title: Epidemiologic approaches to evaluating the potential for human papillomavirus type replacement postvaccination.
abstract: Currently, 2 vaccines exist that prevent infection by the genotypes of human papillomavirus (HPV) responsible for approximately 70% of cervical cancer cases worldwide. Although vaccination is expected to reduce the prevalence of these HPV types, there is concern about the effect this could have on the distribution of other oncogenic types. According to basic ecological principles, if competition exists between ≥2 different HPV types for niche occupation during natural infection, elimination of 1 type may lead to an increase in other type(s). Here, we discuss this issue of "type replacement" and present different epidemiologic approaches for evaluation of HPV type competition. Briefly, these approaches involve: 1) calculation of the expected frequency of coinfection under independence between HPV types for comparison with observed frequency; 2) construction of hierarchical logistic regression models for each vaccine-targeted type; and 3) construction of Kaplan-Meier curves and Cox models to evaluate sequential acquisition and clearance of HPV types according to baseline HPV status. We also discuss a related issue concerning diagnostic artifacts arising when multiple HPV types are present in specific samples (due to the inability of broad-spectrum assays to detect certain types present in lower concentrations). This may result in an apparent increase in previously undetected types postvaccination.
authors: Division of Cancer Epidemiology, Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors: Joseph E
authors: JE
authors: Tota
authors: Agnihotram V
authors: AV
authors: Ramanakumar
authors: Mengzhu
authors: M
authors: Jiang
authors: Joakim
authors: J
authors: Dillner
authors: Stephen D
authors: SD
authors: Walter
authors: Jay S
authors: JS
authors: Kaufman
authors: François
authors: F
authors: Coutlée
authors: Luisa L
authors: LL
authors: Villa
authors: Eduardo L
authors: EL
authors: Franco
mesh_terms: D060085:Coinfection / Q000175:diagnosis / Q000235:genetics / Q000821:virology; D005260:Female; D005838:Genotype; D006801:Humans; D053208:Kaplan-Meier Estimate; D009154:Mutation; D027383:Papillomaviridae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000235:genetics* / Q000276:immunology; D016016:Proportional Hazards Models; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000517:prevention & control* / Q000821:virology; D014779:Virus Replication / Q000187:drug effects* / Q000235:genetics
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV type replacement; cervical cancer; human papillomavirus; vaccination
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