6. Reconsidering the Framing of Clinical Messages to Patients Concerning HPV: Further Evaluation of the Natural History of HPV Infection

Abstract

Purpose: Counseling young women about abnormal pap smears often emphasizes the high likelihood for spontaneous clearance of HPV infection. However, in some women, HPV may cause persistent or even lifelong infection. Messages emphasizing clearance may trivialize the importance of oncogenic HPV infections. In this study, periods of prolonged non-detection within a type-specific infection were identified for common oncogenic, high risk (HR) HPV types. The goal of the study was to gain insights into possible low-level persistence and re-activation of HR-HPV. Methods:WeevaluatedHPV infections of 150unvaccinatedwomen using a longitudinal cohort recruited from 3 Indianapolis clinics. Quarterly vaginal swabs were analyzed for HPV using Roche Linear ArrayHPVGenotyping. The analysis focused onHPV typesmost often detected in cervical cancer (16, 18, 31, 33, 45, 52, and 58). Infection was defined as type specific HPV detection in two consecutive quarterly swabs. Infection duration was defined as the time between first and last type-specific HPV positive swabs. Periods of non-detection were defined as at least two sequential negative swabs interrupting a type specific infection. Survival analysis was used to determine duration of HPV infection. Results: Data from 146 of 150 women (ages 14-17; mean 15.4 years at enrollment) were included based on sufficient data. Most women were Black (94.5%). Duration of follow up was 3.94-9.18 years (average 5.6 years). Twenty-one of 70 women (30%) with HPV 16 infections (mean duration of infection of 794.6 days) had at least one period of non-detection that averaged 24.9 months (SD 22.7). Seven of 35 women (30%) with HPV 18 infections (mean duration of infection of 680.8 days) had at least one period of non-detection that averaged 22.1months (SD 5.4). Three of 30women (10%)with HPV 31 infections (mean duration of infection of 460.8 days) had at least one period of non-detection that averaged 12.3 months (SD 2.9). One of 7 women (14%) with HPV 33 (mean duration of infection of 501.6 days) had at least one period of non-detection that averaged 11 months. Seven of 34 women (21%) with HPV 45 infections (mean duration of infection of 449.0days) had at least one period of non-detection that averaged 11.3 months (SD 3.6). Fourteen of 57 women (25%) with HPV 52 infections (average duration of 613.6 days) had at least one period of non-detection that averaged 26.7 months (SD 24.0). Nine of 33 women (27%) with HPV 58 infections (mean duration of infection of 587.6 days) had at least one period of non-detection that lasted 11.67 months (SD 3.97 months). Conclusions: Prolonged follow-up of adolescentwomenwith highrisk HPV infections reveals that non-detection does not mean resolution. During a HPV type specific infection, many women in our study had prolonged periods of non-detection. This suggests that what might have been traditionally considered clearance of HPV infection,may in fact be periods of non-detection. Accordingly, counseling women with HPV and HPV related diseases needs to consider the potential for disease persistence. Sources of Support: Source of Funding: NIH RO1 A107202001A2