A prospective study of absolute risk and determinants of human papillomavirus incidence among young women in Costa Rica

Megan Clarke, Mark Schiffman, Sholom Wacholder, Ana Cecilia Rodriguez, Allan Hildesheim, Wim Quint, Costa Rican Vaccine Trial Group, Mario Alfaro, Manuel Barrantes, M Concepcion Bratti, Fernando Cárdenas, Bernal Cortés, Albert Espinoza, Yenory Estrada, Paula Gonzalez, Diego Guillén, Rolando Herrero, Silvia E Jimenez, Jorge Morales, Lidia Ana Morera, Elmer Pérez, Carolina Porras, Ana Cecilia Rodriguez, Maricela Villegas, Enrique Freer, Jose Bonilla, Sandra Silva, Ivannia Atmella, Margarita Ramírez, Nora Macklin, Allan Hildesheim, Douglas R Lowy, Mark Schiffman, John T Schiller, Mark Sherman, Diane Solomon, Sholom Wacholder, Ligia Pinto, Alfonso Garcia-Pineres, Claire Eklund, Martha Hutchinson, Wim Quint, Leen-Jan van Doorn, Catherine Bougelet, Megan Clarke, Mark Schiffman, Sholom Wacholder, Ana Cecilia Rodriguez, Allan Hildesheim, Wim Quint, Costa Rican Vaccine Trial Group, Mario Alfaro, Manuel Barrantes, M Concepcion Bratti, Fernando Cárdenas, Bernal Cortés, Albert Espinoza, Yenory Estrada, Paula Gonzalez, Diego Guillén, Rolando Herrero, Silvia E Jimenez, Jorge Morales, Lidia Ana Morera, Elmer Pérez, Carolina Porras, Ana Cecilia Rodriguez, Maricela Villegas, Enrique Freer, Jose Bonilla, Sandra Silva, Ivannia Atmella, Margarita Ramírez, Nora Macklin, Allan Hildesheim, Douglas R Lowy, Mark Schiffman, John T Schiller, Mark Sherman, Diane Solomon, Sholom Wacholder, Ligia Pinto, Alfonso Garcia-Pineres, Claire Eklund, Martha Hutchinson, Wim Quint, Leen-Jan van Doorn, Catherine Bougelet

Abstract

Background: High risk human papillomaviruses (HR-HPV) are known to be extremely common, sexually transmitted infections, but more information is needed regarding the absolute risks of type-specific HR-HPV infections in the years following sexual debut.

Methods: We conducted a survival analysis of 3,737 women aged 18-25 from the control group of the Costa Rican Vaccine trial to determine the absolute risks of HR-HPV infections at 12 months, 24 months, and end of follow-up (average of 50.7 months). To corroborate determinants of infection, we used Cox proportional hazards methods to assess associations between demographics and sexual risk behaviors and incident HR-HPV.

Results: Cumulative incidence for HR-HPV infections was 51.3% at the end of the study period. The most common incident types were HPV52 (15.4%), HPV51 (13.6%), and HPV16 (12.4%). Type-specific cumulative incidence corresponded closely with type-specific prevalences, except that HPV16 was more prevalent than predicted by incidence, suggesting greater persistence. The strongest predictors of incident HR-HPV infections as a group in a multivariate analysis were the expected correlates of sexual behavior of the woman and her partner, such as being single (HR 1.6, 95% CI 1.4-1.8) or divorced/widowed (HR: 2.1, 95% CI: 1.7-2.7), having multiple HPV infections at enrollment (HR: 1.5, 95% CI: 1.3-1.7), and current smoking (HR: 1.2, 95% CI: 1.0-1.3). In women who reported being having only one lifetime sexual partner (being in a monogamous relationship), the strongest predictors of HR-HPV included not living with sex partner (HR: 2.1, 95% CI 1.7-2.5) and age of sex partner (HR: 1.4, 95% CI: 1.0-1.8).

Conclusion: We confirm the extremely high incidence of HR-HPV in young women, emphasizing the importance of vaccinating young girls before sexual debut.

Trial registration: ClinicalTrials.gov NCT00128661.

Figures

Figure 1
Figure 1
A plot of the percent prevalence versus percent cumulative incidence by HR-HPV type.

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