innovation Service (eDRIS), NHS Scotland Information Services Division, Edinburgh, EH16 4UX, UK
| | - Dionysis Vragkos
- Electronic Data Research and Innovation Service (eDRIS), NHS Scotland Information Services Division, Edinburgh, EH16 4UX, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Division of Laboratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Heather A. Cubie
- HPV Research Group, Division of Pathology, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jane E. Norman
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah J. Stock
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH16 4UX, UK
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18
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Block J. Alzheimer's disease might depend on enabling pathogens which do not necessarily cross the blood-brain barrier. Med Hypotheses 2019; 125:129-36. [PMID: 30902141 DOI: 10.1016/j.mehy.2019.02.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/20/2019] [Indexed: 01/04/2023]
Abstract
The development of Alzheimer's Disease (AD) might reflect, in its acquired aspects, a cooperative pathogenesis whereby infectious enablers which do not necessarily cross the blood-brain barrier augment the invasive properties of a less virulent organism, thus enabling it to infect the brain. An example interaction is described which involves Chlamydia species, Human papillomavirus (HPV), microbiota, and yeast, where yeast is a pathogen of low virulence which crosses the blood-brain barrier. The cooperative pathogenesis begins at the mucosal epithelium. Infection by Chlamydia, HPV, or dysbiosis of commensal bacteria disrupts the integrity of the mucosal epithelium, thereby allowing colonizing yeast to penetrate the epithelial barrier and enter into the bloodstream. Chlamydia and enabling commensals promote insulin resistance, which provides yeast with glucose and also sets the stage for accumulation of amyloid beta protein (ABP). Meanwhile, HPV-induced and hyperglycemia-induced immunological changes enable the spread of newly invasive yeast to the brain, where the release of inflammatory cytokines in response to yeast promotes production of ABP. Chlamydia also cross reacts with Candida species, which may stimulate further brain inflammation in response to Candida and may augment production of ABP thereby The yeast's less virulent origins, coupled with immune modulation by enablers, might explain why AD as a model of infectious encephalitis is always slow and insidious rather than occasionally febrile, accompanied by seizures, or marked by signs of meningeal inflammation.
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19
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Hammer A, de Koning MN, Blaakaer J, Steiniche T, Doorbar J, Griffin H, Mejlgaard E, Svanholm H, Quint WG, Gravitt PE. Whole tissue cervical mapping of HPV infection: Molecular evidence for focal latent HPV infection in humans. Papillomavirus Res 2019; 7:82-87. [PMID: 30772498 PMCID: PMC6389775 DOI: 10.1016/j.pvr.2019.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 12/27/2022]
Abstract
In this study, we aimed to provide molecular evidence of HPV latency in humans and discuss potential challenges of conducting studies on latency. We analyzed the entire cervix of two women who underwent hysterectomy unrelated to cervical abnormality. The cervices were sectioned into 242 and 186 sets respectively, and each set was tested separately for HPV using the SPF10-PCR-DEIA-LiPA25 system. To identify whether there was any evidence of transforming or productive infection, we used the biomarkers E4 and P16INK4a to stain slides immediately adjacent to HPV-positive sections. HPV was detected in both cervices. In patient 1, 1/242 sets was positive for HPV31. In patient 2, 13/186 sets were positive for HPV18 and 1/186 was positive for HPV53. The infection was very focal in both patients, and there was no sign of a transforming or productive infection, as evaluated by the markers E4 and P16INK4a. Had we only analyzed one set from each block, the probability of detecting the infection would have been 32.3% and 2%, respectively.Our findings support the idea that HPV may be able to establish latency in the human cervix; however, the risk associated with a latent HPV infection remains unclear.
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Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | | | - Jan Blaakaer
- Department of Obstetrics and Gynecology, Odense University Hospital, Denmark
| | - Torben Steiniche
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Pathology, Aarhus University Hospital, Denmark
| | - John Doorbar
- Department of Pathology, University of Cambridge, United Kingdom
| | - Heather Griffin
- Department of Pathology, University of Cambridge, United Kingdom
| | - Else Mejlgaard
- Department of Pathology, Aarhus University Hospital, Denmark
| | | | - Wim Gv Quint
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Patti E Gravitt
- Department of Global Health, Milken Institute School of Public Health, the George Washington University, USA
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20
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Ermel A, Shew ML, Imburgia TM, Brown M, Qadadri B, Tong Y, Brown DR. Redetection of human papillomavirus type 16 infections of the cervix in mid-adult life. Papillomavirus Res 2018; 5:75-79. [PMID: 29355777 PMCID: PMC5886910 DOI: 10.1016/j.pvr.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/20/2017] [Accepted: 01/12/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess whether HPV 16 originally detected in adolescent women can be redetected in adulthood. METHODS A convenience sample of 27 adult women with known HPV 16 detection during adolescence was assessed for HPV 16 redetection. A comparison of the long control region (LCR) DNA sequences was performed on some of the original and redetected HPV 16 isolates. RESULTS Median age at reenrollment was 27.5 years (interquartile range of 26.7-29.6). Reenrollment occurred six years on average after the original HPV 16 detection. Eleven of 27 women had HPV 16 redetected. Some of these HPV 16 infections had apparently cleared during adolescence. LCR sequencing was successful in paired isolates from 6 women; in 5 of 6 cases the redetected HPV 16 isolates were identical to those detected during adolescence, CONCLUSIONS: HPV 16 may be episodically detected in young women, even over long time periods. HPV 16 redetection with identical LCR sequences suggests low-level persistent infection rather than true clearance, although newly acquired infection with an identical HPV 16 isolate cannot be excluded. However, this study suggests that a new HPV 16-positive test in a clinical setting may not indicate a new infection.
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Affiliation(s)
- Aaron Ermel
- Department of Internal Medicine, Indiana University School of Medicine, USA
| | - Marcia L Shew
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Teresa M Imburgia
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Matt Brown
- Department of Internal Medicine, Indiana University School of Medicine, USA
| | - Brahim Qadadri
- Department of Internal Medicine, Indiana University School of Medicine, USA
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, USA
| | - Darron R Brown
- Department of Internal Medicine, Indiana University School of Medicine, USA; Department of Immunology and Microbiology, Indiana University School of Medicine, USA.
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21
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Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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22
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Mbulawa ZZA, van Schalkwyk C, Hu NC, Meiring TL, Barnabas S, Dabee S, Jaspan H, Kriek JM, Jaumdally SZ, Muller E, Bekker LG, Lewis DA, Dietrich J, Gray G, Passmore JAS, Williamson AL. High human papillomavirus (HPV) prevalence in South African adolescents and young women encourages expanded HPV vaccination campaigns. PLoS One 2018; 13:e0190166. [PMID: 29293566 PMCID: PMC5749739 DOI: 10.1371/journal.pone.0190166] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/08/2017] [Indexed: 11/18/2022] Open
Abstract
The objectives of the study were to investigate prevalence of cervical human papillomavirus (HPV) genotypes to inform HPV vaccination strategy in South Africa and to study factors associated with HPV prevalence. Sexually active, HIV-negative women, aged 16-22 years recruited from Soweto (n = 143) and Cape Town (n = 148) were tested for cervical HPV and other genital infections. Overall HPV prevalence was 66.7% (194/291) in young women. Cape Town women were more likely to have multiple HPV infections than the Soweto women (48.0%, 71/148 versus 35.0%, 50/143 respectively, p = 0.033) and probable HR-HPV types (34.5%, 51/148 versus 21.7%, 31/143 respectively, p = 0.022). The most frequently detected HPV types were HPV-16 (11.7%), HPV-58 (10.3%), HPV-51 (8.9%), HPV-66 (8.6%), HPV-18 and HPV-81 (7.6% each). HPV types targeted by the bivalent HPV vaccine (HPV-16/18) were detected in 18.6% (54/291) of women, while those in the quadrivalent vaccine (HPV-6/11/16/18) were detected in 24.7% (72/291) of women; and those in the nonavalent vaccine (HPV-6/11/16/18/31/33/45/52/58) were detected in 38.5% (112/291) of women. In a multivariable analysis, bacterial vaginosis remained significantly associated with HPV infection (OR: 4.0, 95% CI: 1.4-12.6). Women were more likely to be HPV positive if they had received treatment for STI during the past 6-months (OR: 3.4, 95% CI: 1.1-12.4) or if they had ever been pregnant (OR: 2.3, 95% CI: 1.1-5.5). Compared to women who reported only one sexual partner, those with increased number of lifetime sex partners were more likely to have HPV (4-10 partners: OR: 2.9, 95% CI: 1.1-8.0). The high prevalence of HPV types targeted by the nonavalent HPV vaccine encourages the introduction of this vaccine and catch-up HPV vaccination campaigns in South Africa. The high burden of BV and concurrent STIs also highlights the need to improve the prevention and appropriate management of sexually-acquired and other genital tract infections in South African youth.
