Human papillomavirus infection, risk for subsequent development of cervical neoplasia and associated population attributable fraction.
BACKGROUND
Human papillomavirus (HPV) is the major cause of cervical neoplasia but estimates of the population attributable fraction (PAR%), of HPV vary. PAR% has not been derived from longitudinal studies although assessment of HPV exposure prior to the neoplasia diagnosis should increase validity of such estimates.


OBJECTIVE
Systematic review and meta-analysis of longitudinal studies on HPV associated relative risk (RR) for and PAR% of HPV16 in cervical neoplasia.


METHODS
Pertinent data from longitudinal studies was made available through Medline and substituted by various hand searches. HPV associated weighted mean RR, with 95% confidence interval (CI) of cervical neoplasia, and the PAR% of HPV16 in cervical carcinoma were estimated both for unselected and low HPV prevalence populations.


RESULTS
HPV associated RR of cervical carcinoma in PCR-based studies was 17 (95% CI 8.2-33). HPV16 associated RRs in seroepidemiological studies were 3.3 (95% CI 2.2-4.9) for the unselected population, HPV16 seroprevalence 11.0%, and 12.5 (95% CI 5.5-29) for a population with low HPV16 seroprevalence of 5.3%. Corresponding PAR% estimates of HPV16 were 27 and 44%, respectively.


CONCLUSIONS
Protective vaccination against HPV16 infection would prevent up to 44% of cervical carcinoma.
Lehtinen
M
M
National Public Health, Institute, FIN 00300, Helsinki, Finland. llmale@uta.fi
Luukkaala
T
T
Wallin
K L
KL
Paavonen
J
J
Thoresen
S
S
Dillner
J
J
Hakama
M
M
D016022:Case-Control Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D015201:Meta-Analysis as Topic; D027383:Papillomaviridae / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D016133:Polymerase Chain Reaction / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D014412:Tumor Virus Infections / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D002583:Uterine Cervical Neoplasms / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000821:virology*
D004279:DNA, Viral