Abstract
BackgroundHigh risk human papillomaviruses (HR-HPV) are known to be extremely common, sexually transmitted infections, but more information is needed regarding the absolute risks of type-specific HR-HPV infections in the years following sexual debut.MethodsWe conducted a survival analysis of 3,737 women aged 18–25 from the control group of the Costa Rican Vaccine trial to determine the absolute risks of HR-HPV infections at 12 months, 24 months, and end of follow-up (average of 50.7 months). To corroborate determinants of infection, we used Cox proportional hazards methods to assess associations between demographics and sexual risk behaviors and incident HR-HPV.ResultsCumulative incidence for HR-HPV infections was 51.3% at the end of the study period. The most common incident types were HPV52 (15.4%), HPV51 (13.6%), and HPV16 (12.4%). Type-specific cumulative incidence corresponded closely with type-specific prevalences, except that HPV16 was more prevalent than predicted by incidence, suggesting greater persistence. The strongest predictors of incident HR-HPV infections as a group in a multivariate analysis were the expected correlates of sexual behavior of the woman and her partner, such as being single (HR 1.6, 95% CI 1.4-1.8) or divorced/widowed (HR: 2.1, 95% CI: 1.7-2.7), having multiple HPV infections at enrollment (HR: 1.5, 95% CI: 1.3-1.7), and current smoking (HR: 1.2, 95% CI: 1.0-1.3). In women who reported being having only one lifetime sexual partner (being in a monogamous relationship), the strongest predictors of HR-HPV included not living with sex partner (HR: 2.1, 95% CI 1.7-2.5) and age of sex partner (HR: 1.4, 95% CI: 1.0-1.8).ConclusionWe confirm the extremely high incidence of HR-HPV in young women, emphasizing the importance of vaccinating young girls before sexual debut.
Highlights
High risk human papillomaviruses (HR-Human papillomavirus (HPV)) are known to be extremely common, sexually transmitted infections, but more information is needed regarding the absolute risks of type-specific HPV infections at enrollment (HR)-HPV infections in the years following sexual debut
Cumulative incidence was slightly higher for low-risk HPV (LR-HPV) types compared to HRHPV types (54.3% vs. 51.3%, respectively)
Type-specific High risk human papillomaviruses (HR-HPV) cumulative incidence varied, with HPV52 being the most common (15.4%, 95% CI: 14.3-16.7%), followed by HPV51 (13.6%, 12.5-14.7%) and HPV16 (12.4%, 11.413.5%)
Summary
High risk human papillomaviruses (HR-HPV) are known to be extremely common, sexually transmitted infections, but more information is needed regarding the absolute risks of type-specific HR-HPV infections in the years following sexual debut. Characterizing more fully the incidence of new HR-HPV infections in young sexually active women would be informative for models of HR-HPV transmission and vaccination impact. The Costa Rican Vaccine Trial (CVT) control arm provides an opportunity to study a large number of recently acquired HR-HPV infections within a group of young women aged 18–25 years old. Such a young and narrow age range enables us to look at the acquisition of new HR-HPV infections, presumably around the onset of sexual activity. We were interested in confirming or refuting our prior belief that different HPV types (e.g., high-risk vs. low-risk) have similar predictors
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