Objective The primary cervical cancer screening strategy for women over age 30 is high-risk human papillomavirus (HPV) testing combined with Papanicolaou (Pap) testing (cotesting) every 5 years. This ...combination strategy is a preventive service that is required by the Affordable Care Act to be covered with no cost-sharing by most health insurance plans. The cotesting recommendation was made based entirely on prospective data from an insured population that may have a lower proportion of women with HPV positive and Pap negative results (ie, discordant results). The discordant group represents a very difficult group to manage. If the frequency of discordant results among underserved women is higher, health care providers may perceive the cotesting strategy to be a less favorable screening strategy than traditional Pap testing every 3 years. Study Design The Centers for Disease Control and Prevention's Cervical Cancer Study was conducted at 15 clinics in 6 federally qualified health centers across Illinois. Providers at these clinics were given the option of cotesting for routine cervical cancer screening. Type-specific HPV detection was performed on residual extracts using linear array. Results Pap test results were abnormal in 6.0% and HPV was positive in 7.2% of the underserved women screened in this study (mean age, 45.1 years). HPV prevalence decreased with age, from 10.3% among 30- to 39-year-olds to 4.5% among 50- to 60-year-olds. About 5% of the women had a combination of a positive HPV test and normal Pap test results; HPV 16/18 was identified in 14% of discordant women. Conclusion The rate of discordant results among underserved women was similar to those reported throughout the US in a variety of populations. Typing for HPV 16/18 appears to assist in the management in a small proportion of women with discordant results.
J Oral Pathol Med (2012) 41: 288–291
Background: Oral human papillomavirus (HPV) is associated with several health complications especially in combination with HIV infections. Screening may be ...useful, but methodologies and results have varied widely in previous studies. We conducted a pilot study in an HIV‐positive population to evaluate HPV detection in four different oral sample types.
Methods: Upon enrollment, an oral‐rinse (OR) sample was collected in 10 ml saline. Additional samples of the buccal mucosa, tonsils, and oral lesion if present were collected with cytology brushes. DNA was extracted using LC‐MagNAPure, and the Linear Array HPV genotyping Assay (Roche) was used for HPV genotyping.
Results: In samples from 100 HIV‐positive participants, HPV was detected in 39 (%) of the oral rinses, 13 (%) mucosal and 11 (12.9%) tonsil brushings. Of seven lesion brushings collected, four were HPV positive. All participants with HPV detected in mucosal, tonsil, or lesion brushings were also positive in the OR sample. Among the rinse samples, 27 different genotypes were detected with HPV84 (n = 6), HPV55 (n = 5), and HPV83 (n = 5) being the most common. Multiple infections were detected in 17 samples (range 2–9, mean 1.9 types). As potential cofactors, only receptive oral sex was significantly associated with HPV (P = 0.018, odds ratio 2.9, 95% CI 1.2–6.9).
Conclusion: Sampling is a significant factor for oral prevalence studies. Oral rinse provides the best representation for HPV in the oral cavity. To evaluate associated cofactors other than receptive oral sex, larger studies with case–control design are necessary.
This study sought to determine the prevaccine type-specific prevalence of human papillomavirus (HPV)-associated cancers in the United States to evaluate the potential impact of the HPV types in the ...current and newly approved 9-valent HPV vaccines.
The Centers for Disease Control and Prevention partnered with seven US population-based cancer registries to obtain archival tissue for cancers diagnosed from 1993 to 2005. HPV testing was performed on 2670 case patients that were fairly representative of all participating cancer registry cases by age and sex. Demographic and clinical data were evaluated by anatomic site and HPV status. Current US cancer registry data and the detection of HPV types were used to estimate the number of cancers potentially preventable through vaccination.
