ORIGINAL ARTICLE

Persistent high risk HPV infection associated with development of cervical neoplasia in a prospective population study

K S Cuschieri¹, H A Cubie¹, M W Whitley², G Gilkison¹, M J Arends³, C Graham⁴ and E McGoogan¹

¹ Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
² St Triduanas Medical Practice, 54 Moira Park, Edinburgh EH16 4SA, UK
³ University of Cambridge Pathology Department, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK
⁴ The Epidemiology and Statistics Core, Wellcome Trust Clinical Research Facility, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK

Correspondence to:
Correspondence to:
Dr K Cuschieri
Specialist Virology Centre, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; kate.cuschieri{at}luht.scot.nhs.uk

Aims: To monitor the association between the course of high risk human papillomavirus (HR-HPV) infection and the development of cervical neoplasia over time, from a baseline of normal cervical cytology.

Methods: This paper presents the follow up data from a previous cross sectional analysis. Women from a screening population who had normal cytology and who were HR-HPV positive were recalled after two to three years for cytology and HPV genotyping. The development of cervical neoplasia at follow up was related to the course of HPV infection (clearance, persistence, or sequential infection) and the presence of single or multiple HPV infections at baseline. A comparator control group of women who were HPV and cytologically negative at baseline were selected from the same population.

Results: Twelve cases of dyskaryosis were found in women who were HPV positive at baseline; four were high grade. Only three cases of low grade dyskaryosis were found in the control group. Women with type specific persistent infections were significantly more likely to develop cervical neoplasia than women who cleared the infection (p = 0.0001) or were sequentially infected with different types (p = 0.001). Women with multiple HPV infections at baseline were no more likely to develop cervical dyskaryosis than those with a single infection.

Conclusions: Type specific persistent HR-HPV infection as monitored by genotyping can identify women at increased risk of cervical neoplasia more accurately than a single or repeated presence/absence HPV test. The cost effectiveness of such an approach should be investigated by an appropriate, large scale cost–benefit analysis.

Abbreviations: HPV, human papillomavirus; HR, high risk; LBC, liquid based cytology

Keywords: human papillomavirus; genotyping; longitudinal study; persistent infection; cervical neoplasia

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