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Affiliation(s)
- Zizipho Z. A. Mbulawa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Center for HIV and STIs, National Institute for Communicable Disease, National Health Laboratory Service, Johannesburg, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- UCT-MRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Cari van Schalkwyk
- The South African Department of Science and Technology/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Nai-Chung Hu
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Tracy L. Meiring
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Shaun Barnabas
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Heather Jaspan
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Seattle Children’s Research Institute, University of Washington, Seattle, United States
| | - Jean-Mari Kriek
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Shameem Z. Jaumdally
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Etienne Muller
- Center for HIV and STIs, National Institute for Communicable Disease, National Health Laboratory Service, Johannesburg, South Africa
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - David A. Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, Sydney, Australia
| | - Janan Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, Johannesburg, South Africa
- Canada-African Prevention Trials Network, The Ottawa Hospital General Campus, Ottawa, Canada
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Jo-Ann S. Passmore
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- DST-NRF CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- UCT-MRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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23
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Polman NJ, Veldhuijzen NJ, Heideman DAM, Snijders PJF, Meijer CJLM, Berkhof J. HPV-positive women with normal cytology remain at increased risk of CIN3 after a negative repeat HPV test. Br J Cancer 2017; 117:1557-1561. [PMID: 28881359 PMCID: PMC5680458 DOI: 10.1038/bjc.2017.309] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background: In human papillomavirus (HPV)-based screening, a repeat HPV test is often recommended for HPV-positive women with normal cytology (HPV-pos/cyt-neg), but its absolute risk of cervical precancer (CIN3+) over two screening rounds needs to be assessed. Methods: We compared the 5-year risk of HPV infection and CIN3+ in HPV-pos/cyt-neg women with a negative repeat HPV test to the risk in HPV-negative women with normal cytology (double negatives) in the POBASCAM cohort. We obtained histology data from the Dutch pathology registry (PALGA). Results: Human papillomavirus infection risk was 20.4% (19 of 93) in HPV-pos/cyt-neg, repeat HPV-negative women and 3.2% (294 of 9186; P<0.001) in double negatives. Corresponding CIN3+ risks were 2.0% (4 of 199) and 0.2% (41 of 18 562; P<0.001). Infection risks were also increased in type-specific analyses of HPV16, 31, 33, 39, 52, 56 and 58. Conclusions: HPV-pos/cyt-neg women continue to have an increased CIN3+ risk, also when the repeat HPV test is negative. Therefore, intervals in primary HPV screening should be determined separately for HPV-positive and -negative women.
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Affiliation(s)
- Nicole J Polman
- Department of Pathology, Vrije Universiteit, University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Nienke J Veldhuijzen
- Department of Epidemiology and Biostatistics, Vrije Universiteit, University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Daniëlle A M Heideman
- Department of Pathology, Vrije Universiteit, University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Peter J F Snijders
- Department of Pathology, Vrije Universiteit, University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Chris J L M Meijer
- Department of Pathology, Vrije Universiteit, University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Vrije Universiteit, University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
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24
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Ma S, Stern JE, Feng Q, Hughes JP, Hawes SE, Winer RL. Incidence and risk factors for human papillomavirus infections in young female online daters. J Med Virol 2017; 89:2029-2036. [PMID: 28667755 DOI: 10.1002/jmv.24891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022]
Abstract
Risk factors for incident human papillomavirus (HPV) infections are undefined in young women who use internet dating Web sites. From 2010-2012 we followed 18- to 24-year-old female internet daters (N = 164) triannually for a mean of 1 year. Women collected and returned self-collected vaginal samples for HPV genotyping and health and behavior questionnaires. We used Kaplan-Meier methods to estimate incidence of clinically relevant HPV infection (high-risk HPV, HPV-6, or HPV-11) and generalized estimating equations and Firth logistic regression to identify associated risk factors. At enrollment, women reported a median lifetime number of six male sex partners, and 36% reported a history of HPV vaccination. The 12-month cumulative incidence of clinically relevant HPV was 32.9% (95%CI: 26.0-41.0%). Reporting a recent male sex partner met via the internet versus not was not significantly associated with incident HPV (odds ratio [OR] = 0.91, 95%CI: 0.53-1.55). In multivariate analysis adjusted for lifetime number of partners, reporting new and/or multiple partners in the past 6 months was positively associated with incident HPV (OR = 6.38, 95%CI: 1.56-26.02, compared to reporting no recent partners). In a separate model, self-reporting ≥1 dose of HPV vaccine was inversely associated with vaccine-type HPV (6/11/16/18) (OR = 0.21, 95%CI: 0.05-0.86), but the association was attenuated and not statistically significant after adjusting for sexual history (OR = 0.36, 95%CI: 0.09-1.43). While recent high-risk sexual behavior was associated with incident HPV, sex with partners met via the internet was not associated with increased HPV risk in young female internet daters. Although not statistically significant after adjusting for sexual history, HPV vaccination showed substantial protection against vaccine-type HPV infection.
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Affiliation(s)
- Sharon Ma
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Joshua E Stern
- Department of Global Health, University of Washington, Seattle, Washington
| | | | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, Washington
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25
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Hinten F, Hilbrands LB, Meeuwis KAP, IntHout J, Quint WGV, Hoitsma AJ, Massuger LFAG, Melchers WJG, de Hullu JA. Reactivation of Latent HPV Infections After Renal Transplantation. Am J Transplant 2017; 17:1563-1573. [PMID: 28009475 DOI: 10.1111/ajt.14181] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 01/25/2023]
Abstract
Female renal transplant recipients (RTRs) have an increased risk for developing human papillomavirus (HPV)-related (pre)malignant lesions of the genital tract. This study aims to assess the genital prevalence of HPV before and after renal transplantation (RT). In female patients who were counseled for RT at the Radboud University Medical Center Nijmegen, the Netherlands, gynecological examination was performed at first visit, and 1 and 2 years later. HPV self-sampling and questionnaires on sexual behavior were performed every 3 months. In 65 patients who underwent RT, the high-risk human papillomavirus (hrHPV) prevalence as assessed with the highly sensitive SPF10 -LiPA25 test increased significantly from 19% before to 31% after RT (p = 0.045). Based upon the clinically validated Cobas 4800 HPV test, the hrHPV prevalence increased from 10% before to 14% after RT (p = 0.31). During follow-up, no changes in sexual behavior were reported. Thirty-three patients who did not undergo RT showed a hrHPV prevalence of 21% at study entry and of 27% after 12 months with the sensitive test, and a stable prevalence of 16% with the clinically validated test. The results of this study indicate that activation of latent HPV infections may contribute to the increased risk of HPV-related (pre)malignant lesions in female RTRs.
