Type-Specific Incidence and Persistence of HPV Infection among Young Women: A Prospective Study in North India

Abstract

Background: Infections with human papillomavirus (HPV) are highly prevalent among sexually active young women in India. However, not much is known about the incidence of type-specific human papillomavirus (HPV) infections and their patterns of persistence, especially in the Indian context. Objective: The objective of this study was to evaluate the rate of acquisition and persistence of HPV types in young women. Methods: Women residing in an urban slum in Delhi (n=1300) were followed for 24 months at 6 monthly intervals. Exfoliated cervical cells collected at each visit were tested for the presence of HPV DNA. Genotyping was performed using the reverse line blot assay. Results: The incidence rate for any HPV type was calculated to be 5 per 1000 women-months. Among high risk HPV types, HPV16 had the highest incidence rate followed by HPV59, HPV52 and HPV18, i.e., 3.0, 0.58, 0.41 and 0.35 women per 1000 women-months respectively. The persistence rate was higher for high-risk than low-risk HPV types. Among low-risk types, HPV42, HPV62, HPV84 and HPV89 were found to persist. Whereas almost all high risk types showed persistence, the highest rate was found in women with HPV types 16, 45, 67, 31, 51 and 59. The persistence rate for HPV16 infection was 45 per 1000 women-months. Conclusion: Incident HPV infections and high risk HPV type-specific persistence were found to be high in our study population of young married women. Understanding the patterns of HPV infection may help plan appropriate strategies for prevention programs including vaccination and screening.

HPV Genotypes distribution in Indian women with and without cervical carcinoma: Implication for HPV vaccination program in Odisha, Eastern India

“…Compared to other studies in India, the present study disclosed a high prevalence of HPV infection among the women with normal cytology showing minor gynecological complaint [5, 6, 15–17]. This study, however, did not look for any bacterial, fungal or HIV infection which could make them prone to HPV infection in symptomatic cases.…”

“…Though there are several reports showing the association of multiple infections with cervical cancer [39, 40] the biological effect of multiple infections on cervical diseases has not yet been established. Synergistic effect of multiple infections by HPV genotypes on carcinogenesis is supported by many studies [7–9, 17, 26], while contradicting studies [25, 29, 31, 32, 35] invoke confusion. Association of multiple infections with tumor size is an interesting finding in this regard.…”

“…Data on the prevalence and distribution of three most prominent genotypes in the cancer cases from different geographical regions of India shows a great regional variation [5–9, 15–17]. …”

Type-specific Prevalence of Human Papillomavirus by Cervical Cytology among Women in Brasov, Romania

“…This pattern is observed in the most studies all over the world, although second peaks are sometimes observed in older women (Munoz et al, 2004;Franceschi et al, 2006;Trottier and Franco, 2006;Lee et al, 2012). This decrease in HPV infection prevalence with age may be explained by the fact in most cases HPV infection is self-limited and the virus is cleared by the host innate immune response (Ho et al, 1998;Stanley, 2006;Datta et al, 2012). In some cases the immune response fails to clear the infection and in subjects persistently infected by HR-HPV types there is a risk of progression to high-grade cervical intraepithelial neoplasia and invasive cancer (Ho et al, 1998;Schlecht et al, 2001;Snijders et al, 2006).…”

Prevalence and Genotype Distribution of Human Papillomavirus among Women from Henan, China

“…The highest prevalence of the HR-HPV infection (55.0%) appeared in the >60 years group was more likely for viral persistence than for acquisition of new infection (Castle et al, 2005;Goodman et al, 2008). It was reported that the persistence rate of the HR-HPV infection was higher than LR-HPV infection, and it was a strong predictor for the development of CIN2/3 and invasive cervical cancer (Dalstein et al, 2003;Datta et al, 2012). The previous work found that the HR-HPV DNA was positive among 80% of patients with cervical cancer, so more inspections, including cytology and even colposcopy, should be proceed among women aged >60 years for the prevention of cervical cancer (Wang et al, 2013).…”