HPV DNA was detected in 90.6% of cervical, 91.1% of anal, 75.0% of vaginal, 70.1% of oropharyngeal, 68.8% of vulvar, 63.3% of penile, 32.0% of oral cavity, and 20.9% of laryngeal cancers, as well as in 98.8% of cervical cancer in situ (CCIS). A vaccine targeting HPV 16/18 potentially prevents the majority of invasive cervical (66.2%), anal (79.4%), oropharyngeal (60.2%), and vaginal (55.1%) cancers, as well as many penile (47.9%), vulvar (48.6%) cancers: 24 858 cases annually. The 9-valent vaccine also targeting HPV 31/33/45/52/58 may prevent an additional 4.2% to 18.3% of cancers: 3944 cases annually. For most cancers, younger age at diagnosis was associated with higher HPV 16/18 prevalence. With the exception of oropharyngeal cancers and CCIS, HPV 16/18 prevalence was similar across racial/ethnic groups.
In the United States, current vaccines will reduce most HPV-associated cancers; a smaller additional reduction would be contributed by the new 9-valent vaccine.
Background. Human papillomavirus (HPV) vaccine was recommended in 2006 for routine vaccination of US females aged 11–12 years. Most vaccine used through 2014 was quadrivalent vaccine (4vHPV), which ...prevents HPV-6, -11, -16, and -18 infection. To evaluate vaccine impact, we measured HPV prevalence in the National Health and Nutrition Examination Survey (NHANES). Methods. We analyzed HPV DNA types detected in self-collected cervicovaginal specimens and demographic, sexual behavior, and self-reported vaccination data from females 14–34 years old. We estimated HPV prevalence in the prevaccine (2003–2006) and vaccine eras (2007–2010 and 2011–2014). Results. Among 14- to 19-year-olds, 4vHPV-type prevalence decreased from 11.5% (95% confidence interval CI, 9.1%–14.4%) in 2003–2006 to 3.3% (95% CI, 1.9%–5.8%) in 2011–2014, when ≥1-dose coverage was 55%. Among 20- to 24-year-olds, prevalence decreased from 18.5% (95% CI, 14.9%–22.8%) in 2003–2006 to 7.2% (95% CI, 4.7%–11.1%) in 2011–2014, when ≥1-dose coverage was 43%. Compared to 2003–2006, 4vHPV prevalence in sexually active 14- to 24-year-olds in 2011–2014 decreased 89% among those vaccinated and 34% among those unvaccinated. Vaccine effectiveness was 83%. Conclusions. Within 8 years of vaccine introduction, 4vHPV-type prevalence decreased 71% among 14- to 19-year-olds and 61% among 20- to 24-year-olds. Estimated vaccine effectiveness was high. The decrease in 4vHPV-type prevalence among unvaccinated females suggests herd protection.
Background. We report the first nationally representative prevalence data on genital human papillomavirus (HPV) in males in the United States, using findings from the National Health and Nutrition ...Examination Surveys, 2013–2014. Methods. Using penile swabs from males aged 14–59 years, we estimated the HPV DNA prevalence and prevalence ratios (PRs) with respect to sexual behaviors and demographic characteristics. Results. The prevalence of any HPV was 42.2% (95% confidence interval CI, 38.3%–46.1%) and of high-risk (HR) HPV was 23.4% (95% CI, 21.3%–25.6%). Prevalence of any HPV was 12.5% in 14-19 year olds and was higher in older age groups, through ages 25–29 years, and then similar through age 59 years. After adjustment for age and race, any HPV prevalence was associated with lifetime number of sex partners (≥15 vs 1–2; PR, 3.27; 95% CI, 2.12–5.02) and past-year number of sex partners (≥2 vs 0; PR, 1.26; 95% CI, 1.09–1.46). Comparisons of consecutively older age groups revealed that the prevalence of quadrivalent HPV vaccine types (4vHPV), types 6, 11, 16, and 18, was significantly higher only between ages 25–29 and 20–24 years (PR, 2.79; 95% CI, 1.31–5.96), whereas the prevalence of other HPV types was significantly higher only between ages 20–24 and 14–19 years (PR, 3.39; 95% CI, 2.49–4.61). Conclusions. Overall, 42.2% of US males aged 14–59 years have detectable genital HPV infections. Differences in the age-specific prevalence of 4vHPV types and non-4vHPV types suggest that the vaccination program has had an impact on the prevalence of HPV types 6, 11, 16, and 18 among males.
