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High load for most high risk human papillomavirus genotypes is associated with prevalent cervical cancer precursors but only HPV16 load predicts the development of incident disease
Author(s) -
Gravitt Patti E.,
Kovacic Melinda Butsch,
Herrero Rolando,
Schiffman Mark,
Bratti Concepcion,
Hildesheim Allan,
Morales Jorge,
Alfaro Mario,
Sherman Mark E.,
Wacholder Sholom,
Rodriguez AnaCecilia,
Burk Robert D.
Publication year - 2007
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.23012
Subject(s) - viral load , cervical intraepithelial neoplasia , medicine , population , prospective cohort study , cervical cancer , viral disease , papillomaviridae , oncology , virology , cancer , virus , environmental health
Abstract Cervicovaginal human papillomavirus (HPV) viral load has been purported as a potential marker for the detection of high‐grade cervical intraepithelial neoplasia or cancer (≥CIN2). To examine disease association with type‐specific viral load for the full‐range of anogenital HPV infections, we conducted cross‐sectional and prospective analyses of ∼2,000 HPV‐infected women from a 10,000‐woman population‐based study in Guanacaste, Costa Rica with 7 years of follow‐up. Cervical specimens were tested for >40 HPV types using a MY09/MY11 L1 consensus primer PCR method with type‐specific dot blot hybridization and PCR signal intensity as a measure of viral load. A positive association was observed between prevalent ≥CIN2 and high viral load compared to low viral load for women with baseline single HPV16 infections (OR = 19.2, 95% CI = 4.4–83.2) and single non‐16 carcinogenic infections (OR = 9.2, 95% CI = 2.1–39.9). Inclusion of women with multiple HPV types did not substantially change these associations. In prospective follow‐up, only women infected with HPV16 alone (OR = 27.2, 95% = 3.5–213.5) had a strong association between high viral load and incident ≥CIN2; non‐16 carcinogenic high viral load was not associated with incident ≥CIN2 (OR = 0.7, 95% CI = 0.2–1.9). Single noncarcinogenic type viral load was not associated with increased risk of prevalent or incident ≥CIN2 (OR = 1.2 and 1.1, respectively). In conclusion, carcinogenic high viral load was associated with prevalent ≥CIN2; however HPV16 was uniquely associated with incident ≥CIN2. The extent to which these observations can be translated into clinical practice must be rigorously examined in the context of the method of viral load measurement and the type‐specific differences observed for incident ≥CIN2. © 2007 Wiley‐Liss, Inc.