title: A cross-sectional study on the concordance between vaginal HPV DNA detection and type-specific antibodies in a multi-ethnic cohort of women from Amsterdam, the Netherlands - the HELIUS study.
abstract: BACKGROUND
  Acquisition of genital human papillomavirus (HPV) infection is common among the young, sexually active population. Genital HPV infections do not always lead to seroconversion. We aimed to assess the association between cervico-vaginal high risk (hr) HPV DNA and type-specific antibodies in an ethnically diverse cohort of young women.
  
  
  METHODS
  Women of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan and Turkish origin participating in a large-scale multi-ethnic population-based cohort (the HELIUS study) provided vaginal self-samples and blood samples, and completed a questionnaire regarding demographics, lifestyle and sexual health. Vaginal swabs were tested for HPV using the highly sensitive SPF10-PCR DEIA/LiPA25 system (version1). Serum samples were tested for type-specific L1 antibodies against 7 hrHPV types (16,18,31,33,45,52,58) with multiplex serology. We assessed the association between vaginal HPV DNA and type-specific seropositivity with logistic and linear regression, using generalized estimating equations (GEE). We determined whether this association varies by ethnicity by adding an interaction term.
  
  
  RESULTS
  We selected 532 women who completed the questionnaire, provided a vaginal swab and a blood sample. Their median age was 27 years (interquartile range 24-31 years). Prevalence of DNA of any of the 7 hrHPV was 22 %; HPV-52 was most common. Prevalence of antibodies against one or more hrHPV types was 24 %; HPV-16 seropositivity was most common. In multivariable logistic regression analysis using GEE, adjusting for other determinants, vaginal HPV DNA detection was associated with type-specific HPV seropositivity (OR 1.53, 95 % CI 1.06-2.20). In multivariable linear regression analysis using GEE, the geometric mean of type-specific antibody reactivity was 1.15 (95 % CI 1.04-1.27) times higher in women positive for HPV DNA compared to HPV DNA-negative women. There was little evidence that ethnicity modified the association between HPV DNA, and type-specific seropositivity, or with antibody reactivities (p = 0.47 and p = 0.57, respectively).
  
  
  CONCLUSIONS
  In this multi-ethnic group of young women in Amsterdam, cervico-vaginal hrHPV DNA detection was an independent determinant of type-specific HPV seropositivity.
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, Amsterdam, 1018 WT, The Netherlands. skovalev@ggd.amsterdam.nl.|AMC Graduate School, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands. skovalev@ggd.amsterdam.nl.
authors.forename: Alexandra
authors.identifier: http://orcid.org/0000-0002-1554-5615
authors.initials: A
authors.lastname: Kovaleva
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, Amsterdam, 1018 WT, The Netherlands.
authors.forename: Catharina J
authors.initials: CJ
authors.lastname: Alberts
authors.affiliation: German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Waterboer
authors.affiliation: German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Michel
authors.affiliation: Department of Public Health, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
authors.forename: Marieke B
authors.initials: MB
authors.lastname: Snijder
authors.affiliation: Public Health Laboratory, Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, Amsterdam, 1018 WT, The Netherlands.
authors.forename: Wilma
authors.initials: W
authors.lastname: Vermeulen
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, Amsterdam, 1018 WT, The Netherlands.
authors.forename: Liza
authors.initials: L
authors.lastname: Coyer
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, Amsterdam, 1018 WT, The Netherlands.|Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.affiliation: Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, Amsterdam, 1018 WT, The Netherlands.|Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Schim van der Loeff
keywords: Antibodies; Concordance; HELIUS study; Human papillomavirus; Serology; Vaginal