title: A cross-sectional study to estimate high-risk human papillomavirus prevalence and type distribution in Italian women aged 18-26 years.
abstract: BACKGROUND
  Pre-vaccination information on HPV type-specific prevalence in target populations is essential for designing and monitoring immunization strategies for cervical cancer (CC) prevention. Data on HPV prevalence in Italy are available for women over the age of 24 years, target of the population-based CC screening programmes; while data of HPV prevalence in younger ages are very limited. The present study enrolled Italian women aged 18-26 years in order to assess the prevalence and distribution of high-risk (HR) HPV types. Risk-factors correlated with HR-HPV positivity were also described.
  
  
  METHODS
  A sample of 2,289 women was randomly selected from the resident population lists of ten Local Health Units (LHUs) located in six Italian Regions scattered across the country; both rural and urban LHUs were involved. Women aged between 18 and 26 years and living in the selected LHUs were included in the study; pregnant women and women who did not speak Italian were excluded. A total of 1,102 women met the inclusion criteria and agreed to participate. Participants were offered pap test and Hybrid-Capture 2 (HC2) test for HR-HPV types and genotyping was performed on positive smears.
  
  
  RESULTS
  Out of 1,094 valid samples, 205 (18.7%) were HR-HPV positive. Women with 2-4 (ORadj = 4.15, 95%CI: 2.56-6.72) and ≥5 lifetime partners (ORadj = 10.63, 95%CI: 6.16-18.36) and women who have used any contraceptive in the last six months (ORadj = 1.67, 95%CI: 1.09-2.54) had a higher risk to be infected; women living with their partner had a lower risk (ORadj = 0.56, 95%CI: 0.34-0.92) to acquire infection than women living with parents/friends/alone. Among HC2 positive women, HPV16 was the most prevalent type (30.9%), followed by 31 (19.6%), 66 (12.9%), 51 (11.3%), 18 (8.8%), 56 (8.8%). Co-infections of HR-HC2 targeted types were found in 20.4% of positive samples. The HR-HPV prevalence in women with abnormal cytology (52.4%) was significantly higher than in women with normal cytology (14.6%); however 33.0% of HR-HPV infected women had an abnormal cytology.
  
  
  CONCLUSIONS
  HR-HPV prevalence in Italian women aged 18-26 years was 19%, higher than what detected for older women, by other studies using the same molecular method and laboratory network; this result supports the choice of electing girls before the sexual debut as the primary target of HPV vaccination. The HPV type distribution found in this study may represent a baseline picture; an accurate post-vaccine surveillance is necessary to early detect a possible genotype replacement. The high prevalence of viral types other than vaccine-HPV types supports the necessity to guarantee the progression of CC screening programmes in vaccinated women.
authors: Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. cristina.giambi@iss.it
authors: Cristina
authors: C
authors: Giambi
authors: Serena
authors: S
authors: Donati
authors: Francesca
authors: F
authors: Carozzi
authors: Stefania
authors: S
authors: Salmaso
authors: Silvia
authors: S
authors: Declich
authors: Marta L Ciofi degli
authors: ML
authors: Atti
authors: Guglielmo
authors: G
authors: Ronco
authors: Maria P
authors: MP
authors: Alibrandi
authors: Silvia
authors: S
authors: Brezzi
authors: Natalina
authors: N
authors: Collina
authors: Daniela
authors: D
authors: Franchi
authors: Amedeo
authors: A
authors: Lattanzi
authors: Maria C
authors: MC
authors: Minna
authors: Roberto
authors: R
authors: Nannini
authors: Elena
authors: E
authors: Barretta
authors: Elena
authors: E
authors: Burroni
authors: Anna
authors: A
authors: Gillio-Tos
authors: Vincenzo
authors: V
authors: Macallini
authors: Paola
authors: P
authors: Pierotti
authors: Antonino
authors: A
authors: Bella
mesh_terms: D000293:Adolescent; D000328:Adult; D052685:Alphapapillomavirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity*; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D006801:Humans; D007558:Italy / Q000453:epidemiology; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology*; D015995:Prevalence; D012307:Risk Factors
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