Persistence of HPV in a cohort of female adolescents

Persistence of HPV in a cohort of female adolescents Erika Samoff, Emilia H. Koumans, Lauri E. Markowitz, Maya Sternberg, Mary K. Sawyer, David Swan, John R. Papp, William Secor, Elizabeth R. Unger Centers for Disease Control (CDC), Emory University Dept. of Pediatrics

BackgroundHPV and Cervical Cancer • HPV is necessary but not sufficient to cause cervical cancer • Other sexually transmitted infections may affect HPV persistence and development of cancer • C. trachomatis has been associated with cervical cancer

BackgroundHPV Persistence • Persistence of HPV infection is associated with development of cervical cancer • Concurrent infection (HPV and another genital tract infection) may alter host ability to clear virus • Infection with >1 HPV type may affect the probability of persistence

Study objective To assess whether concurrent infection with C. trachomatis, other organisms, or additional HPV types are associated with HPV persistence.

MethodsStudy Population • Adolescent primary care clinic in public hospital, Atlanta GA • Inclusion: • Adolescent (age 12-19) • Sexually active • Exclusion • HIV-infected • Pregnant • Female

MethodsData collection and laboratory methods • Study visits • Behavioral and exposure data • Urine, vaginal, and cervical samples • 6 month intervals • Laboratory analyses • HPV: Roche line-blot assay (37 HPV types) • C. trachomatis and N. gonorrheae: Nucleic acid amplification tests • T. vaginalis: wet mount • Bacterial vaginosis: Gram stain scored with Nugent’s criteria

MethodsHPVPersistence • Analysis population • Study participants with detection of HPV and a following visit separated by at least 6 months • Persistent outcome • detection of the same HPV type at a pair of sequential visits separated by at least 6 months • Unit of analysis was pairs of visits (high risk and low risk) • Coinfection was assessed at the initial of the pair of visits

MethodsHPV persistence Visit 1 Visit 2 Visit 3 HPV 6 HPV 6 Woman 1 Woman 2 HPV 18 HPV 16 HPV 16

MethodsRegression Analysis • Associations with persistence measured using logistic regression • Generalized estimating equations • allows for analysis of correlated data • exchangeable correlation structure • robust standard errors

ResultsStudy Population N=282 (at least 2 study visits)

ResultsCumulativeHPV detection

ResultsCumulative detection of other genital tract infections

ResultsHPV persistence

Results: Univariate Logistic RegressionAssociations with high-risk HPV persistence

Results: Multivariate Logistic RegressionAssociations with high-risk HPV persistence

ResultsFactors not associated with persistence of high-risk HPV types • Frequency of sex act (vaginal, anal, or oral) in the previous 90 days • Number of sex partners in the previous 90 days • Number of lifetime sex partners before HPV detection • Douching in previous 90 days • Oral contraceptive use in previous 90 days • Smoking was associated in univariate but not multivariate analysis

Conclusions • Co-infection with C. trachomatis is associated with persistence of high-risk HPV types • Infection with >1 HPV type is associated with persistence of high-risk HPV types.

Study participants Study interviewers Study Coordinators Sakinah Carter Antonya Pierce Jamia Holland April Cameron CDC/DSTDP Emily Koumans Lauri Markowitz Eileen Dunne Deblina Datta Maya Sternberg Elizabeth R. Unger Acknowledgements

Persistence of HPV in a cohort of female adolescents