The natural history of human papillomavirus infection and cervical intraepithelial neoplasia among young women in the guanacaste cohort shortly after initiation of sexual lif

THE NATURAL HISTORY OF HUMAN PAPILLOMAVIRUS INFECTION AND CERVICAL INTRAEPITHELIAL NEOPLASIA AMONG YOUNG WOMEN IN THE GUANACASTE COHORT SHORTLY AFTER INITIATION OF SEXUAL LIF

Sex Trans Dis 2007 Jan 17 [Epub ahead of print]

Rodriguez AC, Burk R, Herrero R, Hildesheim A, Bratti C, Sherman ME, Solomon D, Guillen D, Alfaro M, Viscidi R, Morales J, Hutchinson M, Wacholder S, Schiffman M

Division of Cancer Epidemiology and Genetics and the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, DHHS, Rockville, Maryland; Proyecto Epidemiologico Guanacaste, INCIENSA Foundation, San Jose, Costa Rica; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York; Johns Hopkins Medical Institutions, Baltimore, MD; and Womens and Infants Hospital, Providence, Rhode Island.

ABSTRACT:

OBJECTIVE: Cross-sectional analyses of our 10,000-woman, population-based Guanacaste cohort suggest a lag of >/=10 years between the peak of human papillomavirus (HPV) infection and the later peak of cervical intraepithelial neoplasia grade 3 (CIN 3). We wanted to explore early HPV natural history and CIN 3 prospectively.

STUDY DESGIN: As part of the Guanacaste cohort, we followed 206 initially virginal women aged 18 to 26 semiannually for a medial of 3.6 years after initiation of sexual life.

RESULTS: A total of 53.4% of women tested positive during the study for >/=1 HPV type. Very few infections persisted for >1 to 2 years. Three women had histologically confirmed CIN 3, of which 2 showed persistent HPV 16. The other had serologic evidence of HPV 31.

CONCLUSIONS: HPV infection occurs frequently and clears rapidly in most young women initiating sexual intercourse. Persistent HPV 16 can cause early CIN 3. The peak age for CIN 3 will decline with the increased screening intensity and sensitivity typical of longitudinal studies.