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. 2013 Aug 19;8(8):e71617.
doi: 10.1371/journal.pone.0071617. eCollection 2013.

Patterns of human papillomavirus types in multiple infections: an analysis in women and men of the high throughput human papillomavirus monitoring study

Salvatore Vaccarella  1 , Anna Söderlund-Strand, Silvia Franceschi, Martyn Plummer, Joakim Dillner
Affiliations

Patterns of human papillomavirus types in multiple infections: an analysis in women and men of the high throughput human papillomavirus monitoring study

Salvatore Vaccarella et al. PLoS One. .

Abstract

Background: To evaluate the pattern of co-infection of human papillomavirus (HPV) types in both sexes in Sweden.

Methods: Cell samples from genital swabs, first-void urine, and genital swabs immersed in first-void urine were collected in the present cross-sectional High Throughput HPV Monitoring study. Overall, 31,717 samples from women and 9,949 from men (mean age 25) were tested for 16 HPV types using mass spectrometry. Multilevel logistic regression was used to estimate the expected number of multiple infections with specific HPV types, adjusted for age, type of sample, and accounting for correlations between HPV types due to unobserved risk factors using sample-level random effects. Bonferroni correction was used to allow for multiple comparisons (120).

Results: Observed-to-expected ratio for any multiple infections was slightly above unity in both sexes, but, for most 2-type combinations, there was no evidence of significant departure from expected numbers. HPV6/18 was found more often and HPV51/68 and 6/68 less often than expected. However, HPV68 tended to be generally underrepresented in co-infections, suggesting a sub-optimal performance of our testing method for this HPV type.

Conclusions: We found no evidence for positive or negative clustering between HPV types included in the current prophylactic vaccines and other untargeted oncogenic types, in either sex.

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Conflict of interest statement

Competing Interests: The HT-HPV study was supported by Sanofi Pasteur MSD. Dr J. Dillner has acted as consultant for and received research grants from Merck/Sanofi Pasteur MSD. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1
Figure 1. Type-specific human papillomavirus prevalence in samples from women (a) and men (b), Sweden.
Figure 2
Figure 2. Observed versus expected occurrence for 2-type human papillomavirus infections, 31,717 samples from women, Sweden.
Plus signs represent occurrences of HPV pairs. HPV pairs located in the upper triangle indicate positive clustering, while those located in the lower triangle represent negative clustering between the HPV types involved. Three of the p-values for joint HPV infections were significant at the chosen significance level of 0.0004: one positive clustering involving HPV6 with 18; two negative clustering involving the following pairs: HPV51/68, and HPV6/68. Overlaid on the main figure are the occurrences relative to HPV68 (small box on the bottom-right, scaled from 0 to 70) and to HPV6 (small box on the top-left, scaled from 0 to 300). To note, the significant negative cluster involving HPV6/68 appears on both small boxes. HPV68 showed a general tendency to be involved in negative clustering with all other types. The same behaviour was not observed for any other HPV type, including HPV6 that was also involved in 2 significant co-infections, but in opposite directions.
Figure 3
Figure 3. Observed versus expected occurrence for 2-type human papillomavirus infections, 9,949 samples from men, Sweden.
Plus signs represent occurrences of HPV pairs. HPV pairs located in the upper triangle indicate positive clustering, while those located in the lower triangle represent negative clustering between the HPV types involved. There were no significant p-values for joint HPV infections at the chosen significance level of 0.0004.
See this image and copyright information in PMC

References

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