title: The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women.
abstract: OBJECTIVE
  The objectives of this study were to describe the early natural history of human papillomavirus (HPV) infection by examining a cohort of young women positive for an HPV test and to define within this cohort (1) the probability of HPV regression, (2) the risk of having a squamous intraepithelial lesion, and (3) factors that were associated with HPV regression.
  
  
  METHODS
  The study was a cohort analytic design. An inception cohort of 618 women positive for HPV participated. HPV testing, cytologic evaluation, and colposcopic evaluation were performed at 4-month intervals. HPV testing was characterized for two groups: low risk (five types rarely associated with cancers) and high risk (nine types most commonly associated with cancers).
  
  
  RESULTS
  Estimates provided by Kaplan-Meier curves showed that approximately 70% of women were found to have HPV regression by 24 months. Women with low-risk HPV type infections were more likely to show HPV regression than were women with high-risk HPV type infections (log rank test p = 0.002). The relative risk for the development of high-grade squamous intraepithelial lesion (HSIL) was 14.1 (95% confidence interval: 2.3, 84.5) for women with at least three positive tests for high-risk HPV preceding the development of the HSIL compared with that for women with negative tests for high-risk HPV. However, 88% of women with persistent positive HPV tests have not had HSIL to date. No factors associated with high-risk HPV type regression were identified except for a negative association with an incident history of vulvar condyloma (relative risk = 0.5 [95% confidence interval: 0.3 to 0.8]).
  
  
  CONCLUSIONS
  Most young women with a positive HPV test will become negative within a 24-month period. Persistent positive tests with oncogenic HPV types represented a significant risk for the development of HSIL. However, we found that most young women with persistent positive HPV tests did not have cytologically perceptible HSIL over a 2-year period. Factors thought to be associated with the development of HSIL were found not to be important in HPV regression.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Moscicki
authors.forename: S
authors.initials: S
authors.lastname: Shiboski
authors.forename: J
authors.initials: J
authors.lastname: Broering
authors.forename: K
authors.initials: K
authors.lastname: Powell
authors.forename: L
authors.initials: L
authors.lastname: Clayton
authors.forename: N
authors.initials: N
authors.lastname: Jay
authors.forename: T M
authors.initials: TM
authors.lastname: Darragh
authors.forename: R
authors.initials: R
authors.lastname: Brescia
authors.forename: S
authors.initials: S
authors.lastname: Kanowitz
authors.forename: S B
authors.initials: SB
authors.lastname: Miller
authors.forename: J
authors.initials: J
authors.lastname: Stone
authors.forename: E
authors.initials: E
authors.lastname: Hanson
authors.forename: J
authors.initials: J
authors.lastname: Palefsky
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008390:Markov Chains; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000503:physiopathology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000503:physiopathology*; D002583:Uterine Cervical Neoplasms / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000821:virology*
chemical_list: D004279:DNA, Viral