A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica.
BACKGROUND
Cross-sectional human papillomavirus (HPV) DNA prevalence peaks at young ages, reflecting sexual acquisition and typically rapid clearance. In some populations, HPV prevalence demonstrates a second peak in older women. Longitudinal data may help to explain this second peak.


METHODS
We followed a population-based cohort of 7237 women in Guanacaste, Costa Rica, in which we had previously observed a second peak in the baseline HPV prevalence in older women. We tested for >40 HPV types by polymerase chain reaction. We analyzed age-specific patterns of acquisition and persistence 5-7 years after enrollment for individual HPV types.


RESULTS
At enrollment and follow-up, cross-sectional data revealed U-shaped age-specific HPV prevalence curves for virtually every type, with higher prevalences in the younger and older women than in the middle-aged women. Prospectively, acquisition of types decreased significantly as women aged (PTrend<.05, for both), with the highest peak in young women and a secondary minor peak in older women. Type-specific persistence of HPV increased with age (PTrend<.0001). Overall, HPV acquisition predominated at younger ages, whereas persistent infections gradually became more prominent with age (PTrend<.0001).


CONCLUSIONS
Newly apparent infections decreased, whereas persistence increased, with age; this latter tendency supports the utility of HPV screening in older women.
Castle
Philip E
PE
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-7234, USA. castlep@mail.nih.gov
Schiffman
Mark
M
Herrero
Rolando
R
Hildesheim
Allan
A
Rodriguez
Ana Cecilia
AC
Bratti
M Concepcion
MC
Sherman
Mark E
ME
Wacholder
Sholom
S
Tarone
Robert
R
Burk
Robert D
RD
D000328:Adult; D000367:Age Factors; D000368:Aged; D002584:Cervix Uteri / Q000821:virology*; D003364:Costa Rica / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies