Long-term persistence of prevalently detected human papillomavirus infections in the absence of detectable cervical precancer and cancer

Abstract

Background: Detailed descriptions of long-term persistence of human papillomavirus (HPV) in the absence of cervical precancer are lacking.

Methods: In a large, population-based natural study conducted in Guanacaste, Costa Rica, we studied a subset of 810 initially HPV-positive women with ≥ 3 years of active follow-up with ≥ 3 screening visits who had no future evidence of cervical precancer. Cervical specimens were tested for >40 HPV genotypes using a MY09/11 L1-targeted polymerase chain reaction method.

Results: Seventy-two prevalently-detected HPV infections (5%) in 58 women (7%) persisted until the end of the follow-up period (median duration of follow-up, 7 years) without evidence of cervical precancer. At enrollment, women with long-term persistence were more likely to have multiple prevalently-detected HPV infections (P < .001) than were women who cleared their baseline HPV infections during follow-up. In a logistic regression model, women with long-term persistence were more likely than women who cleared infections to have another newly-detected HPV infection detectable at ≥ 3 visits (odds ratio, 2.6; 95% confidence interval, 1.2-5.6).

Conclusions: Women with long-term persistence of HPV infection appear to be generally more susceptible to other HPV infections, especially longer-lasting infections, than are women who cleared their HPV infections.

Figure 1.

Consort diagram to outline which women were included in the analyses of long-term human papillomavirus (HPV) persistence, starting with the subgroup of women who tested HPV positive at baseline by polymerase chain reaction (PCR) regardless of their follow-up, compared with the 2624 women who were undergoing active follow-up). The box at the bottom with gray background and white type highlights the final analytic group. *Includes 29 infections among 18 women with <3 years of follow-up who cleared infection.

Figure 2.

Percentage of prevalently-detected human papillomavirus (HPV) infections that demonstrated long-term HPV persistence by groups of HPV genotypes defined by phylogenetic species or cancer risk. Binomial 95% confidence intervals for groups of HPV genotypes are shown as vertical bars.