Differences in human papillomavirus (HPV) prevalence among males and females have been reported. Using the 2013-2014 National Health and Nutrition Examination Survey, we evaluated sex differences in ...prevalence overall and by demographic and sexual behavior characteristics.
Self-collected penile and cervicovaginal swabs from participants aged 14-59 were tested for HPV DNA. Prevalences of any HPV and high-risk HPV (HR-HPV) were estimated for sexually experienced males and females. Overall and in models stratified by demographic characteristics and behaviors, prevalence was compared in males and females using prevalence ratios (PR).
Overall, males had higher prevalence than females of any HPV (PR, 1.14; 95% confidence interval CI, 1.03-1.27) and HR-HPV (PR, 1.24; 95% CI, 1.07-1.43). Prevalences were lower among males than females at ages 14-19 and higher at ages 40-49 and 50-59. Sex differences in models stratified by race/ethnicity, poverty, sexual behaviors, and smoking were observed. After adjusting for lifetime sex partners, most sex differences were attenuated, but males had lower prevalences at ages 14-19 and 20-24 and higher HR-HPV prevalence among non-Hispanic blacks.
Any HPV and HR-HPV prevalences were significantly higher in males; sex differences varied by age group and race/ethnicity. Lifetime partners explained many of the differences by sex.
Human papillomavirus (HPV) vaccine has been recommended in the United States since 2006 for routine vaccination of girls at age 11–12 years and through age 26 years for women not previously ...vaccinated. Changes in vaccine-type HPV (VT) prevalence can be used to evaluate vaccine impact, including herd effects.
We determined type-specific HPV in cytology specimens from women aged 20–29 years screened for cervical cancer at Kaiser Permanente Northwest in 2007 and in two vaccine era periods: 2012–2013 and 2015–2016. Detection and typing used L1 consensus PCR with hybridization for 37 types, including quadrivalent vaccine types (HPV 6/11/16/18).
Among 20–24 year-olds in 2012–2013 and 2015–2016, 44% and 64% had a history of ≥1-dose vaccination. VT prevalence decreased from 13.1% in 2007 to 2.9% in 2015–2016 (prevalence ratio PR = 0.22; 95% confidence interval CI 0.17–0.29). HPV 31 prevalence was also lower in the vaccine periods compared with 2007. VT prevalence in 2015–2016 among 20–24 year-olds was lower in both vaccinated, 1.3% (PR = 0.10; 95% CI 0.06–0.16), and unvaccinated women, 5.8% (PR = 0.45; 95% CI 0.33–0.61). Among 25–29 year-olds, 21% and 32% had a history of ≥1-dose vaccination. VT prevalence decreased from 8.1% in 2007 to 5.0% in 2015–2016 (PR = 0.62; 95% CI 0.50–0.78). Non-VT high risk prevalence was higher in the vaccine periods compared with the pre-vaccine era in both age groups, however, not in 2015–2016 compared with 2012–2013.
Within 9–10 years of vaccine introduction, VT prevalence decreased 78% among 20–24 year-olds and 38% in 25–29 year-olds. There were declines in both vaccinated and unvaccinated women, showing evidence of direct and herd protection.
Abstract
Background
Highly effective human papillomavirus (HPV) vaccines are used in many national programs in 3- or 2-dose schedules. We examined HPV vaccine effectiveness against HPV prevalence by ...number of doses.
Methods
We collected residual liquid-based cytology samples from US women aged 20–29 years who were screened for cervical cancer. Women continuously enrolled from 2006 through the specimen collection date were analyzed. Specimens were tested using the Linear Array assay. We analyzed prevalence of quadrivalent HPV vaccine (4vHPV) types (HPV 6,11,16,18) and other HPV-type categories and determined prevalence ratios (PRs) and 95% confidence intervals (CIs) for 1, 2, and 3 compared with no vaccine doses.
