Prevalence of high-risk human papillomavirus among older women

Abstract

Objective: To estimate the prevalence, genotypes, and individual-level correlates of high-risk human papillomavirus (HPV) among women aged 57-85.

Methods: Community-residing women (N=1,550), aged 57-85, were drawn from a nationally representative probability sample. In-home interviews and biomeasures, including a self-collected vaginal specimen, were obtained between 2005 and 2006. Specimens were analyzed for high-risk HPV DNA using Hybrid Capture 2; of 1,028 specimens provided, 1,010 were adequate for analysis. All samples testing positive were analyzed for HPV DNA by L1 consensus polymerase chain reaction followed by type-specific hybridization.

Results: The overall population-based weighted estimate of high-risk HPV prevalence by Hybrid Capture 2 (Digene Corp.) was 6.0% (95% confidence interval 4.5- 7.9). Current marital and smoking status, frequency of sexual activity, history of cancer, and hysterectomy were associated with high-risk HPV positivity. Among high-risk HPV-positive women, 63% had multiple type infections. Human papillomavirus-16 or -18 was present in 17.4% of all high-risk HPV-positive women. The most common high-risk genotypes among high-risk HPV-positive women were HPV-61 (19.1%), -31 (13.1%), -52 (12.9%), -58 (12.5%), -83 (12.3%), -66 (12.0%), -51 (11.7%), -45 (11.2%), -56 (10.3%), -53 (10.2%), -16 (9.7%), and -62 (9.2%). Being married and having an intact uterus were independently associated with lower prevalence of high-risk HPV. Among unmarried women, current sexual activity and smoking were independently and positively associated with high-risk HPV infection.

Conclusion: In this nationally representative population, nearly 1 in 16 women aged 57-85 was found to have high-risk HPV, and prevalence was stable across older age groups.

Level of evidence: II.

Figure 1

National Social Life Health & Aging Project HPV study participation and test results summary (n, unweighted percentages). hc2, probe hybridization and signal amplification; HPV, human papillomavirus *Due to computer entry error for respondent gender, this respondent was not offered vaginal swab testing. †Tried, but unable to provide specimen (n=9), Equipment/material problems (n=6), Lost/ruined (n=3) ‡Negative for all 37 anogenital high-risk and low-risk HPV genotypes detectable by the Linear Array assay

Figure 2

A. HPV genotype distribution among 56 hc2 high-risk HPV positive specimens B. Number of HPV genotypes present among 56 hc2 high-risk HPV positive specimens Note: Weighted percentages underestimate population prevalences because high-risk HPV negative women were not genotyped. Standard errors are not shown because they are based on fewer than 8 variance strata with observations in both primary sampling units. hc2, probe hybridization and signal amplification; HPV, Human papillomavirus

Figure 2

A. HPV genotype distribution among 56 hc2 high-risk HPV positive specimens B. Number of HPV genotypes present among 56 hc2 high-risk HPV positive specimens Note: Weighted percentages underestimate population prevalences because high-risk HPV negative women were not genotyped. Standard errors are not shown because they are based on fewer than 8 variance strata with observations in both primary sampling units. hc2, probe hybridization and signal amplification; HPV, Human papillomavirus