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Affiliation(s)
- F Hinten
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K A P Meeuwis
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J IntHout
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W G V Quint
- Delft Diagnostic Laboratory, Rijswijk, the Netherlands
| | - A J Hoitsma
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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26
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Malagón T, Lemieux-Mellouki P, Laprise JF, Brisson M. Bias Due to Correlation Between Times-at-Risk for Infection in Epidemiologic Studies Measuring Biological Interactions Between Sexually Transmitted Infections: A Case Study Using Human Papillomavirus Type Interactions. Am J Epidemiol 2016; 184:873-883. [PMID: 27927619 DOI: 10.1093/aje/kww152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 10/05/2016] [Indexed: 12/29/2022] Open
Abstract
The clustering of human papillomavirus (HPV) infections in some individuals is often interpreted as the result of common risk factors rather than biological interactions between different types of HPV. The intraindividual correlation between times-at-risk for all HPV infections is not generally considered in the analysis of epidemiologic studies. We used a deterministic transmission model to simulate cross-sectional and prospective epidemiologic studies measuring associations between 2 HPV types. When we assumed no interactions, the model predicted that studies would estimate odds ratios and incidence rate ratios greater than 1 between HPV types even after complete adjustment for sexual behavior. We demonstrated that this residual association is due to correlation between the times-at-risk for different HPV types, where individuals become concurrently at risk for all of their partners' HPV types when they enter a partnership and are not at risk when they are single. This correlation can be controlled in prospective studies by restricting analyses to susceptible individuals with an infected sexual partner. The bias in the measured associations was largest in low-sexual-activity populations, cross-sectional studies, and studies which evaluated infection with a first HPV type as the exposure. These results suggest that current epidemiologic evidence does not preclude the existence of competitive biological interactions between HPV types.
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27
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Skinner SR, Apter D, De Carvalho N, Harper DM, Konno R, Paavonen J, Romanowski B, Roteli-Martins C, Burlet N, Mihalyi A, Struyf F. Human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine for the prevention of cervical cancer and HPV-related diseases. Expert Rev Vaccines 2016; 15:367-87. [PMID: 26902666 DOI: 10.1586/14760584.2016.1124763] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vaccines are available against human papillomavirus (HPV), the causal agent of cervical and other cancers. Efficacy data from the HPV-16/18 AS04-adjuvanted vaccine clinical trial program were reviewed. Six randomized, controlled phase II/III trials evaluating cervical endpoints enrolled women from diverse populations and geographical locations. The program analyzed extensively the cohorts most relevant from a public health perspective: the total vaccinated cohort (TVC), approximating a general population including those with existing or previous HPV infection, and TVC-naïve, approximating a population of young women before sexual debut. Results show that the vaccine reduces HPV-16/18 infection and associated cervical endpoints in women regardless of age, location, or sexual experience. It provides cross-protection against some non-vaccine oncogenic HPV types and types causing genital warts, and may be effective against vulvar, oral, and anal HPV infection. Early epidemiology data following its introduction suggest a decline in the prevalence of vaccine and some non-vaccine HPV types.
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Affiliation(s)
- S Rachel Skinner
- a Sydney University Discipline of Paediatrics and Child Health , The Children's Hospital at Westmead , Sydney , NSW , Australia.,b Vaccine Trials Group, Telethon Kids Institute , University of Western Australia , Perth , Australia
| | - Dan Apter
- c Family Federation of Finland , Sexual Health Clinic , Helsinki , Finland
| | - Newton De Carvalho
- d Department of Gynecology and Obstetrics, Gynecology and Obstetrics Infectious Diseases Sector , University of Parana , Curitiba , Parana , Brazil
| | - Diane M Harper
- e Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth , Hanover , NH , USA.,f Department of Family and Geriatric Medicine, University of Louisville School of Medicine , Louisville , KY , USA
| | - Ryo Konno
- g Department of Obstetrics and Gynaecology , Jichi Medical University Saitama Medical Center , Saitama , Japan
| | - Jorma Paavonen
- h Department of Obstetrics and Gynaecology , University of Helsinki , Helsinki , Finland
| | - Barbara Romanowski
- i Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry , University of Alberta , Edmonton , AB , Canada
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28
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Valentine K, Vanden Broeck D, Benoy I, Truyens M, Bogers J. Cytology at the Time of HPV: Some Things to Think about when Discussing HPV. Acta Cytol 2016; 60:527-533. [PMID: 27816982 DOI: 10.1159/000450821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 12/26/2022]
Abstract
'In the current 28 Member States of the European Union (EU), approximately 34,000 new cases of cervical cancer and 13,000 deaths occur' [Ferlay et al.: Eur J Cancer 2014;49:1374-1403]. 'The current 10-fold gradient in the mortality rates of cervical cancer among the EU Member States largely reflects the persistent absence, or inadequate implementation of cervical cancer screening programmes more than 10 years after organized, population-based screening programmes following European quality assurance guidelines were unanimously recommended by the Health Ministers of the EU' [Council of the European Union: Off J Eur Union 2003;327:34-38]. This article will compare the strengths, weaknesses and risks of the following 4 cervical health screening strategies: HPV as a triage of cytology, cytology as a triage of HPV, cotesting (parallel) or cytology at the time of HPV (HPV-informed guided screening). 'The optimal screening strategy should identify those cervical cancer precursors likely to progress to invasive cancers (maximizing the benefits of screening) and avoid the detection and unnecessary treatment of transient HPV infection and its associated benign lesions that are not destined to become cancerous (minimizing the potential harms of screening)' [Saslow et al.: Am J Clin Pathol 2012;137:516-542].
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29
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Lehtinen M, Apter D. Gender-neutrality, herd effect and resilient immune response for sustainable impact of HPV vaccination. Curr Opin Obstet Gynecol 2015; 27:326-32. [PMID: 26308204 DOI: 10.1097/GCO.0000000000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review summarize the impact of various strategies of human papillomavirus (HPV) vaccination, such as vaccinating only girls or both girls and boys. RECENT FINDINGS Slow and inefficient implementation of HPV vaccination programmes has delayed the impact of the first human cancer vaccine. Vaccinating only girls, with a rather low coverage, has led to a limited herd effect and, thus, not full use of the HPV vaccine potential. SUMMARY Gender-neutral vaccination based on comparative effectiveness research will hopefully soon tackle the whole spectrum of HPV cancers in both sexes. The remaining challenges are how to ensure resilience of HPV vaccine-induced immunity and herd effect to guarantee population-level impact of HPV vaccination, and how to guard against HPV type replacement.
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30
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Luttmer R, De Strooper LMA, Dijkstra MG, Berkhof J, Snijders PJF, Steenbergen RDM, van Kemenade FJ, Rozendaal L, Helmerhorst TJM, Verheijen RHM, Ter Harmsel WA, van Baal WM, Graziosi PGCM, Quint WGV, Spruijt JWM, van Dijken DKE, Heideman DAM, Meijer CJLM. FAM19A4 methylation analysis in self-samples compared with cervical scrapes for detecting cervical (pre)cancer in HPV-positive women. Br J Cancer 2016; 115:579-87. [PMID: 27415009 PMCID: PMC4997542 DOI: 10.1038/bjc.2016.200] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND High-risk human papillomavirus (hrHPV)-positive women require triage to identify those with cervical high-grade intraepithelial neoplasia and cancer (⩾CIN3 (cervical intraepithelial neoplasia grade 3)). FAM19A4 methylation analysis, which detects advanced CIN and cancer, is applicable to different sample types. However, studies comparing the performance of FAM19A4 methylation analysis in hrHPV-positive self-samples and paired physician-taken scrapes are lacking. METHODS We compared the performance of FAM19A4 methylation analysis (and/or HPV16/18 genotyping) in self-samples and paired physician-taken scrapes for ⩾CIN3 detection in hrHPV-positive women (n=450,18-66 years). RESULTS Overall FAM19A4 methylation levels between sample types were significantly correlated, with strongest correlation in women with ⩾CIN3 (Spearman's ρ 0.697, P<0.001). The performance of FAM19A4 methylation analysis and/or HPV16/18 genotyping did not differ significantly between sample types. In women ⩾30 years, ⩾CIN3 sensitivity of FAM19A4 methylation analysis was 78.4% in self-samples and 88.2% in scrapes (ratio 0.89; CI: 0.75-1.05). In women <30 years, ⩾CIN3 sensitivities were 37.5% and 45.8%, respectively (ratio 0.82; CI: 0.55-1.21). In both groups, ⩾CIN3 specificity of FAM19A4 methylation analysis was significantly higher in self-samples compared with scrapes. CONCLUSIONS FAM19A4 methylation analysis in hrHPV-positive self-samples had a slightly lower sensitivity and a higher specificity for ⩾CIN3 compared with paired physician-taken scrapes. With a similarly good clinical performance in both sample types, combined FAM19A4 methylation analysis and HPV16/18 genotyping provides a feasible triage strategy for hrHPV-positive women, with direct applicability on self-samples.
