title: Longitudinal outcomes of high-risk human papillomavirus (HPV) infections as competing-risks events following cervical HPV test at baseline visit in the NIS-LAMS cohort.
abstract: BACKGROUND
  The complex natural history of human papillomavirus (HPV) infections following a single HPV test can be modeled as competing-risks events (i.e., no-, transient- or persistent infection) in a longitudinal setting. The covariates associated with these competing events have not been previously assessed using competing-risks regression models.
  
  
  OBJECTIVE
  To gain further insights in the outcomes of cervical HPV infections, we used univariate- and multivariate competing-risks regression models to assess the covariates associated with these competing events.
  
  
  METHODS
  Covariates associated with three competing outcomes (no-, transient- or persistent HR-HPV infection) were analysed in a sub-cohort of 1,865 women prospectively followed-up in the NIS (n = 3,187) and LAMS Study (n = 12,114).
  
  
  RESULTS
  In multivariate competing-risks models (with two other outcomes as competing events), permanently HR-HPV negative outcome was significantly predicted only by the clearance ofASCUS+ Pap during FU, while three independent covariates predicted transient HR-HPV infections: i) number of recent (< 12 months) sexual partners (risk increased), ii) previous Pap screening history (protective), and history of previous CIN (increased risk). The two most powerful predictors of persistent HR-HPV infections were persistent ASCUS+ Pap (risk increased), and previous Pap screening history (protective). In pair-wise comparisons, number of recent sexual partners and previous CIN history increase the probability of transient HR-HPV infection against the HR-HPV negative competing event, while previous Pap screening history is protective. Persistent ASCUS+ Pap during FU and no previous Pap screening history are significantly associated with the persistent HR-HPV outcome (compared both with i) always negative, and ii) transient events), whereas multiparity is protective.
  
  
  CONCLUSIONS
  Different covariates are associated with the three main outcomes of cervical HPV infections. The most significant covariates of each competing events are probably distinct enough to enable constructing of a risk-profile for each main outcome.
authors.affiliation: Department of Oncology & Radiotherapy, Turku University Hospital, Turku, Finland. kari.syrjanen@tyks.fi
authors.forename: K
authors.initials: K
authors.lastname: Syrjänen
authors.forename: I
authors.initials: I
authors.lastname: Shabalova
authors.forename: L
authors.initials: L
authors.lastname: Sarian
authors.forename: P
authors.initials: P
authors.lastname: Naud
authors.forename: A
authors.initials: A
authors.lastname: Longatto-Filho
authors.forename: S
authors.initials: S
authors.lastname: Derchain
authors.forename: V
authors.initials: V
authors.lastname: Kozachenko
authors.forename: S
authors.initials: S
authors.lastname: Zakharchenko
authors.forename: C
authors.initials: C
authors.lastname: Roteli-Martins
authors.forename: R
authors.initials: R
authors.lastname: Nerovjna
authors.forename: L
authors.initials: L
authors.lastname: Kljukina
authors.forename: S
authors.initials: S
authors.lastname: Tatti
authors.forename: M
authors.initials: M
authors.lastname: Branovskaja
authors.forename: M
authors.initials: M
authors.lastname: Branca
authors.forename: V
authors.initials: V
authors.lastname: Grunjberga
authors.forename: M
authors.initials: M
authors.lastname: Erzen
authors.forename: A
authors.initials: A
authors.lastname: Juschenko
authors.forename: L Serpa
authors.initials: LS
authors.lastname: Hammes
authors.forename: J
authors.initials: J
authors.lastname: Podistov
authors.forename: S
authors.initials: S
authors.lastname: Costa
authors.forename: S
authors.initials: S
authors.lastname: Syrjänen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000821:virology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012044:Regression Analysis; D012306:Risk; D014626:Vaginal Smears