Risk of newly detected infections and cervical abnormalities in adult women seropositive or seronegative for naturally acquired HPV-16/18 antibodies

Abstract

Background: Infections with human papillomavirus (HPV) types 16 and 18 account for ~70% of invasive cervical cancers but the degree of protection from naturally acquired anti-HPV antibodies is uncertain. We examined the risk of HPV infections as defined by HPV DNA detection and cervical abnormalities among women >25 years in the Human Papilloma VIrus Vaccine Immunogenicity ANd Efficacy trial's (VIVIANE, NCT00294047) control arm.

Methods: Serum anti-HPV-16/18 antibodies were determined at baseline and every 12 months in baseline DNA-negative women (N = 2687 for HPV-16 and 2705 for HPV-18) by enzyme-linked immunosorbent assay (ELISA) from blood samples. HPV infections were identified by polymerase chain reaction (PCR) every 6-months, and cervical abnormalities were confirmed by cytology every 12 months. Data were collected over a 7-year period. The association between the risk of type-specific infection and cervical abnormalities and serostatus was assessed using Cox proportional hazard models.

Results: Risk of newly detected HPV-16-associated 6-month persistent infections (PI) (hazard ratio [HR] = 0.56 [95%CI:0.32; 0.99]) and atypical squamous cells of undetermined significance (ASC-US+) (HR = 0.28 [0.12; 0.67]) were significantly lower in baseline seropositive vs baseline seronegative women. HPV-16-associated incident infections (HR = 0.81 [0.56; 1.16]) and 12-month PI (HR = 0.53 [0.24; 1.16]) showed the same trend. A similar trend of lower risk was observed in HPV-18-seropositive vs -seronegative women (HR = 0.95 [0.59; 1.51] for IIs, HR = 0.43 [0.16; 1.13] for 6-month PIs, HR = 0.31 [0.07; 1.36] for 12-month PIs, and HR = 0.61 [0.23; 1.61] for ASC-US+).

Conclusions: Naturally acquired anti-HPV-16 antibodies were associated with a decreased risk of subsequent infection and cervical abnormalities in women >25 years. This possible protection was lower than that previously reported in 15- to 25-year-old women.

Keywords: cervical abnormality; human papillomavirus infection; naturally acquired antibodies; redetection or reactivation of HPV infection; risk reduction.

Conflict of interest statement

D Rosillon and F Struyf are employed by the GSK group of companies and received GSK shares. L Baril was employed by the GSK group of companies at the time of the study and received GSK shares. G Dubin is currently a full‐time employee of Takeda Pharmaceuticals, Deerfield, Illinois, and receives salary and stock shares. MR Del Rosario‐Raymundo reports payment of honorarium as principal investigator and support for travel to meetings for the study from the GSK group of companies during the conduct of the study; payment for lectures including service on speakers' bureaus from the GSK group of companies. M Martens reports grants from the GSK group of companies, during the conduct of the study. C Bouchard reports grants from the GSK group of companies, during the conduct of the study. She reports grants and honorarium from Merck. KL Fong reports grant from the GSK group of companies via her institution for the conduct of the study. MC Bozonnat is a consultant outsourced from 4Clinics to the GSK group of companies. A Chatterjee received grant funding for clinical trials, and served on the speakers' bureau and advisory boards for the GSK group of companies and Merck. SM Garland has received advisory board fees and grants from CSL and the GSK group of companies, and lectures fees from Merck, the GSK group of companies, and Sanofi Pasteur. In addition, she received funding through her institution to conduct HPV vaccines studies for MSD and the GSK group of companies. She is a member of the Merck Global Advisory Board as well as the Merck Scientific Advisory Committee for HPV. E Lazcano‐Ponce received fees to conduct HPV vaccines studies from the GSK group of companies and Merck. SA McNeil has received research grants from the GSK group of companies and Sanofi Pasteur and speaker honoraria from Merck. B Romanowski received research grants, travel support, and speaker honoraria from the GSK group of companies. SR Skinner received funds through her institution from the GSK group of companies to cover expenses involved in the collection of data for this study. The GSK group of companies provided funds to reimburse expenses incurred with travel to conference to present data from other studies and paid honoraria to her institution for work conducted in the context of Advisory Board and educational meetings. CM Wheeler's institution received a contract from the GSK group of companies to act as a clinical trial site for this study, and reimbursements for travel related to publication activities and for HPV vaccine studies. Her institution also received funding from Merck to conduct HPV vaccine trials, and from Roche Molecular Systems equipment and reagents for HPV genotyping studies, outside the submitted work. X Castellsagué received research funding through his institution (ICO) from Merck & Co, SPMSD, the GSK group of companies, and Genticel. He also received honoraria for conferences from Vianex and SPMSD. G Minkina, as an investigator at a study clinical site, received fees from the GSK group of companies through her institution. She also received funding from Merck Sharp & Dohme to participate as principal investigator in efficacy trials. She received travel support to attend scientific meetings, honoraria for speaking engagements and participation in advisory board meetings, and consulting fees from the GSK group of companies and Merck Sharp & Dohme. T Stoney received honoraria from the GSK group of companies for study committee membership (Asia Pacific study follow‐up committee for Zoster studies), for conference attendance, and travel support. Her institution also received additional funding from a bioCSL grant for a project in which she is an investigator, funded by National Health and Medical Research Council. She also received travel support for participation in study investigator meetings from Novartis Vaccine and Diagnostics, Sanofi Pasteur, Alios BioPharma, and Pfizer. SC Quek received honoraria and travel expenses from the GSK group of companies for speaking at various symposia. A Savicheva received grants and fees from the GSK group of companies to participate in an epidemiological study (HERACLES). J Salmeron received grants from the GSK group of companies, Qiagen, and Merck Inc. D Money has received grants from Merck, the GSK group of companies, Novartis, and Sanofi for studies conduct. CS Vallejos, TYK Lim, B ter Harmsel, M Cruickshank, A Fiander, and A Ilancheran have nothing to disclose.

© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

Figure 1

Flowcharts. HPV, human papillomavirus; TVC, total vaccinated cohort; N, number of women; Sero+, women seropositive for HPV‐16/18; Sero −, women seronegative for HPV‐16/18

Figure 2

Risk ratio of incident, 6‐mo persistent, and 12‐mo persistent infection and atypical squamous cell of undetermined significance or greater in HPV‐16/HPV‐18 type‐specific seropositive vs seronegative women. Error bars represent 95% confidence intervals; #95% confidence intervals are narrow and not visible; HPV, human papillomavirus; PI, persistent infection; bin, binary; ab, antibody; ACS‐US+, atypical squamous cell of undetermined significance or greater