title: Human papillomavirus persistence in young unscreened women, a prospective cohort study.
abstract: OBJECTIVE
  To evaluate hr-HPV persistence and associated risk factors in a prospective cohort of young unscreened women. Additionally, the relation between hr-HPV status and cytology/histology results is examined.
  
  
  RESULTS
  Two year follow-up of 235 out of 2065 young women (18-29 years), participating in a large, one year epidemiological study, with questionnaires, self-collected cervico-vaginal samples (Vibabrush), and SPF(10)LiPA for HPV detection. Only women hr-HPV positive at sample month 12 were invited for a second year of follow-up. After study follow-up, available cytology/histology data were requested from PALGA (the national network and registry of histo- and cytopathology in The Netherlands). These data were compared with available cytology/histology data of the month 12 hr-HPV negative women from the same cohort. 44.1% of the hr-HPV types detected at study month 12, persisted during follow-up. HPV types 45, 31, 16 and 18 were most likely to persist with percentages of 60.0%, 56.8%, 54.4%,and 50.0%, respectively. Compared to newly detected infections at month 12, infections present since 6 months or baseline had an increased risk to persist (OR 3.09 [95% CI: 1.74-5.51] and OR 4.99 [95% CI: 2.67-9.32], respectively). Other co-factors influencing persistence were, multiple HPV infections, smoking and multiple lifetime sexual partners. The percentage of women with a HSIL/CIN2+ (12.1%) in the persistent HPV group, was not significantly different (p = 0.107) from the 5.3% of the women who cleared the hr-HPV infection, but was significantly (p 0.000) higher than to the 1.6% of women in the hr-HPV negative control group.
  
  
  CONCLUSIONS
  We showed that HPV genotype, multiple infections, smoking, and multiple lifetime sexual partners are co-factors that increase the risk of hr-HPV persistency. Most importantly, we showed that hr-HPV infections are more likely to persist the longer they have been present and that women with a persistent hr-HPV infection have a high risk of HSIL/CIN2+ development.
authors: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. c.schmeink@obgyn.umcn.nl
authors: Channa E
authors: CE
authors: Schmeink
authors: Willem J G
authors: WJ
authors: Melchers
authors: Albertus G
authors: AG
authors: Siebers
authors: Wim G V
authors: WG
authors: Quint
authors: Leon F A G
authors: LF
authors: Massuger
authors: Ruud L M
authors: RL
authors: Bekkers
mesh_terms: D000293:Adolescent; D000328:Adult; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening; D009426:Netherlands / Q000453:epidemiology; D027383:Papillomaviridae / Q000502:physiology*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000821:virology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult