Journal
INTERNATIONAL JOURNAL OF CANCER
Volume 131, Issue 8, Pages 1874-1881Publisher
WILEY
DOI: 10.1002/ijc.27418
Keywords
HPV infection re-appearance; CIN2+; risk after re-appearance; HPV infection epidemiology
Categories
Funding
- National Institutes of Health [N01-CP-21081, N01-CP-33061, N01-CP-40542, N01-CP-50535, N01-CP-81023]
- Intramural Program [CA78527]
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Carcinogenic human papillomavirus (HPV) infections are very common after sexual debut and nearly all become undetectable (clear) within a few years. Following clearance, the long-term risks of type-specific HPV re-appearance and subsequent risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) are not well defined. In the 7-year, population-based cohort study in Guanacaste, Costa Rica, we studied how often type-specific carcinogenic HPV infections re-appeared after clearance and how often re-appearance led to CIN2+. We considered 1,740 carcinogenic HPV infections detected by MY09/11 PCR among 2,805 women (1891 years old, median 34) who were actively followed at 6- or 12-month intervals. We identified women with one or more type-specific HPV infections that cleared and re-appeared and further defined a subgroup of definite clearance and re-appearance (=2 intervening negative results over a period of =1 year). We determined the absolute risk of CIN2+ among the different groups. p values are two-sided. Only 7.7% (81/1,052) of HPV-infected women had intervening negative results. Very few (3.7%, 39/1,052) had definite clearance and re-appearance, of which 5.1% (2/39) subsequently persisted to a diagnosis of CIN2. There were zero CIN3+ lesions. Extremely few women (2/2,805 of women in our cohort) had a type-specific carcinogenic HPV infection clear, re-appear and lead to CIN2+. If confirmed, this argues against vaccination to avoid re-appearance that leads to precursor lesions and against the need of frequent HPV screening after initial negative results.
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