Patterns of Human Papillomavirus Types in Multiple Infections: An Analysis in Women and Men of the High Throughput Human Papillomavirus Monitoring Study

Abstract

BackgroundTo evaluate the pattern of co-infection of human papillomavirus (HPV) types in both sexes in Sweden.MethodsCell samples from genital swabs, first-void urine, and genital swabs immersed in first-void urine were collected in the present cross-sectional High Throughput HPV Monitoring study. Overall, 31,717 samples from women and 9,949 from men (mean age 25) were tested for 16 HPV types using mass spectrometry. Multilevel logistic regression was used to estimate the expected number of multiple infections with specific HPV types, adjusted for age, type of sample, and accounting for correlations between HPV types due to unobserved risk factors using sample-level random effects. Bonferroni correction was used to allow for multiple comparisons (120).ResultsObserved-to-expected ratio for any multiple infections was slightly above unity in both sexes, but, for most 2-type combinations, there was no evidence of significant departure from expected numbers. HPV6/18 was found more often and HPV51/68 and 6/68 less often than expected. However, HPV68 tended to be generally underrepresented in co-infections, suggesting a sub-optimal performance of our testing method for this HPV type.ConclusionsWe found no evidence for positive or negative clustering between HPV types included in the current prophylactic vaccines and other untargeted oncogenic types, in either sex.

Evaluation of HPV type‐replacement in unvaccinated and vaccinated adolescent females—Post‐hoc analysis of a community‐randomized clinical trial (II)

“…26,27 Thus, we used it but only as a sensitivity analysis to achieve more insight into a priori hypothesized prevalence rate ratio differences. 12,[28][29][30][31][32][33][34][35][36] Indeed, if significant clustering of HPV types was observed it was regarded as a bias stemming from the unspecific genotyping of different HPV types. As for HPV16, its unique clearance characteristics make it difficult to compare the different HPV specific clustering observations.…”

“…7 However, thus far HPV type-replacement has not been observed at the individual level among HPV vaccinated females with low vaccination coverage in the target population. [10][11][12] Implementation of national HPV vaccination programs, however, tends to increase prevalence of some non-vaccine covered HPV types suggesting type-replacement. [10][11][12] Implementation of national HPV vaccination programs, however, tends to increase prevalence of some non-vaccine covered HPV types suggesting type-replacement.…”

Distinct geographic clustering of oncogenic human papillomaviruses multiple infections in cervical cancers: Results from a worldwide cross‐sectional study

“…[25][26][27] Particularly, some HPVs such as HPV39 and HPV51 not included in the vaccine formulations have previously shown increase in prevalence after vaccination suggesting the possibility of type replacement. 25,26 However, thus far, competition between HPV types, which is the prerequisite for HPV type replacement, has not been persistently observed among unvaccinated 7,18,28,29 or vaccinated populations. [25][26][27]…”

Comparison of Two Widely Used Human Papillomavirus Detection and Genotyping Methods, GP5+/6+-Based PCR Followed by Reverse Line Blot Hybridization and Multiplex Type-Specific E7-Based PCR

“…GP5ϩ/6ϩ primers have long been known to be deficient in detection of HPV53 (18,19), and a series of meta-analyses of global HPV type distribution (20)(21)(22) has always considered HPV53 to be undetectable by GP5ϩ/6ϩ PCR. Underdetection of HPV68 has been reported for GP5ϩ/6ϩ PCR in two independent comparisons against another HPV genotyping method, Papillocheck (23,24), and for a modified GP5ϩ/6ϩ PCR assay (25), which was thought to be related to a deficiency in detecting one of two HPV68 subtypes (23).…”