Results
Among 4269 women, 1052 (24.6%) were unvaccinated, 2610 (61.1%) received 3 doses, 304 (7.1%) received 2 doses, and 303 (7.1%) received 1 dose. The 4vHPV-type prevalence was 7.4% among unvaccinated women compared with 1.7%, 1.0%, and 1.0% among 1-, 2-, and 3-dose recipients. Among women vaccinated at ≤18 years, adjusted PRs for 1, 2, and 3 doses were 0.06 (95% CI, 0.01–0.42), 0.05 (95% CI, 0.01–0.39), and 0.06 (95% CI, 0.04–0.12).
Conclusions
Among women who received their first dose at age ≤18, estimated HPV vaccine effectiveness was high regardless of number of doses.
In this observational study of HPV vaccine effectiveness for prevention of vaccine-type prevalent infection, among women who had received their first vaccine dose at age ≤18 years, estimated vaccine effectiveness for 1, 2, and 3 doses was 92% or greater.
DNA from archived FFPE can be used for papillomavirus genotyping, but potential problems include paraffin as a physical barrier, DNA cross-linking, and PCR inhibitors. To address these complications, ...we combined a commercially available DNA isolation kit (Qiagen DNeasy) with a heat treatment and evaluated the resulting DNA with regards to HPV typing. DNA was extracted from 10-μm sections from 150 FFPE cancer samples. One protocol followed the manufacturer's recommendation, including paraffin removal by xylene and tissue lysis at 56°C. A second section was directly incubated at 120°C and subsequently lysed at 65°C. After spin-column purification, both extracts were tested with a linear array HPV genotyping assay. Additionally, cellular DNA yield, HPV16 DNA copies, and PCR inhibitors were assessed by real-time qPCR assays. Inadequate linear array HPV genotyping assay results were significantly more frequent ( P = 0.0003) in xylene-treated (29/150, 19.3%) than in heat-treated extracts (8/150, 5.3%). HPV detection also differed, with 94/150 (62.7%) and 110/150 (73.3%) positive results, respectively ( P = 0.0026). The heat method also yielded more PCR-amplifiable cellular DNA (8.2-fold; P < 0.001) and HPV16 copies (6.5-fold; P = 0.009), although PCR inhibitors also had a greater effect ( P = 0.035). Aggressive heat treatment demonstrated an advantage over traditional xylene purification protocols, resulting in higher DNA yields and increased sensitivity for HPV testing.
Human papillomavirus (HPV) prevalence is high among men who have sex with men (MSM), yet little is known about HPV among transgender women (TGW). We assessed HPV prevalence and knowledge among TGW ...compared with MSM.
We enrolled TGW and MSM aged 18 to 26 years from clinics in Chicago and Los Angeles during 2012 to 2014. Participants self-reported gender identity, HIV status, HPV knowledge, and vaccination status. Self-collected anal and oral specimens were tested for HPV DNA (37 types); serum was tested for HPV antibodies (4 vaccine types). Prevalence among unvaccinated TGW and MSM was compared using prevalence ratios (PRs) and 95% confidence intervals (CIs). Participants without DNA or serologic evidence of HPV were considered naïve.
Among 1033 participants, 49 were TGW. Among 44 TGW and 855 MSM who were unvaccinated, any HPV DNA was detected in anal specimens from 39 (88.6%) TGW and 606 (70.9%) MSM (PR, 1.3; 95% CI, 1.1-1.4), and oral specimens from 4 (9.1%) TGW and 81 (9.5%) MSM (PR, 1.0; 95% CI, 0.4-2.5). Antibodies were detected among 37 (84.1%) TGW and 467 (54.6%) MSM (PR, 1.5; 95% CI, 1.3-1.8). Most participants were naïve to 1 or more HPV vaccine type/s, including 29 (65.9%) TGW and 775 (90.6%) MSM (PR, 0.7; 95% CI, 0.6-0.9). Most TGW (55.1%) had never heard of HPV vaccine.
Among TGW, HPV prevalence was high and knowledge was low. Most were still naïve to 1 or more HPV vaccine type. Although vaccination ideally occurs prior to exposure, findings support existing national recommendations to vaccinate TGW and MSM, and suggest additional outreach might increase vaccination.
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