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Affiliation(s)
- Roosmarijn Luttmer
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Lise M A De Strooper
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Maaike G Dijkstra
- Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Renske D M Steenbergen
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Lawrence Rozendaal
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Theo J M Helmerhorst
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - René H M Verheijen
- UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - W Marchien van Baal
- Department of Obstetrics and Gynaecology, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - Peppino G C M Graziosi
- Department of Obstetrics and Gynaecology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Wim G V Quint
- DDL Diagnostic Laboratory, Visseringlaan 25, 2288 ER Rijswijk, The Netherlands
| | - Johan W M Spruijt
- Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Dorenda K E van Dijken
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis West, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Daniëlle A M Heideman
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Vorsters A, Van Keer S, Biesmans S, Hens A, De Coster I, Goossens H, Ieven M, Van Damme P. Long-Term Follow-up of HPV Infection Using Urine and Cervical Quantitative HPV DNA Testing. Int J Mol Sci 2016; 17:ijms17050750. [PMID: 27196899 PMCID: PMC4881571 DOI: 10.3390/ijms17050750] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/26/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022] Open
Abstract
The link between infection with high-risk human papillomavirus (hrHPV) and cervical cancer has been clearly demonstrated. Virological end-points showing the absence of persistent HPV infection are now accepted as a way of monitoring the impact of prophylactic vaccination programs and therapeutic vaccine trials. This study investigated the use of urine samples, which can be collected by self-sampling at home, instead of cervical samples for follow-up of an HPV intervention trial. Eighteen initially HPV DNA-positive women participating in an HPV therapeutic vaccine trial were monitored during a three-year follow-up period. A total of 172 urine samples and 85 cervical samples were collected. We obtained a paired urine sample for each of the 85 cervical samples by recovering urine samples from six monthly gynaecological examinations. We performed a small pilot study in which the participating women used a urine collection device at home and returned their urine sample to the laboratory by mail. All samples were analyzed using quantitative real-time HPV DNA PCR. A good association (κ value of 0.65) was found between the presence of HPV DNA in urine and a subsequent cervical sample. Comparisons of the number of HPV DNA copies in urine and paired cervical samples revealed a significant Spearman rho of 0.676. This correlation was superior in women with severe lesions. The HPV DNA results of the small pilot study based on self-collected urine samples at home are consistent with previous and subsequent urine and/or cervical results. We demonstrated that urine sampling may be a valid alternative to cervical samples for the follow-up of HPV intervention trials or programs. The potential clinical value of urine viral load monitoring should be further investigated.
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Affiliation(s)
- Alex Vorsters
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, 2610 Wilrijk, Belgium.
| | - Severien Van Keer
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, 2610 Wilrijk, Belgium.
| | - Samantha Biesmans
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, 2610 Wilrijk, Belgium.
| | - Annick Hens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, 2610 Wilrijk, Belgium.
| | - Ilse De Coster
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, 2610 Wilrijk, Belgium.
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium.
- Clinical Microbiology, Antwerp University Hospital, 2650 Edegem, Belgium.
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium.
- Clinical Microbiology, Antwerp University Hospital, 2650 Edegem, Belgium.
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, 2610 Wilrijk, Belgium.
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Nyitray AG, Carvalho da Silva RJ, Chang M, Baggio ML, Ingles DJ, Abrahamsen M, Papenfuss M, Lin HY, Salmerón J, Quiterio M, Lazcano-Ponce E, Villa LL, Giuliano AR. Incidence, Duration, Persistence, and Factors Associated With High-risk Anal Human Papillomavirus Persistence Among HIV-negative Men Who Have Sex With Men: A Multinational Study. Clin Infect Dis 2016; 62:1367-1374. [PMID: 26962079 DOI: 10.1093/cid/ciw140] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/26/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Given high rates of anal disease, we investigated the natural history of high-risk anal human papillomavirus (HPV) among a multinational group of men who have sex with men (MSM) aged 18-64 years. METHODS Anal specimens from human immunodeficiency virus-negative men from Brazil, Mexico, and the United States were genotyped. Over 2 years, 406 MSM provided evaluable specimens every 6 months for ≥2 visits. These men were stratified into men who have sex only with men (MSOM, n = 70) and men who have sex with women and men (MSWM, n = 336). Persistence was defined as ≥12 months' type-specific duration and could begin with either a prevalent or incident infection. Prevalence ratios and 95% confidence intervals were calculated by Poisson regression. RESULTS Median follow-up time was 2.1 years. Retention was 82%. Annual cumulative incidence of 9-valent vaccine types was 19% and 8% among MSOM and MSWM, respectively (log-rank P = .02). Duration of anal HPV did not differ for MSOM and MSWM and was a median of 6.9 months for HPV-16 after combining men from the 2 groups. Among men with prevalent high-risk infection (n = 106), a total of 36.8%, retained the infection for at least 24 months. For those with prevalent HPV-16 (n = 27), 29.6% were persistent for at least 24 months. Persistence of high-risk HPV was associated with number of male anal sex partners and inversely associated with number of female sex partners. CONCLUSIONS MSM with prevalent high-risk HPV infection should be considered at increased risk for nontransient infection.
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Affiliation(s)
- Alan G Nyitray
- Center for Infectious Diseases, University of Texas School of Public Health at Houston
| | | | - Mihyun Chang
- Division of Biostatistics, University of Texas School of Public Health at Houston
| | - Maria Luiza Baggio
- Center of Translational Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Brazil
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Nashville, Tennessee
| | - Martha Abrahamsen
- Center for Infection Research in Cancer,Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mary Papenfuss
- Center for Infection Research in Cancer,Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hui-Yi Lin
- Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans
| | - Jorge Salmerón
- Instituto Nacional de Salud Pública.,Instituto Mexicano del Seguro Social, and
| | - Manuel Quiterio
- Instituto Nacional de Salud Pública, Cuernavaca, México; and
| | | | - Luisa L Villa
- Faculdade de Medicina, Universidade de São Paulo Department of Radiology and Oncology, Centro de Investigação Translacional em Oncologia, ICESP, Brazil
| | - Anna R Giuliano
- Center for Infection Research in Cancer,Moffitt Cancer Center and Research Institute, Tampa, Florida
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Abstract
As whether Chlamydia trachomatis infection increases the risk of cervical cancer is controversial in the literature, we performed a meta-analysis.Based on a comprehensive search of publications in the Medline, Cochrane, and EMBASE databases, we identified and extracted data from all relevant articles examining C. trachomatis infection and the risk of cervical cancer. The quality of each included study was assessed according to the 9-star Newcastle-Ottawa scale. The strength of association between the C. trachomatis and risk of cervical cancer was estimated by odds ratio (OR) and 95% confidence intervals (CIs). This review was registered at PROSPERO with registration No. CRD42014015672. A total of 22 studies with 4291 cervical cancer cases and 7628 controls were identified. Overall, C. trachomatis was significantly linked to increased cervical cancer risk in prospective studies (OR = 2.21, 95% CI: 1.88-2.61, P < 0.001), as well as in retrospective studies (OR = 2.19, 95% CI: 1.74-2.74, P < 0.001). Additionally, with a multivariate logistic regression analysis adjusted for HPV and age, C. trachomatis infection was identified as an independent predictor of cervical cancer in 11 studies (OR = 1.76, 95% CI: 1.03-3.01, P = 0.04). Coinfection of human papilloma virus and C. trachomatis has a higher risk of cervical cancer (OR = 4.03, 95% CI: 3.15-5.16, P < 0.001). A subgroup analysis based on histological type indicated an elevated risk for both squamous cell carcinoma (OR = 2.21, 95% CI: 2.00-2.45, P < 0.001), and adenocarcinoma (OR = 1.61, 95% CI: 1.21-2.15, P = 0.001), in associated with C. trachomatis. Subgroup analysis by where C. trachomatis infection was detected showed a significantly higher risk of cervical cancer associated with C. trachomatis infection detected in serum (OR = 2.20, 95% CI: 2.01-2.42, P < 0.001), cervical tissue blocks (OR = 2.88, 95% CI: 1.21-6.83, P = 0.02), and cervical secretion (OR = 2.71, 95% CI: 1.41-5.20, P = 0.003), especially in serum with no obvious heterogeneity.In conclusion, our novel data demonstrate that individuals infected with C. trachomatis have a higher risk of cervical cancer. Therefore, it is necessary to expand C. trachomatis infection screening and treat women with C. trachomatis promptly, particularly those with human papilloma virus infections. This approach will not only protect against pelvic inflammatory disease and infertility, but may also prevent cervical cancer.
