Age-specific HPV type distribution in high-grade cervical disease in screened and unvaccinated women

• Published in: Gynecologic oncology Vol. 154; no. 2; pp. 354 - 359
• Main Authors: Aro, Karoliina, Nieminen, Pekka, Louvanto, Karolina, Jakobsson, Maija, Virtanen, Seppo, Lehtinen, Matti, Dillner, Joakim, Kalliala, Ilkka
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2019
• Subjects: Genotype; HPV human papillomavirus; Medicin och hälsovetenskap; Prevalence; Squamous intraepithelial lesions of the cervix; Genotype; Prevalence; Squamous intraepithelial lesions of the cervix; HPV human papillomavirus
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2019.05.024

Age-specific type-distribution of high-risk human papillomavirus (hrHPV) in cervical precancerous lesions is subject to change in the HPV vaccination era. Knowing the pre-vaccination type-distribution helps to anticipate changes induced by mass vaccination and optimize screening.
We recruited 1279 women referred to colposcopy for abnormal cytology into a population-based study on HPV type distribution in diagnostic cervical samples (ISRCTN10933736). The HPV genotyping findings were grouped as: HPV16/18+, other hrHPV+ (HPV31/33/35/39/45/51/52/56/58/59/66/68), non-vaccine targeted hrHPV+ (HPV35/39/51/56/59/66/68), low-risk HPV, and HPV negative. We estimated the HPV group-specific prevalence rates according to diagnostic histopathological findings in the age groups of <30 (n = 339), 30–44.9 (n = 614), and ≥45 (n = 326).
Altogether 503 cases with high grade squamous intraepithelial lesion or worse (HSIL+) were diagnosed. More than half, 285 (56.7%) of HSIL+ cases were associated with HPV16/18: 64.3% (101/157) in women <30 years (reference group), 58.4% (157/269) in women 30–44.9 years (risk ratio (RR) 0.91, 95% confidence interval (95% CI) 0.78–1.06), and 35.1% (27/77) in women ≥45 years of age (RR 0.55, 95% CI 0.39–0.75). Conversely, other hrHPV's were associated with 191 (38.0%) of HSIL+: 31.9% (50/157) in women <30, 36.8% (99/269) in women 30–44.9 years, 54.6% (42/77) and in women ≥45 (RR 1.71, 95% CI 1.26–2.33). The proportion of non-vaccine targeted hrHPV and HPV negative HSIL+ increased with advancing age.
Pre-vaccination HPV type distribution in HSIL+ was distinctly polarised by age with HPV16/18 attributed disease being markedly more prevalent in women aged <30. In the older women the other hrHPV types, however, dominated suggesting a need for more age-dependent screening strategies.
•HPV distribution was markedly polarised by age in women referred to colposcopy.•HPV16/18 was twice as common in women <30 years than in women ≥45 with HSIL lesions.•In women ≥45 years other high-risk HPVs were more common in HSIL lesions.•In women ≥45 years approximately 10% of HSIL lesions were negative for high-risk HPV.