Abstract
BackgroundIn China, high-risk human papillomavirus (HR-HPV) prevalence is unexpectedly high in older women, but the possible reasons have not been well studied yet. This study investigated the age trends of HR-HPV infection in a prospective study.MethodsA total of 7397 women aged 25-65 years without cervical precancer or cancer were evaluated during 2010-2011 with a stratified sample of 2791 women re-evaluated after one year. Test results for careHPV and careHPV16/18/45 were used to describe the HR-HPV prevalence, incidence and clearance. Risk factors associated with HR-HPV infections were explored using a logistic regression model.ResultsThe overall HR-HPV prevalence was 13.1% at baseline, with a peak of 19.3% in women aged 55-59 years. The prevalence of HR-HPV (p for trends < 0.001), HPV16/18/45 (p for trends = 0.002), and HR-HPV other than HPV16/18/45 (p for trends = 0.002) generally increased with increasing age. Number of infections that cleared was generally greater than number of incident infections within age groups. One-year clearance rate decreased with increasing age (p for trends < 0.001), however, incidence rate was unrelated to age (p for trends = 0.159). Risk factors that associated with HR-HPV infection differed between younger and older women.ConclusionsThe greater HR-HPV prevalence in older versus younger women in rural China may be explained by a cohort effect, higher than expected incidence, and/or poorer clearance at older age.
Highlights
In China, high-risk human papillomavirus (HR-HPV) prevalence is unexpectedly high in older women, but the possible reasons have not been well studied yet
Using data from a multi-center study of lower-cost molecular HPV tests in rural China, we described the prevalence and short-term dynamics of HR-HPV infection as measured by careHPV (Qiagen, Gaithersburg, MD, USA), a DNA test for a pool of 13 carcinogenic HPV genotypes and one possible carcinogenic HPV genotype, which had been evaluated in multiple countries [20,21], and a research-use only DNA test for a pool of HPV16,18, and 45 (HPV16/18/45) made available for the careHPV platform (“careHPV16/18/45”)
969 of 7397 women (13.1%, 95% confidence intervals (CIs): 12.3%13.9%) were HR-HPV positive at baseline, and the positive rates varied among study sites (12.8% for Yangcheng, 11.9% for Xinmi, and 15.4% for Tonggu)
Summary
In China, high-risk human papillomavirus (HR-HPV) prevalence is unexpectedly high in older women, but the possible reasons have not been well studied yet. Previous studies of age-specific high-risk human papillomavirus (HR-HPV) prevalence have demonstrated substantial variability across geographical regions [1,2,3]. Women within a few years of their age of sexual debut were observed to have the highest HR-HPV prevalence. Due to the lack of well-organized, nation-wide HPVbased cervical cancer screening programmes, the age distribution of HPV prevalence in China has not been well demonstrated, and results from population-based studies differed from each other [8,9,10,11,12]. World Health Organization (WHO) is considering 6month persistent infection as a surrogate endpoint for HPV vaccine trials
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