IMR Press / EJGO / Volume 29 / Issue 2 / pii/1630995390770-213511062

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Original Research
Epidemiological, clinical and viral determinants of the increased prevalence of high-risk human papillomavirus (HPV) infections in elderly women
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1 Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
2 Department of Oral Pathology, Institute of Dentistry, and MediCity Research Laboratory, University of Turku, Finland
3 N.N. Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
4 Russian Academy of Post-Graduate Medical Education, Moscow, Russia
5 Novgorod Clinical Regional Hospital, Centralised Cytology Laboratory, Novgorod, Russia
6 Novgorod Municipal Dermato-venereological Dispensary, Department of Gynaecology, Novgorod, Russia
7 Novgorod Female Consultative Outpatient Hospital, Department of Gynaecology, Novgorod, Russia
8 Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
9 Minsk State Medical Institute, Department of Gynaecology and Obstetrics, Minsk, Belarus
10 Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
11 Department of Human Pathology and Oncology, University of Siena (Italy)
Eur. J. Gynaecol. Oncol. 2008, 29(2), 114–122;
Published: 10 April 2008
Abstract

Background: Population-based studies have reported a second peak of human papillomavirus (HPV) prevalence among women > 55 years, but reasons for this U-shaped HPV prevalence curve are poorly understood. Objectives: To analyse determinants of highrisk HPV (HR-HPV) infections among postmenopausal women. Study design and Methods: A cohort of 3,187 women was stratified into three age categories: i) youngest age group < 25 years (n = 1.103); ii) women between 26-55 years (n = 2.004), and iii) women > 55 years (n = 80), analysed for epidemiological, clinical and virological determinants of their HR-HPV infections. Real-time PCR was used for HPV genotyping, analysis of viral loads for HPV16, 18/45, 31, 33/52/58, 35 and 39, and load of integrated HPV16. Results: Age-standardised prevalence of HR-HPV infections showed a second peak among women > 55 years, with a perfect Ushaped curve (R2 = 0.966). The factors explaining this increased HR-HPV prevalence among older women include: i) cohort effect, ii) higher viral loads for HR-HPV types with cubic model curve (R2 = 0.714) for HPV16, iii) distinct shift (p = 0.0001) from multiple- type infections to single HR-HPV types, iv) transition from episomal to integrated HPV16 (p = 0.009), v) higher load of integrated HPV16 (p = 0.009), and, vi) higher proportion of incident infections, higher rate of viral persistence, and lower rate of HRHPV clearance. Conclusions: These data suggest that in women who fail to eradicate their HR-HPV infection until menopause, selection of integrated viral clone has taken place, driving the process towards progressing disease. Consequent to this, most of the HRHPV infections in women > 55 years were associated with high-grade CIN or invasive carcinoma.
Keywords
High-risk HPV
Postmenopause
Prevalence
Second peak
Predictors
Sexual behavior
Viral load
Integration
CIN
cervical cancer
Follow-up
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