Acquisition, prevalence and clearance of type-specific human papillomavirus infections in young sexually active Indian women: A community-based multicentric cohort study

Richard Muwonge, Partha Basu, Tarik Gheit, Devasena Anantharaman, Yogesh Verma, Neerja Bhatla, Smita Joshi, Pulikottil O Esmy, Usha Rani Reddy Poli, Anand Shah, Eric Zomawia, Surendra S Shastri, Sharmila Pimple, Priya R Prabhu, Sanjay Hingmire, Aruna Chiwate, Catherine Sauvaget, Eric Lucas, Sylla G Malvi, Maqsood Siddiqi, Subha Sankaran, Thiraviam Pillai Rameshwari Ammal Kannan, Rintu Varghese, Uma Divate, Shachi Vashist, Gauravi Mishra, Radhika Jadhav, Massimo Tommasino, M Radhakrishna Pillai, Rengaswamy Sankaranarayanan, Kasturi Jayant, Indian HPV vaccine study group, Richard Muwonge, Partha Basu, Tarik Gheit, Devasena Anantharaman, Yogesh Verma, Neerja Bhatla, Smita Joshi, Pulikottil O Esmy, Usha Rani Reddy Poli, Anand Shah, Eric Zomawia, Surendra S Shastri, Sharmila Pimple, Priya R Prabhu, Sanjay Hingmire, Aruna Chiwate, Catherine Sauvaget, Eric Lucas, Sylla G Malvi, Maqsood Siddiqi, Subha Sankaran, Thiraviam Pillai Rameshwari Ammal Kannan, Rintu Varghese, Uma Divate, Shachi Vashist, Gauravi Mishra, Radhika Jadhav, Massimo Tommasino, M Radhakrishna Pillai, Rengaswamy Sankaranarayanan, Kasturi Jayant, Indian HPV vaccine study group

Abstract

In context of the ongoing multi-centric HPV vaccine study in India, unvaccinated married women (N = 1484) aged 18-23 years were recruited in 2012-2015 as age-matched controls to the vaccinated women and followed up yearly. We assess type-specific prevalence, natural history and potential determinants of human papillomavirus (HPV) infection in these unvaccinated women. Cervical samples were collected yearly for at least four consecutive years. A Multiplex Type-Specific E7-Based polymerase chain reaction assay was used to detect 21 HPV types. HPV prevalence was 36.4% during 6 years. Most common HPV types were 16 (6.5%) and 31 (6.1%). Highest persistence were observed for HPV 35 (62.5%) and 52 (25%). New HPV acquisition rate was 5.6/1000 person-months of observation (PMO), highest for HPV 16 (1.1/1000 PMO). Type-specific clearance rates ranged between 2.9-5.5/100 PMO. HPV 16 and/or 18 infections were 41% (95% CI 4-63%) lower among women with 2-<3 years between marriage and first cervical sample collection compared to those with <2 years. HPV prevalence and acquisition rates in young Indian women were lower than their Western counterparts. HPV 16 infections being most common shows the importance and potential impact of HPV vaccination in India. Women with 2-3 years exposure had reduced risk possibly due to higher infections clearance.

Conflict of interest statement

The corresponding authors, on behalf of all authors, declares the following potential competing interests: Neerja Bhatla has received research funding through her institute from GlaxoSmithKline and Merck. Smita Joshi has received funds from GlaxoSmithKline through the Jehangir Clinical Development Center to do an HPV vaccine study. Partha Basu has received research funding from GlaxoSmithKline through Chittaranjan National Cancer Institute, India during his previous position at the institute. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors declare no competing interests.

Figures

Fig 1. Kaplan-Meier curves of cumulative probability…
Fig 1. Kaplan-Meier curves of cumulative probability of HPV infection among women negative for a specific type on their first cervical cell sample collection.
Fig 2. Kaplan-Meier curves of the proportion…
Fig 2. Kaplan-Meier curves of the proportion women who had type-specific HPV clearance.
Fig 3. Cervical cancer incidence reported by…
Fig 3. Cervical cancer incidence reported by population-based cancer registries at the Indian study sites and rank of cervical cancer by incidence among all cancers in females (Data source: National Cancer Registry Programme, India).

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