Contributions of Recent and Past Sexual Partnerships on Incident Human Papillomavirus Detection: Acquisition and Reactivation in Older Women

Epidemiology, Johns Hopkins Bloomberg School of Public Health.
Cancer Research (Impact Factor: 9.33). 09/2012; 72(23). DOI: 10.1158/0008-5472.CAN-12-2635
Source: PubMed


Understanding the fraction of newly detected human papillomavirus (HPV) infections due to acquisition and reactivation has important implications on screening strategies and prevention of HPV-associated neoplasia. Information on sexual activity and cervical samples for HPV DNA detection using Roche Linear Array were collected semi-annually for two years from 700 women age 35-60 years. Incidence and potential fraction of HPV infections associated with new and lifetime sexual partnerships were estimated using Poisson models. Cox frailty models were used to estimate hazard ratios (HR) for potential risk factors of incident HPV detection. Recent and lifetime numbers of sexual partners were both strongly associated with incident HPV detection. However, only 13% of incident detections were attributed to new sexual partners whereas 72% were attributed to ≥5 lifetime sexual partners. Furthermore, 155 out of 183 (85%) incident HPV detections occurred during periods of sexual abstinence or monogamy, and were strongly associated with cumulative lifetime sexual exposure (HR: 4.1, 95% CI: 2.0, 8.4). This association increased with increasing age. These data challenge the paradigm that incident HPV detection is driven by current sexual behavior and new viral acquisition. Our observation that most incident HPV infection was attributable to past, not current, sexual behavior at older ages supports a natural history model of viral latency and reactivation. As the highly exposed baby-boomer generation of women with sexual debut after the sexual revolution transition to menopause, the implications of HPV reactivation at older ages on cervical cancer risk and screening recommendations should be carefully evaluated.

Download full-text


Available from: Anne Fortino Rositch
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: At present, there is no consensus in the scientific community regarding the ability for human papillomavirus (HPV) infections to establish latency. Based on animal studies, a model of papillomavirus latency has been proposed in which papillomaviruses can be retained in the basal epithelial stem cell pool as latent infections and periodically induced to reactivate when the stem cell divides and one daughter cell is committed to terminal differentiation and induction of the viral life cycle. Tissue resident memory T-cells are hypothesized to control these periodic reactivation episodes and thus limit their duration. In this paper, evidence from human studies consistent with this model of papillomavirus latency is reviewed. Given the strong circumstantial evidence supporting a natural history of HPV infection which includes a immunologically controlled latent state, the longer term implications of HPV latency on a highly infected and aging population may warrant a more serious evaluation.
    Full-text · Article · Dec 2012 · The Open Virology Journal
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Human immunodeficiency virus (HIV)-infected individuals are at greater risk for human papillomavirus (HPV)-associated anal than oropharyngeal cancers. The prevalence of anal vs oral HPV infections is higher in this population, but whether this is explained by higher incidence or persistence is unknown. Methods: Oral rinse and anal swab samples were collected semiannually from 404 HIV-infected adults in Baltimore, Maryland. Samples were tested for 37 HPV types using PGMY09/11 primers and reverse line-blot hybridization. Risk factors for HPV persistence were explored using adjusted Wei-Lin-Weissfeld models. Results: The prevalence (84% vs 28%), incidence (145 vs 31 per 1000 person-months), and 12-month persistence (54% vs 29%) were higher for anal vs oral HPV infections, respectively (each P < .001). Heterosexual men had lower incidence of anal HPV than men who have sex with men and women, but a higher incidence of oral HPV infection (test of interaction P < 0.001). In adjusted analyses, risk factors for HPV persistence included prevalent vs incident (adjusted hazard ratio [aHR] = 4.0; 95% confidence interval [CI], 3.5-4.8) and anal vs oral HPV infections (aHR = 1.5; 95% CI, 1.2-1.9). Conclusions: The higher incidence and persistence of anal vs oral HPV infections likely contributes to the higher burden of anal as compared to oral HPV-associated cancers in HIV-infected individuals.
    Full-text · Article · Apr 2013 · The Journal of Infectious Diseases
  • [Show abstract] [Hide abstract]
    ABSTRACT: Genital human papillomavirus (HPV) infection is the most common sexually transmitted infection. Most HPV infections are benign and resolve on their own, but some women develop persistent HPV infections. Persistent HPV infection with certain high-risk HPV genotypes is the necessary cause of most epithelial lesions of the uterine cervix. The importance of latent or quiescent HPV, waning immunity, hormonal milieu, microbiota, and other factors modifying the natural history of HPV infections across a woman's lifetime deserves further study. Promising biomarkers are emerging that may aid in defining which HPV-infected women are at risk of developing invasive cervical cancer.
    No preview · Article · Jun 2013 · Obstetrics and Gynecology Clinics of North America
Show more