Acquisition, prevalence and clearance of type-specific human papillomavirus infections in young sexually active Indian women: A community-based multicentric cohort study.

Richard Muwonge,Massimo Tommasino,Shachi Vashist,Gauravi Mishra,Subha Sankaran,Thiraviam Pillai Rameshwari Ammal Kannan,Sylla G Malvi,Maqsood Siddiqi,Anand Shah,Catherine Sauvaget,Uma Divate,M Radhakrishna Pillai,Tarik Gheit,Priya R Prabhu,Kasturi Jayant,Rengaswamy Sankaranarayanan,Neerja Bhatla,Devasena Anantharaman,Sharmila Pimple,Surendra S Shastri,Aruna Chiwate,Smita Joshi,Partha Basu,Eric Zomawia,Radhika Jadhav,Eric Lucas,Rintu Varghese,Sanjay Hingmire,Pulikottil Okkuru Esmy ,Usha Rani Poli ,Yogesh Kumar Verma

doi:10.1371/journal.pone.0244242

Abstract

In context of the ongoing multi-centric HPV vaccine study in India, unvaccinated married women (N = 1484) aged 18–23 years were recruited in 2012–2015 as age-matched controls to the vaccinated women and followed up yearly. We assess type-specific prevalence, natural history and potential determinants of human papillomavirus (HPV) infection in these unvaccinated women. Cervical samples were collected yearly for at least four consecutive years. A Multiplex Type-Specific E7-Based polymerase chain reaction assay was used to detect 21 HPV types.HPV prevalence was 36.4% during 6 years. Most common HPV types were 16 (6.5%) and 31 (6.1%). Highest persistence were observed for HPV 35 (62.5%) and 52 (25%). New HPV acquisition rate was 5.6/1000 person-months of observation (PMO), highest for HPV 16 (1.1/1000 PMO). Type-specific clearance rates ranged between 2.9–5.5/100 PMO. HPV 16 and/or 18 infections were 41% (95% CI 4–63%) lower among women with 2-<3 years between marriage and first cervical sample collection compared to those with <2 years. HPV prevalence and acquisition rates in young Indian women were lower than their Western counterparts. HPV 16 infections being most common shows the importance and potential impact of HPV vaccination in India. Women with 2–3 years exposure had reduced risk possibly due to higher infections clearance.

Highlights

A working group of the International Agency for Research on Cancer (IARC) categorized 12 types of Human Papillomavirus (HPV), phylogenetically all belonging to the alpha genus, as ‘definitely carcinogenic’ to humans [1]
Type-specific HPV acquisition, prevalence and clearance cervical samples assessed for HPV genotyping till June 2019
The median time of follow-up was 36.9 months (IQR: 0.03–53.0 months; range: 0.03–71.2 months). These participants had a mean age at recruitment of 20.3 years (SD: 1.1), 878 (59.2%) had high school or higher formal education and majority of them belonged to low income group

Summary

Introduction

A working group of the International Agency for Research on Cancer (IARC) categorized 12 types of Human Papillomavirus (HPV), phylogenetically all belonging to the alpha genus, as ‘definitely carcinogenic’ to humans [1]. These include HPV 16, 31, 33, 35, 52 and 58 (species alpha-9), HPV 18 and 45 (species alpha-7), 51 (species alpha-5), type 56 (species alpha-6), and HPV 39 and 59 (species alpha-7). A population-based estimate of the type-specific prevalence of HPV infection in young women from different regions of the country will create a valuable baseline for future surveillance studies assessing the vaccine impact

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Discussion

Conclusion