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Affiliation(s)
- Haiyan Zhu
- From the Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Luttmer R, De Strooper LMA, Berkhof J, Snijders PJF, Dijkstra MG, Uijterwaal MH, Steenbergen RDM, van Kemenade FJ, Rozendaal L, Helmerhorst TJM, Verheijen RHM, Ter Harmsel WA, Van Baal WM, Graziosi PGCM, Quint WGV, Heideman DAM, Meijer CJLM. Comparing the performance of FAM19A4 methylation analysis, cytology and HPV16/18 genotyping for the detection of cervical (pre)cancer in high-risk HPV-positive women of a gynecologic outpatient population (COMETH study). Int J Cancer 2015; 138:992-1002. [PMID: 26317579 DOI: 10.1002/ijc.29824] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/14/2015] [Indexed: 01/05/2023]
Abstract
Recently, DNA methylation analysis of FAM19A4 in cervical scrapes has been shown to adequately detect high-grade cervical intraepithelial neoplasia and cervical cancer (≥ CIN3) in high-risk HPV (hrHPV)-positive women. Here, we compared the clinical performance of FAM19A4 methylation analysis to cytology and HPV16/18 genotyping, separately and in combination, for ≥ CIN3 detection in hrHPV-positive women participating in a prospective observational multi-center cohort study. The study population comprised hrHPV-positive women aged 18-66 years, visiting a gynecological outpatient clinic. From these women, cervical scrapes and colposcopy-directed biopsies (for histological confirmation) were obtained. Cervical scrapes were analyzed for FAM19A4 gene promoter methylation, cytology and HPV16/18 genotyping. Methylation analysis was performed by quantitative methylation-specific PCR (qMSP). Sensitivities and specificities for ≥ CIN3 were compared between tests. Stratified analyses were performed for variables that potentially influence marker performance. Of all 508 hrHPV-positive women, the sensitivities for ≥ CIN3 of cytology, FAM19A4 methylation analysis, and cytology combined with HPV16/18 genotyping were 85.6, 75.6 and 92.2%, respectively, with corresponding specificities of 49.8, 71.1 and 29.4%, respectively. Both sensitivity and specificity of FAM19A4 methylation analysis were associated with age (p ≤ 0.001 each). In women ≥ 30 years (n = 287), ≥ CIN3 sensitivity of FAM19A4 methylation analysis was 88.3% (95%CI: 80.2-96.5) which was noninferior to that of cytology [85.5% (95%CI: 76.0-94.0)], at a significantly higher specificity [62.1% (95%CI: 55.8-68.4) compared to 47.6% (95%CI: 41.1-54.1)]. In conclusion, among hrHPV-positive women from an outpatient population aged ≥ 30 years, methylation analysis of FAM19A4 is an attractive marker for the identification of women with ≥ CIN3.
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Affiliation(s)
- Roosmarijn Luttmer
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Lise M A De Strooper
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maaike G Dijkstra
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Margot H Uijterwaal
- Department of Obstetrics and Gynecology, Flevo Hospital, Almere, The Netherlands
| | | | | | - Lawrence Rozendaal
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Theo J M Helmerhorst
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rene H M Verheijen
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - W Marchien Van Baal
- Department of Obstetrics and Gynecology, Flevo Hospital, Almere, The Netherlands
| | - Peppino G C M Graziosi
- Department of Obstetrics and Gynecology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Wim G V Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | | | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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Shew ML, Ermel AC, Tong Y, Tu W, Qadadri B, Brown DR. Episodic detection of human papillomavirus within a longitudinal cohort of young women. J Med Virol 2015; 87:2122-9. [PMID: 26112742 DOI: 10.1002/jmv.24284] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 12/26/2022]
Abstract
Redetection of a type-specific human papillomavirus (HPV) infection may represent reinfection. However, a growing body of literature suggests that reactivation of HPV is common and that episodic detection of a HPV infection may represent reactivation of a persistent virus. A cohort of prospectively followed adolescent women (N = 150), ages 14-17, was observed on average 6.4 years. The authors describe the redetection of 37 HPV types and associated factors of redetection of high-risk (HR) and low-risk (LR) types using Cox proportional hazard models. Of 1,248 HPV type-specific infections, 286 (22.9%) were associated with redetection after apparent clearance. Chlamydia infections (HR = 1.99 [95%CI, 1.15-3.49]) and non-condom use (HR = 1.1 [95%CI, 1.04-1.99]) were associated with increased redetection of HR-HPV infections. Oral contraceptive pills (HR = 2.73 [95%CI, 1.52-4.90]) and number of sexual partners (HR = 1.44 [95%CI, 1.04-1.99]) were associated with increased redetection of LR-HPV infections. Episodic detection of HPV is common for HR- and LR-HPV types. This finding and identified factors or redetection have clinical implications and enhances the understanding of HPV natural history.
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Affiliation(s)
- Marcia L Shew
- Departments of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron C Ermel
- Departments of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Yan Tong
- Departments of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wanzhu Tu
- Departments of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brahim Qadadri
- Departments of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Darron R Brown
- Departments of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Departments of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana
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Ko K, Kwon MJ, Woo HY, Park H. Investigation of Transition Types of HPV DNA Test Results over Time in Korean Women. Asian Pac J Cancer Prev 2015; 16:3167-72. [PMID: 25921116 DOI: 10.7314/apjcp.2015.16.8.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the history of human papilloma virus (HPV) infection is important for interpretation of a positive HPV DNA screening test, future work-up and treatment. We investigated the transition of HPV DNA test results in Korean women, and analyzed the association of cytology result with transition type. MATERIALS AND METHODS We retrospectively reviewed annual HPV DNA test results for 5,274 subjects between January 2005 and December 2012. Each subject had a minimum of five annual tests over the eight-year period. Based on the pattern of results, the transition type for each subject was assigned to one of the following: negative, persistent, latent, transient, and unclassifiable. Associations of cytology results with the HPV DNA transition types, number of positive results, and the durations of positive results were also analyzed. RESULTS The proportion of abnormal cytology findings decreased in the following order of transition patterns: persistent, latent, transient, and negative. Among transient patterns, a duration of three years or more significantly correlated with cytology results of non-high grade squamous intraepithelial lesion (HSIL; p<0.001). In the persistent group, duration of five years or more correlated with both non-HSIL and HSIL (p<0.001). Latent group showed no correlation with duration. Irrespective of patterns, having five or more positive results was significantly associated with HSIL (p<0.001). CONCLUSIONS Our findings may contribute to better understanding of HPV infection, interpretation of HPV DNA screening results, and prediction of prognosis according to transition type.
