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.
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.