Epidemiologic Profile of Type‐Specific Human Papillomavirus Infection and Cervical Neoplasia in Guanacaste, Costa Rica

Albert Einstein College of Medicine, New York, New York, United States
The Journal of Infectious Diseases (Impact Factor: 6). 06/2005; 191(11):1796-807. DOI: 10.1086/428850
Source: PubMed


Detailed epidemiologic studies of cervical type-specific human papillomavirus (HPV) infection in large populations are scarce.
We recruited a population-based cohort in Guanacaste, Costa Rica. Participants were interviewed, screened for cervical neoplasia, and tested for >40 HPV types by use of MY09/11 L1 consensus primer polymerase chain reaction. We estimated the risk factors for infection and the associations between type-specific HPV infections and cervical intraepithelial neoplasia (CIN) and cancer in 8514 sexually active women who had not undergone a hysterectomy.
The overall HPV prevalence was 26.5%. The most common type was HPV-16 (3.6% of the population). HPV prevalence showed a U-shaped age-specific curve. Sexual behaviors were the main determinants of oncogenic and nononcogenic infections; age at first sexual intercourse was not independently associated with infection. Barrier contraceptive use was somewhat protective against infection. Oncogenic infections were strongly associated with risk of all grades of CIN and of cancer. Types 16, 18, and 58 were the most common in women diagnosed with CIN3 and cancer. Except for those that included HPV-16, multiple-type infections were associated with an increased risk (compared with that for single-type infections) of all grades of CIN and of cancer.
We confirmed the bimodal age pattern of HPV infection in Guanacaste and the sexually transmitted nature of both oncogenic and nononcogenic HPV types.

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Available from: Ana Cecilia Rodriguez
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    • "The number of multiple-genotype infections (6.5%) was high in Yunnan; furthermore, the prevalence of single-genotype (10.9%) infections was also high. Multiplegenotype infections can increase the risk of cervical cancer development in infected cases compared with women who are infected with only a single genotype (Herrero et al., 2005). Low incomes and low asset values are not only correlated but also mutually reinforcing. "
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    ABSTRACT: The prevalence and genotype distribution of human papillomavirus (HPV) vary throughout the world. To assess the prevalence and genotype distribution of HPV among three ethnic groups in two geographic locations in northwestern Yunnan, we recruited 522 women in Shangri-le (n=255) and Lijiang (n=267). PCR amplification of HPV DNA was performed on cervical cells from these women using two consensus primer systems (MY09/11 and GP5/6). Amplified HPV DNA was genotyped using the HPV GenoArray test. Geographically, the HPV prevalence was significantly higher (P=0.002) among Shangri-le women than among Lijiang women. Infections with high-risk (HR)-HPV and with multiple HPV genotypes were also significantly more common (P=0.001) among women in Shangri-le than women in Lijiang. Additionally, the prevalence of overall, HR-HPV, and single genotype HPV infections was significantly higher (P=0.001) among Tibetan women than among Naxi and Han women. HPV-16 and HPV-33 were significantly more frequent in Shangri-le women compared with Lijiang (P=0.006) women. In addition, HPV-16 (9.81%) and HPV-33 (5.88%) were significantly more prevalent in Tibetan women than in Naxi and Han women. Here, for the first time, we highlight the significant variation in the prevalence and genotype distribution of HPV in various populations in the north-western region of Yunnan Province. This article is protected by copyright. All rights reserved.
    Full-text · Article · Aug 2015 · Journal of Medical Virology
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    • "; however, a higher prevalence of LR-HPV was observed in the present study than in other studies conducted in Asia [16] [17]. These differences may be explained by the uniqueness of the study population, differences in the age of the participants , and the methods used to detect HPV. "
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    ABSTRACT: Objective To describe the distribution of specific types of low-risk (LR) human papillomavirus (HPV) among a general population of northern Chinese women. Methods Between 2007 and 2012, 118 096 women were tested with the HPV Geno-Array Test Kit (HybriBio) at China Medical University’s Shengjing Affiliated Hospital, Shenyang, China. Among these women, 80 418 underwent cervical cytology and colposcopic examination, and 30 961 of these had a cervical biopsy. The prevalence of HPV infection among the women was analyzed according to age, and cytologic and histologic findings. Results CP8304 was the most common type of LR-HPV overall, and was most prevalent in the youngest age group. The overall prevalence of LR-HPV (averaged across all types) was 1.7% in women with normal cytology, 8.8% in those with atypical squamous cells of undetermined significance (ASCUS), 8.0% in those with low-grade squamous intraepithelial lesions (LSIL), and 5.8% in those with high-grade squamous intraepithelial lesions (HSIL). LR-HPV alone, without any high-risk (HR)-HPV, was most common among women with ASCUS and cervical intraepithelial neoplasia (CIN) not otherwise specified (CINNOS) together. Co-infections of LR-HPV and HR-HPV were most common among women with LSIL and CIN1. Conclusion These data will facilitate modeling of the cost-effectiveness of a prophylactic LR-HPV vaccination in China.
    Preview · Article · Jul 2014 · International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
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    • "It has been hypothesised that reactivation of HPV may be at least partly responsible for the high HPV prevalence observed in older women (see, for example, [5,6]), while another possibility worth consideration is changes in sexual behaviour of men and/or women in middle-age [1]. In the case of Australia, the latter appears unlikely to be responsible for a U-shaped prevalence curve, should it be observed, as the most recently conducted comprehensive sexual behaviour survey (the Australian Study of Health and Relationships (ASHR)), did not demonstrate any notable increase in sexual activity in older Australians [7]. "
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    ABSTRACT: Background Some regional cross-sectional human papillomavirus (HPV) DNA prevalence data show an increase in prevalence in older women, the reasons for which are as yet unknown. A recently published study suggests that the increase may be at least partly due to reactivation of latent HPV in menopausal women. Methods We developed a dynamic mathematical model of HPV-16 transmission to estimate the key consequences of hypothetical HPV-16 reactivation in the Australian heterosexual population. We only consider a worst case scenario with regard to reactivation in the Australian setting when all women who are latently infected reactivate and, wherever feasible, we choose model parameter values which may lead to a more pronounced reactivation. The ongoing National HPV vaccination program covering both women and men is incorporated in the model. Results We estimate that about 1 in 10 women and men who appear to have cleared HPV-16 infection may be latently infected. The prevalence of HPV-16 in older Australian women will increase by a factor of up to 3.1 between now and 2025 which will be accompanied by an increase by a factor of around 1.9 in older men. However, the long-term impact of the HPV vaccination is not significantly altered by reactivation. Conclusions If the reactivation hypothesis we consider is substantiated, the public health response should be focused on further improvement of cervical screening coverage for older women. Our study also highlights the urgent need for surveillance of HPV prevalence in older Australians.
    Full-text · Article · Jun 2014 · BMC Infectious Diseases
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