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Affiliation(s)
- Kiwoong Ko
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea E-mail :
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37
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Abstract
Clearance of anogenital and oropharyngeal HPV infections is attributed primarily to a successful adaptive immune response. To date, little attention has been paid to the potential role of stochastic cell dynamics in the time it takes to clear an HPV infection. In this study, we combine mechanistic mathematical models at the cellular level with epidemiological data at the population level to disentangle the respective roles of immune capacity and cell dynamics in the clearing mechanism. Our results suggest that chance—in form of the stochastic dynamics of basal stem cells—plays a critical role in the elimination of HPV-infected cell clones. In particular, we find that in immunocompetent adolescents with cervical HPV infections, the immune response may contribute less than 20% to virus clearance—the rest is taken care of by the stochastic proliferation dynamics in the basal layer. In HIV-negative individuals, the contribution of the immune response may be negligible. Worldwide, 5% of all cancers are associated with the sexually transmitted human papillomavirus (HPV). The most common cancer types attributed to HPV are cervical and anal cancers, but HPV-related head and neck cancers are on the rise, too. Even though the lifetime risk of infection with HPV is as high as 80%, most infections clear spontaneously within 1–2 years, and only a small fraction progress to cancer. In order to identify who is at risk for HPV-related cancer, a better understanding of the underlying biology is of great importance. While it is generally accepted that the immune system plays a key role in HPV clearance, we investigate here a mechanism which could be equally important: the stochastic division dynamics of stem cells in the infected tissues. Combining mechanistic mathematical models at the cell-level with population-level data, we disentangle the contributions from immune system and cellular dynamics in the clearance process. We find that cellular stochasticity may play an even more important role than the immune system. Our findings shed new light onto open questions in HPV immunobiology, and may influence the way we vaccinate and screen individuals at risk of HPV-related cancers.
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Affiliation(s)
- Marc D. Ryser
- Department of Mathematics, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Evan R. Myers
- Department of Obstetrics and Gynecology, Duke University Medical School, Durham, North Carolina, United States of America
| | - Rick Durrett
- Department of Mathematics, Duke University, Durham, North Carolina, United States of America
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Abstract
Prevention and treatment of human papillomavirus related cervical cancer through vaccination is a relative new field with many scientific, technological and implementational challenges requiring numerous new clinical trials. The initial prophylactic HPV vaccine trials allowed to set new end-points based on persistent infection in order to determine vaccine efficacy for prevention of cervical cancer. Major progress has been made regarding detection of HPV DNA in urine and high correlations between urinary HPV DNA and cervical infections have been established. Urine sampling has a number of assets such as its non-invasive character, and allowing for self-collection at home creating options to simplify follow-up of HPV in women participating in HPV vaccine efficacy trials. The current reported variability in urinary HPV sampling and detection can be overcome through relative simple sampling and testing guidelines. Determining persistent infection or lack of therapy response by urinary HPV detection may be an interesting approach to assess a viral end-point in HPV prophylactic and therapeutic vaccine efficacy trials for women.
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Skinner SR, Szarewski A, Romanowski B, Garland SM, Lazcano-Ponce E, Salmerón J, Del Rosario-Raymundo MR, Verheijen RHM, Quek SC, da Silva DP, Kitchener H, Fong KL, Bouchard C, Money DM, Ilancheran A, Cruickshank ME, Levin MJ, Chatterjee A, Stapleton JT, Martens M, Quint W, David MP, Meric D, Hardt K, Descamps D, Geeraerts B, Struyf F, Dubin G. Efficacy, safety, and immunogenicity of the human papillomavirus 16/18 AS04-adjuvanted vaccine in women older than 25 years: 4-year interim follow-up of the phase 3, double-blind, randomised controlled VIVIANE study. Lancet 2014; 384:2213-27. [PMID: 25189358 DOI: 10.1016/s0140-6736(14)60920-x] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although adolescent girls are the main population for prophylactic human papillomavirus (HPV) vaccines, adult women who remain at risk of cervical cancer can also be vaccinated. We report data from the interim analysis of the ongoing VIVIANE study, the aim of which is to assess the efficacy, safety, and immunogenicity of the HPV 16/18 AS04-adjuvanted vaccine in adult women. METHODS In this phase 3, multinational, double-blind, randomised controlled trial, we randomly assigned healthy women older than 25 years to the HPV 16/18 vaccine or control (1:1), via an internet-based system with an algorithm process that accounted for region, age stratum, baseline HPV DNA status, HPV 16/18 serostatus, and cytology. Enrolment was age-stratified, with about 45% of participants in each of the 26-35 and 36-45 years age strata and 10% in the 46 years and older stratum. Up to 15% of women in each age stratum could have a history of HPV infection or disease. The primary endpoint was vaccine efficacy against 6-month persistent infection or cervical intraepithelial neoplasia grade 1 or higher (CIN1+) associated with HPV 16/18. The primary analysis was done in the according-to-protocol cohort for efficacy, which consists of women who received all three vaccine or control doses, had negative or low-grade cytology at baseline, and had no history of HPV disease. Secondary analyses included vaccine efficacy against non-vaccine oncogenic HPV types. Mean follow-up time was 40·3 months. This study is registered with ClinicalTrials.gov, number NCT00294047. FINDINGS The first participant was enrolled on Feb 16, 2006, and the last study visit for the present analysis took place on Dec 10, 2010; 5752 women were included in the total vaccinated cohort (n=2881 vaccine, n=2871 control), and 4505 in the according-to-protocol cohort for efficacy (n=2264 vaccine, n=2241 control). Vaccine efficacy against HPV 16/18-related 6-month persistent infection or CIN1+ was significant in all age groups combined (81·1%, 97·7% CI 52·1-94·0), in the 26-35 years age group (83·5%, 45·0-96·8), and in the 36-45 years age group (77·2%, 2·8-96·9); no cases were seen in women aged 46 years and older. Vaccine efficacy against atypical squamous cells of undetermined significance or greater associated with HPV 16/18 was also significant. We also noted significant cross-protective vaccine efficacy against 6-month persistent infection with HPV 31 (79·1%, 97·7% CI 27·6-95·9) and HPV 45 (76·9%, 18·5-95·6]) Serious adverse events occurred in 285 (10%) of 2881 women in the vaccine group and 267 (9%) of 2871 in the control group; five (<1%) and eight (<1%) of these events, respectively, were believed to be related to vaccination. INTERPRETATION In women older than 25 years, the HPV 16/18 vaccine is efficacious against infections and cervical abnormalities associated with the vaccine types, as well as infections with the non-vaccine HPV types 31 and 45. FUNDING GlaxoSmithKline Biologicals SA.
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Affiliation(s)
- S Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, WA, Australia; Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, NSW, Australia.
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Department of Microbiology, The Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
| | | | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Morelos, Mexico
| | | | - René H M Verheijen
- Gynaecological Oncology and HumVac Research Group, University Medical Center Utrecht, Utrecht, Netherlands
| | - Swee Chong Quek
- Parkway Gynaecology Screening & Treatment Centre, Gleneagles Hospital, Singapore
| | - Daniel P da Silva
- Departmento de Ginecologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
| | - Henry Kitchener
- Women's Cancer Centre, Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Kah Leng Fong
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | | | - Deborah M Money
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; The Women's Health Research Institute, Vancouver, BC, Canada
| | | | | | - Myron J Levin
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Archana Chatterjee
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, and Sanford Children's Specialty Clinics, Sioux Falls, SD, USA
| | - Jack T Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Mark Martens
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, Netherlands
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Castellsagué X, Pawlita M, Roura E, Margall N, Waterboer T, Bosch FX, de Sanjosé S, Gonzalez CA, Dillner J, Gram IT, Tjønneland A, Munk C, Pala V, Palli D, Khaw KT, Barnabas RV, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Fagherazzi G, Kaaks R, Lukanova A, Steffen A, Trichopoulou A, Trichopoulos D, Klinaki E, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita HBA, Peeters PH, Lund E, Weiderpass E, Quirós JR, Sánchez MJ, Navarro C, Barricarte A, Larrañaga N, Ekström J, Hortlund M, Lindquist D, Wareham N, Travis RC, Rinaldi S, Tommasino M, Franceschi S, Riboli E. Prospective seroepidemiologic study on the role of Human Papillomavirus and other infections in cervical carcinogenesis: evidence from the EPIC cohort. Int J Cancer 2014; 135:440-52. [PMID: 24338606 DOI: 10.1002/ijc.28665] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/17/2013] [Accepted: 11/14/2013] [Indexed: 11/11/2022]
Abstract
To evaluate prospectively the association between serological markers of selected infections, including HPV, and risk of developing cervical cancer (CC) and precancer, we performed a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) study that included 184 cases of invasive CC (ICC), 425 cases of cervical intraepithelial neoplasia (CIN) grade 3 or carcinoma in situ (CIS), and 1,218 matched control women. At enrollment participants completed lifestyle questionnaires and provided sera. Subjects were followed-up for a median of 9 years. Immunoassays were used to detect serum antibodies to Human Herpes Virus 2 (HHV-2), Chlamydia trachomatis (CT), Chlamydia pneumoniae, L1 proteins of mucosal and cutaneous HPV types, E6/E7 proteins of HPV16/18, as well as to four polyomaviruses. Adjusted odds ratios (OR) [and 95% confidence intervals (CI)] for CIN3/CIS and ICC risk were respectively: 1.6 (1.2-2.0) and 1.8 (1.1-2.7) for L1 seropositivity to any mucosal HPV type, 1.0 (0.4-2.4) and 7.4 (2.8-19.7) for E6 seropositivity to HPV16/18, 1.3 (0.9-1.9) and 2.3 (1.3-4.1) for CT seropositivity, and 1.4 (1.0-2.0) and 1.5 (0.9-2.6) for HHV-2 seropositivity. The highest OR for ICC was observed for HPV16 E6 seropositivity [OR = 10.2 (3.3-31.1)]. Increasing number of sexually transmitted infections (STIs) was associated with increasing risk. Non-STIs were not associated with CC risk. In conclusion, this large prospective study confirms the important role of HPV and a possible contribution of CT and HHV-2 in cervical carcinogenesis. It further identifies HPV16 E6 seropositivity as the strongest marker to predict ICC well before disease development.
