Age-dependent prevalence of 14 high-risk HPV types in the Netherlands: implications for prophylactic vaccination and screening.
We determined the prevalence of type-specific hrHPV infections in the Netherlands on cervical scrapes of 45 362 women aged 18-65 years. The overall hrHPV prevalence peaked at the age of 22 with peak prevalence of 24%. Each of the 14 hrHPV types decreased significantly with age (P-values between 0.0009 and 0.03). The proportion of HPV16 in hrHPV-positive infections also decreased with age (OR=0.76 (10-year scale), 95% CI=0.67-0.85), and a similar trend was observed for HPV16 when selecting hrHPV-positive women with cervical intraepithelial neoplasia grade 2 or worse (CIN2+) (OR=0.76, 95% CI=0.56-1.01). In women eligible for routine screening (age 29-61 years) with confirmed CIN2+, 65% was infected with HPV16 and/or HPV18. When HPV16/18-positive infections in women eligible for routine screening were discarded, the positive predictive value of cytology for the detection of CIN2+ decreased from 27 to 15%, the positive predictive value of hrHPV testing decreased from 26 to 15%, and the predictive value of a double-positive test (positive HPV test and a positive cytology) decreased from 54 to 41%. In women vaccinated against HPV16/18, screening remains important to detect cervical lesions caused by non-HPV16/18 types. To maintain a high-positive predictive value, screening algorithms must be carefully re-evaluated with regard to the screening modalities and length of the screening interval.
Coupé
V M H
VM
Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, PO Box 7057, Amsterdam 1007 MB, The Netherlands. v.coupe@vumc.nl
Berkhof
J
J
Bulkmans
N W J
NW
Snijders
P J F
PJ
Meijer
C J L M
CJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D052685:Alphapapillomavirus / Q000145:classification* / Q000302:isolation & purification*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000145:classification* / Q000453:epidemiology* / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D015995:Prevalence; D014611:Vaccination; D014626:Vaginal Smears
D053918:Papillomavirus Vaccines