Human Papillomavirus Intermittence and Risk Factors Associated With First Detections and Redetections in the Ludwig-McGill Cohort Study of Adult Women
Talía Malagón, Helen Trottier, Mariam El‐Zein, Luisa L. Villa, Eduardo L. Franco, Ludwig-McGill Cohort Study, São Paulo, Maria Luiza Baggio, Lenice Galan, João Simão Sobrinho, José Carlos Mann Prado, Lara Termini, Maria Cecília Costa, Romulo Miyamura, Andrea Trevisan, Patrícia Thomann, João Manuel Grisi Candeias, Laura Sichero, Paula Rahal, Antonio Ruíz, Jane Haruko Lima Kaiano, Mónica Santos, Patricia Savio, Paulo Maciag, Tatiana Rabachini, Silvaneide Ferreira, Luisa L. Villa, Mariam El-Zein, Marie‐Claude Rousseau, Salaheddin M. Mahmud, Nicolas F. Schlecht, Helen Trottier, Harriet Richardson, Alex Ferenczy, Thomas E. Rohan, Myriam Chévarie‐Davis, Karolina Louvanto, Joseph E. Tota, Eileen Shaw, Agnihotram V. Ramanakumar, Eliane Duarte, Sophie Kulaga, Juliette Robitaille, Eduardo L. Franco
Abstract
BACKGROUND: We assessed the incidence and risk factors for first detection and redetection with the same human papillomavirus (HPV) genotype, and prevalence of cytological lesions during HPV redetections. METHODS: The Ludwig-McGill cohort study followed women aged 18-60 years from São Paulo, Brazil in 1993-1997 for up to 10 years. Women provided cervical samples for cytology testing and HPV DNA testing at each visit. A redetection was defined as a recurring genotype-specific HPV positive result after 1 or more intervening negative visits. Predictors of genotype-specific redetection were assessed using adjusted hazard ratios (aHR) with Cox regression modeling. RESULTS: In total, 2184 women contributed 2368 incident HPV genotype-specific first detections and 308 genotype-specific redetections over a median follow-up of 6.5 years. The cumulative incidence of redetection with the same genotype was 6.6% at 1 year and 14.8% at 5 years after the loss of positivity of the first detection. Neither age (aHR 0.90; 95% confidence interval [CI], .54-1.47 for ≥45 years vs < 25 years) nor new sexual partner acquisition (aHR 0.98; 95% CI, .70-1.35) were statistically associated with genotype-specific redetection. High-grade squamous intraepithelial lesion prevalence was similar during first HPV detections (2.9%) and redetection (3.2%). CONCLUSIONS: Our findings suggest many HPV redetections were likely reactivations of latent recurring infections.