Association of Serum 25-Hydroxyvitamin D With Prevalence, Incidence, and Clearance of Vaginal HPV Infection in Young Women

Abstract

Background: We assessed the association between serum 25-hydroxyvitamin D levels and genital human papillomavirus (HPV) prevalence, incidence, and clearance among female participants in the HPV Infection and Transmission among Couples through Heterosexual activity (HITCH) Cohort Study.

Methods: We genotyped HPV DNA in vaginal samples and quantified baseline serum 25-hydroxyvitamin D levels using Roche's Linear Array and Total vitamin D assay, respectively. We used logistic and Cox proportional hazards models, respectively, to estimate adjusted odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: There was no association between vitamin D levels (every 10-ng/mL increase) at baseline and HPV prevalence (OR, 0.88; 95% CI, .73-1.03) or incidence (HR, 0.88; 95% CI, .73-1.06), but we observed a modest negative association with HPV clearance (HR, 0.76; 95% CI, .60-.96). Vitamin D levels <30 ng/mL, compared with those ≥30 ng/mL, were not associated with HPV prevalence (OR, 0.98; 95% CI, .57-1.69) or incidence (HR, .87; 95% CI, .50-1.43), but they were associated with a marginally significant increased clearance (OR, 2.14; 95% CI, .99-4.64). We observed consistent results with restricted cubic spline modeling of vitamin D levels and clinically defined categories. HPV type-specific analyses accounting for multiple HPV infections per participant showed no association between vitamin D levels and all study outcomes.

Conclusions: This study provided no evidence of an association between low vitamin D levels and increased HPV prevalence, acquisition, or clearance.

Keywords: 25-hydroxyvitamin D; HPV DNA infection; HPV clearance; HPV prevalence; vitamin D.

Figure 1.

Association between vitamin D Levels and the prevalence of human papillomavirus (HPV) infection. Serum vitamin D levels were modeled using restricted cubic splines for any HPV (A) and for subgenus 1 (B), 2 (C), and 3 (D). Solid lines represent the model estimates, and shaded regions correspond to the 95% confidence intervals.

Figure 2.

Association between baseline serum vitamin D levels and the incidence of human papillomavirus (HPV) infection at follow-up. Serum vitamin D levels were modeled using restricted cubic splines for any HPV (A) and for subgenus 1 (B), 2 C), and 3 (D), using 30 ng/mL as the reference value. Solid lines represents the model estimates, and dashed lines correspond to the 95% confidence intervals. Abbreviation: HR, hazard ratio.

Figure 3.

Association between baseline serum vitamin D levels and clearance of human papillomavirus (HPV) infection at follow-up. Serum vitamin D levels were modeled using restricted cubic splines for any HPV (A) and for subgenus 1 (B), 2 (C), and 3 (D), using 30 ng/mL as the reference value. Solid lines represent the model estimates, and dashed lines correspond to the 95% confidence intervals. Abbreviation: HR, hazard ratio.