Dataset Information

Long-term Persistence of Oral HPV Over 7 Years of Follow-up.

ABSTRACT: Background:Human papillomavirus-related oropharyngeal cancer (HPV-OPC) incidence is increasing, but the natural history of the precursor-oral HPV-has not been well described. Methods:This observational cohort study of people living with HIV and at-risk HIV uninfected people evaluated participants semiannually using 30-second oral rinse and gargle specimens over 7?years. Initially, 447 participants were followed for 4 years as part of the Persistent Oral Papillomavirus Study, and a subset of 128 who showed persistent infections at the last Persistent Oral Papillomavirus Study visit had an additional visit, as part of the Men and Women Understanding Throat HPV Study, on average 2.5?years later. Extracted DNA from oral rinse and gargle specimens was amplified using polymerase chain reaction and type specification of 13 oncogenic HPV types. Risk factors for oncogenic oral HPV clearance were evaluated using Cox models. Results:The majority of oncogenic oral HPV infections cleared quickly, with a median time to clearance of 1.4?years (interquartile range =?0.5-3.9 years). After 7?years of follow-up, 97% of incident and 71% of prevalent infections had cleared. Lower HPV-16 viral load was statistically significantly associated with clearance (per 10-fold decrease in copy number: adjusted hazard ratio [aHR] = 2.51, 95% confidence interval [CI] = 1.20 to 5.26; P = .01). Adjusted analyses showed that oncogenic oral HPV clearance was lower among prevalent than incident-detected infections (aHR?=?0.44, 95% CI?=?0.35 to 0.55), among men than women (aHR?=?0.74, 95% CI?=?0.60 to 0.91), for older participants (aHR per 10?years increasing age?=?0.81, 95% CI?=?0.74 to 0.89), and among people living with HIV (aHR?=?0.76, 95% CI?=?0.60 to 0.95). One participant who had oral HPV-16 consistently detected at 10 study visits over 4.5?years was subsequently diagnosed with HPV-OPC. Conclusions:This prospective study of oncogenic oral HPV infection is the longest and largest quantification of oral HPV-16 infections to date.

SUBMITTER: D'Souza G

PROVIDER: S-EPMC7667996 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Long-term Persistence of Oral HPV Over 7 Years of Follow-up.

D'Souza Gypsyamber G Clemens Gwendolyn G Strickler Howard D HD Wiley Dorothy J DJ Troy Tanya T Struijk Linda L Gillison Maura M Fakhry Carole C

JNCI cancer spectrum 20200605 5

<h4>Background</h4>Human papillomavirus-related oropharyngeal cancer (HPV-OPC) incidence is increasing, but the natural history of the precursor-oral HPV-has not been well described.<h4>Methods</h4>This observational cohort study of people living with HIV and at-risk HIV uninfected people evaluated participants semiannually using 30-second oral rinse and gargle specimens over 7 years. Initially, 447 participants were followed for 4 years as part of the Persistent Oral Papillomavirus Study, and a ...[more]

PMID: 33225205

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Project description:ObjectivesTo assess whether the increased sensitivity of screening for human papillomavirus (HPV) may represent overdiagnosis and to compare the long term duration of protective effect against cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HPV based and cytology based screening.Design13 year follow-up of the Swedescreen randomised controlled trial of primary HPV screening.SettingOrganised cervical screening programme in Sweden.Participants12,527 women aged 32-38 attending organised screening were enrolled and randomised to HPV and cytology double testing (intervention arm, n=6257) or to cytology only, with samples frozen for future HPV testing (control arm, n=6270).Main outcome measuresCumulative incidence of CIN2+ and CIN3+ (Kaplan Meier curves). Longitudinal test characteristics were calculated for cytology only, HPV testing only, and cytology and HPV testing combined, adjusting for censoring.ResultsThe increased detection of CIN2+ in the intervention arm decreased over time. After six years, the cumulative incidence of CIN3+ was similar in both trial arms, and after 11 years the cumulative incidence of CIN2+ became similar in both arms. The longitudinal sensitivity of cytology for CIN2+ in the control arm at three years was similar to the sensitivity of HPV testing in the intervention arm at five years of follow-up: 85.94% (95% confidence interval 76.85% to 91.84%) v 86.40% (79.21% to 91.37%). The sensitivity of HPV screening for CIN3+after five years was 89.34% (80.10% to 94.58%) and for cytology after three years was 92.02% (80.59% to 96.97%).ConclusionsOver long term follow-up, the cumulative incidence of CIN2+ was the same for HPV screening and for cytology, implying that the increased sensitivity of HPV screening for CIN2+ reflects earlier detection rather than overdiagnosis. The low long term risks of CIN3+ among women who tested negative in HPV screening, support screening intervals of five years for such women.Trial registrationClinicaltrials.gov NCT00479375.

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Long-term Persistence of Oral HPV Over 7 Years of Follow-up.

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Long-term Persistence of Oral HPV Over 7 Years of Follow-up.

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