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Epidemiological, clinical and viral determinants of the increased prevalence of high-risk human papillomavirus (HPV) infections in elderly women.
Eur J Gynaecol Oncol 2008; 29(2):114-22EJ

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 high-risk 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 U-shaped 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 HPV 16, 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 HR-HPV 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 HR-HPV infections in women > 55 years were associated with high-grade CIN or invasive carcinoma.

Authors+Show Affiliations

Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland. kari.syrjanen@tyks.fiNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18459542

Citation

Syrjänen, K, et al. "Epidemiological, Clinical and Viral Determinants of the Increased Prevalence of High-risk Human Papillomavirus (HPV) Infections in Elderly Women." European Journal of Gynaecological Oncology, vol. 29, no. 2, 2008, pp. 114-22.
Syrjänen K, Kulmala SM, Shabalova I, et al. Epidemiological, clinical and viral determinants of the increased prevalence of high-risk human papillomavirus (HPV) infections in elderly women. Eur J Gynaecol Oncol. 2008;29(2):114-22.
Syrjänen, K., Kulmala, S. M., Shabalova, I., Petrovichev, N., Kozachenko, V., Zakharova, T., ... Syrjänen, S. (2008). Epidemiological, clinical and viral determinants of the increased prevalence of high-risk human papillomavirus (HPV) infections in elderly women. European Journal of Gynaecological Oncology, 29(2), pp. 114-22.
Syrjänen K, et al. Epidemiological, Clinical and Viral Determinants of the Increased Prevalence of High-risk Human Papillomavirus (HPV) Infections in Elderly Women. Eur J Gynaecol Oncol. 2008;29(2):114-22. PubMed PMID: 18459542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiological, clinical and viral determinants of the increased prevalence of high-risk human papillomavirus (HPV) infections in elderly women. AU - Syrjänen,K, AU - Kulmala,S M, AU - Shabalova,I, AU - Petrovichev,N, AU - Kozachenko,V, AU - Zakharova,T, AU - Pajanidi,J, AU - Podistov,J, AU - Chemeris,G, AU - Sozaeva,L, AU - Lipova,E, AU - Tsidaeva,I, AU - Ivanchenko,O, AU - Pshepurko,A, AU - Zakharenko,S, AU - Nerovjna,R, AU - Kljukina,L, AU - Erokhina,O, AU - Branovskaja,M, AU - Nikitina,M, AU - Grunjberga,V, AU - Grunjberg,A, AU - Juschenko,A, AU - Santopietro,R, AU - Cintorino,M, AU - Tosi,P, AU - Syrjänen,S, PY - 2008/5/8/pubmed PY - 2008/6/11/medline PY - 2008/5/8/entrez SP - 114 EP - 22 JF - European journal of gynaecological oncology JO - Eur. J. Gynaecol. Oncol. VL - 29 IS - 2 N2 - 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 high-risk 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 U-shaped 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 HPV 16, 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 HR-HPV 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 HR-HPV infections in women > 55 years were associated with high-grade CIN or invasive carcinoma. SN - 0392-2936 UR - https://www.unboundmedicine.com/medline/citation/18459542/Epidemiological_clinical_and_viral_determinants_of_the_increased_prevalence_of_high_risk_human_papillomavirus__HPV__infections_in_elderly_women_ L2 - http://screening.iarc.fr/atlashisto.php DB - PRIME DP - Unbound Medicine ER -