Wending Li1, Yifan Meng2, Yi Wang1, Xiaodong Cheng3, Chen Wang4, Songshu Xiao4, Xiaofei Zhang3, Zaixing Deng5, Mengjun Hu6, Pingrong Shen7, Shengfeng Xu8, Chenglin Fu9, Wen Jiang10, Bing Wu11, Kezhen Li2, Gang Chen2, Juncheng Wei2, Ling Xi2, Junbo Hu12, Ding Ma2, Min Xue13, Xing Xie14, Peng Wu15. 1. School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. 2. Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. 3. Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. 4. Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China. 5. Department of Obstetrics and Gynecology, Huzhou Maternity and Child Care Center, Huzhou, Zhejiang, China. 6. Department of Obstetrics and Gynecology, Zhuji People's Hospital, Shaoxing, Zhejiang, China. 7. Department of Obstetrics and Gynecology, Ninghai Maternity and Child Care Center, Ningbo, Zhejiang, China. 8. Department of Obstetrics and Gynecology, Jiaxing Maternity and Child Care Center, Jiaxing, Zhejiang, China. 9. Department of Obstetrics and Gynecology, Taizhou First People's Hospital, Taizhou, Zhejiang, China. 10. Department of Obstetrics and Gynecology, Zhoushan Maternity and Child Care Center, Zhoushan, Zhejiang, China. 11. Department of Obstetrics and Gynecology, Zhuji Maternity and Child Care Center, Shaoxing, Zhejiang, China. 12. The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. 13. Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China. Electronic address: xueminxy3@163.com. 14. Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. Electronic address: xiex@zju.edu.cn. 15. Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: pengwu8626@tjh.tjmu.edu.cn.
Abstract
OBJECTIVE: Cervical HR-HPV persistence is the main risk factor for cervical cancer. We aimed to investigate the association of age and viral factors with HR-HPV persistence. METHODS: From 2010 to 2017, 343,128 women underwent 390,411 tests performed by the Cervista HR-HPV assay (Data C3) and 157,123 women underwent 206,505 tests performed by the GenoArray HR-HPV assay (Data G14) in nine medical centers located in central and eastern China. We combined the test results and identified 9234 HPV-specific baseline-negative records for time-to-event analyses. The study endpoint event was defined as clearance of type/group-specific HPV. Therefore, hazard ratio (HR) < 1 indicated a higher risk of HPV persistence, which is contrary to the common meaning of HR. RESULTS: The median persistence time was 375 and 541.5 days for Data C3 and Data G14, respectively. For every 5-year increase in age, a 15% (95% confidence interval [CI], 11%-19%) decrease in the clearance rate was observed only after 400 days of infection. For each additional co-infected HPV, the HR was 1.80 (95% CI, 1.63-1.97) on infection initiation but decreased by 22% (95% CI, 18%-26%) every 100 days. The HR of infection recurrence was 0.48 (95% CI, 0.32-0.72). The findings were consistent across different populations and test methods and were robust in sensitivity analysis. CONCLUSIONS: We found a time-dependent association of age and viral factors with HPV clearance. Older age reduced HPV clearance only after 400 days of infection. Co-infection promoted HPV clearance in the beginning, but the effect attenuated and reversed as infection persisted. Recurrent same-type infection cleared slower than the previous one.
OBJECTIVE: Cervical HR-HPV persistence is the main risk factor for cervical cancer. We aimed to investigate the association of age and viral factors with HR-HPV persistence. METHODS: From 2010 to 2017, 343,128 women underwent 390,411 tests performed by the Cervista HR-HPV assay (Data C3) and 157,123 women underwent 206,505 tests performed by the GenoArray HR-HPV assay (Data G14) in nine medical centers located in central and eastern China. We combined the test results and identified 9234 HPV-specific baseline-negative records for time-to-event analyses. The study endpoint event was defined as clearance of type/group-specific HPV. Therefore, hazard ratio (HR) < 1 indicated a higher risk of HPV persistence, which is contrary to the common meaning of HR. RESULTS: The median persistence time was 375 and 541.5 days for Data C3 and Data G14, respectively. For every 5-year increase in age, a 15% (95% confidence interval [CI], 11%-19%) decrease in the clearance rate was observed only after 400 days of infection. For each additional co-infected HPV, the HR was 1.80 (95% CI, 1.63-1.97) on infection initiation but decreased by 22% (95% CI, 18%-26%) every 100 days. The HR of infection recurrence was 0.48 (95% CI, 0.32-0.72). The findings were consistent across different populations and test methods and were robust in sensitivity analysis. CONCLUSIONS: We found a time-dependent association of age and viral factors with HPV clearance. Older age reduced HPV clearance only after 400 days of infection. Co-infection promoted HPV clearance in the beginning, but the effect attenuated and reversed as infection persisted. Recurrent same-type infection cleared slower than the previous one.
Authors: Chameera Ekanayake Weeramange; Danhua Shu; Kai Dun Tang; Jyotsna Batra; Rahul Ladwa; Lizbeth Kenny; Sarju Vasani; Ian H Frazer; Riccardo Dolcetti; Jonathan J Ellis; Richard A Sturm; Paul Leo; Chamindie Punyadeera Journal: Cancer Date: 2022-02-17 Impact factor: 6.921