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Affiliation(s)
- Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Tracy JK, Schluterman NH, Greene C, Sow SO, Gaff HD. Planning for human papillomavirus (HPV) vaccination in sub-Saharan Africa: A modeling-based approach. Vaccine 2014; 32:3316-22. [DOI: 10.1016/j.vaccine.2014.03.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
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Castellsagué X, Naud P, Chow SN, Wheeler CM, Germar MJV, Lehtinen M, Paavonen J, Jaisamrarn U, Garland SM, Salmerón J, Apter D, Kitchener H, Teixeira JC, Skinner SR, Limson G, Szarewski A, Romanowski B, Aoki FY, Schwarz TF, Poppe WAJ, Bosch FX, de Carvalho NS, Peters K, Tjalma WAA, Safaeian M, Raillard A, Descamps D, Struyf F, Dubin G, Rosillon D, Baril L. Risk of newly detected infections and cervical abnormalities in women seropositive for naturally acquired human papillomavirus type 16/18 antibodies: analysis of the control arm of PATRICIA. J Infect Dis 2014; 210:517-34. [PMID: 24610876 PMCID: PMC4111909 DOI: 10.1093/infdis/jiu139] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND We examined risk of newly detected human papillomavirus (HPV) infection and cervical abnormalities in relation to HPV type 16/18 antibody levels at enrollment in PATRICIA (Papilloma Trial Against Cancer in Young Adults; NCT00122681). METHODS Using Poisson regression, we compared risk of newly detected infection and cervical abnormalities associated with HPV-16/18 between seronegative vs seropositive women (15-25 years) in the control arm (DNA negative at baseline for the corresponding HPV type [HPV-16: n = 8193; HPV-18: n = 8463]). RESULTS High titers of naturally acquired HPV-16 antibodies and/or linear trend for increasing antibody levels were significantly associated with lower risk of incident and persistent infection, atypical squamous cells of undetermined significance or greater (ASCUS+), and cervical intraepithelial neoplasia grades 1/2 or greater (CIN1+, CIN2+). For HPV-18, although seropositivity was associated with lower risk of ASCUS+ and CIN1+, no association between naturally acquired antibodies and infection was demonstrated. Naturally acquired HPV-16 antibody levels of 371 (95% confidence interval [CI], 242-794), 204 (95% CI, 129-480), and 480 (95% CI, 250-5756) EU/mL were associated with 90% reduction of incident infection, 6-month persistent infection, and ASCUS+, respectively. CONCLUSIONS Naturally acquired antibodies to HPV-16, and to a lesser extent HPV-18, are associated with some reduced risk of subsequent infection and cervical abnormalities associated with the same HPV type.
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Affiliation(s)
- Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia, IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Paulo Naud
- Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil
| | - Song-Nan Chow
- Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan
| | - Cosette M Wheeler
- Department of Pathology and Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque
| | - Maria Julieta V Germar
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippine General Hospital, Manila, The Philippines
| | | | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Finland
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Childrens Research Institute Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Morelos, Mexico
| | - Dan Apter
- Family Federation of Finland, Sexual Health Clinic, Helsinki, Finland
| | - Henry Kitchener
- Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, United Kingdom
| | - Julio C Teixeira
- Departamento de Tocoginecologia da Unicamp, University of Campinas, Sao Paulo, Brazil
| | - S Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, Western Australia Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Genara Limson
- College of Medicine, University of the Philippines, Philippine General Hospital, Makati Medical Centre, Makati City, The Philippines
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Fred Y Aoki
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Tino F Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Academic Teaching Hospital of the University of Wuerzburg, Germany
| | - Willy A J Poppe
- Department of Gynaecology, University Hospital KU Leuven Gasthuisberg, Belgium
| | - F Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia, IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain Network on Cooperative Cancer Research, RTICC, Catalonia, Spain
| | - Newton S de Carvalho
- Department of Gynecology and Obstetrics, Federal University of Paraná, Infectious Diseases in Gynecology and Obstetrics Sector, Curitiba, Brazil
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg, Germany
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic-Gynecologic Oncology, Antwerp University Hospital, University of Antwerp, Belgium
| | - Mahboobeh Safaeian
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, Maryland
| | | | | | | | - Gary Dubin
- GlaxoSmithKline Vaccines, King of Prussia, Pennsylvania
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Wilson L, Pawlita M, Castle PE, Waterboer T, Sahasrabuddhe V, Gravitt PE, Schiffman M, Wentzensen N. Seroprevalence of 8 oncogenic human papillomavirus genotypes and acquired immunity against reinfection. J Infect Dis 2014; 210:448-55. [PMID: 24569064 DOI: 10.1093/infdis/jiu104] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Natural human papillomavirus (HPV) antibody titers have shown protection against subsequent HPV infection, but previous studies were restricted to few HPV genotypes. We examined the association of naturally occurring antibodies against 8 carcinogenic HPV types with subsequent infections. METHODS A total of 2302 women enrolled in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study provided blood samples at baseline. Serum samples were tested for antibodies against 8 carcinogenic HPV genotypes (16, 18, 31, 33, 35, 45, 52, and 58) using a multiplex serology assay. We analyzed the relationship between HPV antibodies and HPV infection during 2 years of follow-up among women negative for the specific HPV type at baseline. RESULTS Baseline seroprevalence for HPV16 L1 was associated with decreased risk of DNA positivity for HPV16 (odds ratio, 0.39 [95% confidence interval, .18-.86]) at ≥2 follow-up visits. We observed similar but nonsignificant decreased risks for HPV18 and 31. These findings were restricted to women reporting a new sex partner during follow-up. There was no association between baseline seroprevalence and detection of precancer during follow-up. CONCLUSIONS Seroprevalence conferred protection against subsequent HPV infection for HPV16 and indicated possible protection for 2 other genotypes, suggesting that this effect is common to several HPV genotypes.
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Affiliation(s)
- Lauren Wilson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina
| | | | | | | | - Vikrant Sahasrabuddhe
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda
| | - Patti E Gravitt
- Department of Epidemiology Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, Maryland
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda
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TOBIN KATY, COMISKEY CATHERINE. A NOVEL APPLICATION OF A CLASSICAL METHOD FOR CALCULATING THE BASIC REPRODUCTIVE NUMBER, R0 FOR A GENDER AND RISK STRUCTURED TRANSMISSION DYNAMIC MODEL OF HUMAN PAPILLOMAVIRUS INFECTION. INT J BIOMATH 2013. [DOI: 10.1142/s1793524513500460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mathematical models are increasingly being used in the evaluation of control strategies for infectious disease such as the vaccination program for the Human Papillomavirus (HPV). Here, an ordinary differential equation (ODE) transmission dynamic model for HPV is presented and analyzed. Parameter values for a gender and risk structured model are estimated by calibrating the model around the known prevalence of infection. The effect on gender and risk sub-group prevalence induced by varying the epidemiological parameters are investigated. Finally, the outcomes of this model are applied using a classical mathematical method for calculating R0 in a heterogeneous mixing population. Estimates for R0 under various gender and mixing scenarios are presented.
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Affiliation(s)
- KATY TOBIN
- Academic Unit of Neurology, Trinity College Dublin, Dublin 2, Ireland
| | - CATHERINE COMISKEY
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
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Liu SH, Cummings DAT, Zenilman JM, Gravitt PE, Brotman RM. Characterizing the temporal dynamics of human papillomavirus DNA detectability using short-interval sampling. Cancer Epidemiol Biomarkers Prev 2013; 23:200-8. [PMID: 24130223 DOI: 10.1158/1055-9965.epi-13-0666] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Variable detection of human papillomavirus (HPV) DNA can result in misclassification of infection status, but the extent of misclassification has not been quantitatively evaluated. METHODS In 2005-2007, 33 women of ages 22 to 53 years self-collected vaginal swabs twice per week for 16 consecutive weeks. Each of the 955 swabs collected was tested for 37 HPV types/subtypes. Assuming that a woman's underlying infection status did not change over the short study period, biases in prevalence estimates obtained from single versus multiple swabs were calculated. Using event history analysis methods, time to recurrent gain and loss of at least one HPV type was determined, separately. Baseline any-type and high risk-type HPV prevalence was 60.6% and 24.2%, respectively. Cumulative any-HPV and high-risk HPV prevalence over the 16-week period was 84.8% and 60.6%, separately. RESULTS Overall, there were 319 events of detection and 313 events of loss of detection. Median times to a recurrent detection and loss of detection were 11 and seven days, respectively. Neither vaginal sex nor condom use during follow-up was associated with recurrent viral detection or loss of detection. Assuming the cumulative 16-week prevalence reflects the true prevalence of infection, the baseline any-HPV prevalence underestimated infection status by 24.2%, with a bootstrapped mean of 20.2% [95% confidence interval (CI), 8.9%-29.6%]. CONCLUSIONS These findings suggest that a substantial proportion of HPV-infected women are misclassified as being uninfected when using a single-time DNA measurement. IMPACT Short-term variation in detectable HPV DNA needs to be considered while interpreting the natural history of infections using single samples collected at long intervals.
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Affiliation(s)
- Su-Hsun Liu
- Authors' Affiliations: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine; Institute for Genome Sciences; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland; Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; and Perdana University Graduate School of Medicine, Serdang, Malaysia
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Katki HA, Schiffman M, Castle PE, Fetterman B, Poitras NE, Lorey T, Cheung LC, Raine-Bennett T, Gage JC, Kinney WK. Five-year risks of CIN 3+ and cervical cancer among women who test Pap-negative but are HPV-positive. J Low Genit Tract Dis. 2013;17:S56-S63. [PMID: 23519306 DOI: 10.1097/lgt.0b013e318285437b] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Current US guidelines for cotesting recommend that the large numbers of women who test Pap-negative, but human papillomavirus (HPV)-positive, return in 1 year, and those who remain HPV-positive or have low-grade squamous intraepithelial lesion (LSIL) or worse Pap results be referred for colposcopy. However, the performance of these guidelines in routine clinical practice has not been evaluated. METHODS We estimated cumulative 5-year risks of cervical intraepithelial neoplasia grade 3 or worse (CIN 3+) among 32,374 women aged 30 to 64 years with HPV-positive/Pap-negative cotest results at Kaiser Permanente Northern California during 2003 to 2010. RESULTS The 5-year CIN 3+ risk after an HPV-positive/Pap-negative cotest result, which was found in 3.6% of women, was 4.5% (95% confidence interval [CI] = 4.2%-4.8%). The 5-year cancer risk was 0.34% (95% CI = 0.26%-0.45%), and half of the cases were adenocarcinoma. Overall, 48% of the women remained HPV-positive on return (median = 418 days after baseline), a percentage that varied little over ages 30 to 64 years. At the return after a baseline HPV-positive/Pap-negative result, almost every repeat cotest result predicted greater subsequent 5-year CIN 3+ risk than the same cotest result had at baseline (HPV-positive/LSIL, 9.2% vs 6.1%, p = .01; HPV-positive/atypical squamous cells of undetermined significance [ASC-US], 7.9% vs 6.8%, p = .2; HPV-positive/Pap-negative, 7.4% vs 4.5%, p < .0001; HPV-negative/LSIL,1.7% vs 2.0%, p = .8; HPV-negative/ASC-US, 2.9% vs 0.43%, p = .0005; HPV-negative/Pap-negative, 0.93% vs 0.08%, p < .0001). CONCLUSIONS Using the principle of "equal management of equal risks," women testing HPV-positive/Pap-negative had a subsequent CIN 3+ risk consistent with risk thresholds for a 1-year return. However, on returning in approximately 1 year, about one-half of women will be referred for colposcopy because of continued HPV positivity or Pap abnormality. Clinicians should keep in mind that cotest results at the return after a baseline HPV-positive/Pap-negative finding are riskier than the same baseline cotest results in the general population, supporting intensified clinical management at return testing.
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Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infectious agent; its 14 oncogenic types are causally associated with 5-10% of all cancers. The major structural HPV protein self-assembles into immunogenic virus-like particles. Two licensed HPV vaccines--the bivalent vaccine comprising HPV types 16 and 18, and the quadrivalent vaccine comprising HPV types 6, 11, 16 and 18--have proven to be safe and efficacious against 6-month-persistent cervical infections of HPV16 and HPV18 and associated precancerous lesions, and both have efficacies of 90-100%. Among baseline HPV-negative adolescent females, vaccine efficacies against the immediate precursor of cervical cancer (intraepithelial neoplasia grade 3) irrespective of HPV type are 93.2% and 43.0% for the bivalent and quadrivalent vaccines, respectively. The quadrivalent vaccine is efficacious (>75% vaccine efficacy) against any of the more-severe precursors of vulval, vaginal and anal cancers. A strong increase in vaccine efficacy with increasing severity of the precancerous lesion is explained by accumulation of the most-oncogenic HPV types 16 and 18 in these lesions. Therefore, prophylactic HPV vaccination will exceed the best results from screening for cancer. With the extremely efficacious prophylactic HPV vaccines, the focus of organized intervention (vaccination and screening) programmes should, however, shift from reducing the HPV disease burden to controlling the prevalence of oncogenic HPV (and nononcogenic HPV) types. Eradication of the major oncogenic HPV types should be pursued.
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Affiliation(s)
- Matti Lehtinen
- University of Tampere, School of Health Sciences, Kalevantie 4, FI-33014 Tampere, Finland.
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Abstract
Model systems show that papillomavirus DNA can persist after lesion-regression, and be maintained in a subset of epithelial basal cells. These are very likely long-lived 'stem-cells' or 'stem-like cells', with latency arising via at least two distinct mechanisms. The first involves low-titre virus infection and the retention of viral DNA at levels that are too low to allow life-cycle completion. The second involves lesion-formation, and clearance by the adaptive immune system, followed by persistence with low-level viral gene expression, and possible reactivation upon immune depletion. Mechanical irritation, inflammation and other extracellular influences affect viral copy number in the latently infected cell, and may predispose to lesion-reappearance. Reactivation may account for the recurrence of 'apparently cleared' cervical lesions caused by high-risk types, the appearance of Beta HPV-lesions following immunosuppression, and the development of recurrent respiratory papillomatosis in afflicted children.
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Affiliation(s)
- John Doorbar
- Division of Virology, National Institute for Medical Research, London, United Kingdom.
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