High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

Abstract

We followed 353 women referred with abnormal cervical cytology in a non-intervention cohort study. In 91 pregnant women we compared high-risk human papilloma virus rates in the subsequent trimesters and postpartum in comparison to 262 nonpregnant women. High-risk human papilloma virus clearance was compared with 179 high-risk human papilloma virus positive non-pregnant women. Our main questions were: (1) do high-risk human papilloma virus rates change during pregnancy?; and (2) is there any difference between high-risk human papilloma virus clearance in pregnant and non-pregnant women? Women were monitored 3 -4 monthly by cytology, colposcopy, and high-risk human papilloma virus testing. The median follow-up time was 33 months (range 3 -74). Non-pregnant women showed prevalence rates of high-risk human papilloma virus of 64, 57, 53, and 50%, respectively, in four subsequent 3-months periods since the start of the study. These high-risk human papilloma virus rates were higher than in the three trimesters of pregnancy, and during the first 3 months postpartum, i.e. 50, 44, 45, and 31%, respectively. Postpartum only, this difference was statistically significant (P=0.004). Paired comparisons of high-risk human papilloma virus prevalence rates of the different trimesters with the postpartum rate showed (McNemar test) decreased rates: first trimester: 18% (P=0.02), second trimester: 13% (P=0.02) and third trimester: 23% (P50.005). Such a phenomenon was not found in non-pregnant women. Pregnant women showed a trend for increased high-risk human papilloma virus clearance during the third trimester and postpartum compared to non-pregnant women (hazard ratios 3.3 (0.8 -13.7) and 4.6 (1.6 -12.8), respectively). These results suggest a lowered immune-response against human papilloma virus during the first two trimesters of pregnancy with a catch-up postpartum. Keywords: human papillomavirus; pregnancy; follow-up study; natural history; prevalence Several epidemiological and biological studies have established the important role of infection with high-risk types of human papilloma virus (HPV) for development of cervical cancer and its precursor lesions. In women with or without abnormal cervical smears a positive high-risk HPV test result indicates an increased risk for development of high grade cervical lesions (Ho et al, 1995;Remmink et al, 1995;Rozendaal et al, 1996Rozendaal et al, , 2000Nobbenhuis et al, 1999). Moreover, in nearly all cervical cancers high-risk HPV types have been detected .The increased prevalence of high grade cervical lesions and cervical cancer in immunocompromised patients, such as AIDS patients and transplant recipients, indicates that persistence of high-risk HPV and consequently HPV-mediated carcinogenesis is related to compromised immunosurveillance (IARC, 1995;Petry et al, 1996;Sun et al, 1997). Pregnancy is believed to alter immune-response in women (Schneider et al, 1987;Sethi et al, 1998). Some authors concluded pregnancy has no effect on CIN (Jain et al, 1997). Others reported high regress...

Epidemiology of human papillomavirus genotypes in pregnant Japanese women

“…The accelerated clearance of HPV may be due to the host immune system normalizing during the third trimester. 18 Our results showed that HPV 16 and HPV 52 were the two most common genotypes among pregnant Japanese women. Our data among 154 non-pregnant Japanese women also showed that HPV 16 and HPV 52 were the two most common genotype.…”

“…Following PCR amplification, hybridization of the HPV amplicon was performed using an array of oligonucleotide probes that allowed independent identification of individual HPV genotypes. This kit can detect 37 HPV genotypes (6,11,16,18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73 (MM9), 81, 82 (MM4), 83 (MM7), 84 (MM8), IS39 and CP6108 (89)). For consistency with previous studies, we considered 16 HPV genotypes (16, 18, 31, 33, 35, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73 and 82) as high-risk genotypes that are related to cervical cancer.…”

Effect of Second Pregnancy on Maternal Carriage and Outcome of High-Risk Human Papillomavirus (HPV)

“…In this analysis, 2nd pregnancy had no significant effect on clearance or acquisition of incident HR-HPV during the 36-month follow-up, which was also confirmed by the Cox proportional hazard regression model (data not in figures). Only one previous study has addressed this issue, reporting that pregnant women with a history of abnormal PAP smear showed a trend for increased HR-HPV clearance during the 3rd trimester and post-partum as compared to non-pregnant women [24] . However, the long-term course of HR-HPV infection remained unaffected in their study as well.…”

Prevalencia de infección por virus de papiloma humano (VPH) de alto riesgo y factores asociados en embarazadas derechohabientes del IMSS en el estado de Morelos

“…15,16 También se ha informado que mujeres infectadas con VPH muestran mayor persistencia y progresión de la infección durante y después del embarazo; sin embargo, no se encuentran bien documentados los mecanismos por medio de los cuales el embarazo modifica el riesgo de la infección y la persistencia y progresión a lesiones clínicas. [17][18][19] En este estudio se encontró una prevalencia de infección de VPH de alto riesgo de 37.2%, que es una cifra similar a las informadas en los estudios de Fife y colaboradores (29.5%) y Hangensse y colaboradores (20%). 20,27 Considerando que las prevalencias pueden variar de acuerdo con la edad y el tiempo de gestación, en este estudio no se observa un patrón claro, pero la mayor ridad de 0-9 años (RM = 2.2; IC 95%1.5-4.3).…”