Different human papillomavirus types share early natural history transitions in immunocompetent women

Abstract

Necessary stages of cervical carcinogenesis include acquisition of a carcinogenic human papillomavirus (HPV) type, persistence associated with the development of precancerous lesions, and invasion. Using prospective data from immunocompetent women in the Guanacaste HPV Natural History Study (NHS), the ASCUS‐LSIL Triage Study (ALTS) and the Costa Rica HPV Vaccine Trial (CVT), we compared the early natural history of HPV types to inform transition probabilities for health decision models. We excluded women with evidence of high‐grade cervical abnormalities at any point during follow‐up and restricted the analysis to incident infections in all women and prevalent infections in young women (aged <30 years). We used survival approaches accounting for interval‐censoring to estimate the time to clearance distribution for 20 529 HPV infections (64% were incident and 51% were carcinogenic). Time to clearance was similar across HPV types and risk classes (HPV16, HPV18/45, HPV31/33/35/52/58, HPV 39/51/56/59 and noncarcinogenic HPV types); and by age group (18‐29, 30‐44 and 45‐54 years), among carcinogenic and noncarcinogenic infections. Similar time to clearance across HPV types suggests that relative prevalence can predict relative incidence. We confirmed that there was a uniform linear association between incident and prevalent infections for all HPV types within each study cohort. In the absence of progression to precancer, we observed similar time to clearance for incident infections across HPV types and risk classes. A singular clearance function for incident HPV infections has important implications for the refinement of microsimulation models used to evaluate the cost‐effectiveness of novel prevention technologies.

Epidemiology and Molecular Biology of HPV Variants in Cervical Cancer: The State of the Art in Mexico

“…Cervical cancer (CC) is the most common neoplasia related to HPV infections. A persistent infection with HR-HPV is the main risk factor for the development of most CCs (>85%) [ 2 , 3 ]. Additionally, other anogenital cancers, such as anal, vulvar, vaginal, penile, and a proportion of oropharyngeal and oral cancers, are also caused by HPV [ 4 , 5 ].…”

Risk prediction for HPV-induced lesions in early sexual intercourse

“…The natural history of cervical carcinogenesis includes the acquisition of a high-risk HPV, its persistence, the development of precancerous lesions, and eventually the progression to invasion. (Adebamowo et al, 2022;Sichero et al, 2020) HPV is a necessary but not sufficient factor, therefore, other biological, behavioral and environmental cofactors have been implicated in the development of cancer. ( Kops et al, 2019) Among the risk factors for cervical cancer, sexual behaviors related to HPV infection, such as early sexual intercourse and the multiplicity of partners, stand out.…”

Differential long-term bivalent HPV vaccine cross-protection by variants in the Costa Rica HPV vaccine trial

“…We included women with at least one HPV DNA test result after two years post-enrollment who did not have an HPV type-specific outcome of interest during the initial two-year period to minimize misclassification of infections present at the time of recruitment that were not detected by our HPV genotyping assay. The two-year period was used because most (80%-90%) HPV infections spontaneously clear within two years 33 . The analytical cohort for the randomized trial phase (years 1–4) included women who received three doses of Cervarix (HPV-vaccine arm), and three doses of Havrix (HAV-vaccine arm); women who were free of type-specific infections in the two years following recruitment were genotyped at years 3 and 4.…”