title: Persistent high risk HPV infection associated with development of cervical neoplasia in a prospective population study.
abstract: OBJECTIVE
  To monitor the association between the course of high risk human papillomavirus (HR-HPV) infection and the development of cervical neoplasia over time, from a baseline of normal cervical cytology.
  
  
  METHODS
  This paper presents the follow up data from a previous cross sectional analysis. Women from a screening population who had normal cytology and who were HR-HPV positive were recalled after two to three years for cytology and HPV genotyping. The development of cervical neoplasia at follow up was related to the course of HPV infection (clearance, persistence, or sequential infection) and the presence of single or multiple HPV infections at baseline. A comparator control group of women who were HPV and cytologically negative at baseline were selected from the same population.
  
  
  RESULTS
  Twelve cases of dyskaryosis were found in women who were HPV positive at baseline; four were high grade. Only three cases of low grade dyskaryosis were found in the control group. Women with type specific persistent infections were significantly more likely to develop cervical neoplasia than women who cleared the infection (p = 0.0001) or were sequentially infected with different types (p = 0.001). Women with multiple HPV infections at baseline were no more likely to develop cervical dyskaryosis than those with a single infection.
  
  
  CONCLUSIONS
  Type specific persistent HR-HPV infection as monitored by genotyping can identify women at increased risk of cervical neoplasia more accurately than a single or repeated presence/absence HPV test. The cost effectiveness of such an approach should be investigated by an appropriate, large scale cost-benefit analysis.
authors.affiliation: Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK. kate.cuschieri@luht.scot.nhs.uk
authors.forename: K S
authors.initials: KS
authors.lastname: Cuschieri
authors.forename: H A
authors.initials: HA
authors.lastname: Cubie
authors.forename: M W
authors.initials: MW
authors.lastname: Whitley
authors.forename: G
authors.initials: G
authors.lastname: Gilkison
authors.forename: M J
authors.initials: MJ
authors.lastname: Arends
authors.forename: C
authors.initials: C
authors.lastname: Graham
authors.forename: E
authors.initials: E
authors.lastname: McGoogan
mesh_terms: D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology*