Human papillomavirus genotype-specific risks for cervical intraepithelial lesions

ABSTRACT

Prevalence of different HPV genotypes is changing after HPV vaccination. The associated risks are needed for optimizing cervical cancer screening.

To estimate HPV type-specific prevalence, odds ratio (OR), and positive predictive value (PPV) for cervical cytological abnormalities, we determined 41 different HPV genotypes in cervical samples from a population-based sample of 8351 women aged 18–51 years before HPV vaccination era (V501-033; NCT01077856).

Prevalence of HPV16 was 4.9% (95% CI: 4.4–5.5) with the PPV for high-grade cytology 11.2%, and OR 11.9 (95% CI: 8.5–16.5). Carcinogenic HPVs included in the nonavalent vaccine (HPV16,18,31,33,45,52,58) had a population prevalence of 14.4% (95% CI: 13.5–15.4), with PPV of 8.0% (95% CI: 6.8–9.3) and OR 23.7 (95% CI: 16.0–63.5) for high-grade cytology. HPV types currently included in most screening tests, but not vaccinated against (HPV35,39,51,56,59,66,68) had a joint prevalence of 8.5% (95% CI: 7.8–9.2) with PPV of 4.4% (95% CI: 3.3–5.7) and OR of 2.9 (95% CI: 2.0–4.0) for high-grade cytology. The other 27 non-carcinogenic genotypes had a prevalence of 11.8%, PPV of 2.9% (95% CI:2.1–3.9), and OR 1.5 (95% CI: 1.1–2.2.) for high-grade cytology.

These results suggest that HPV screening tests in the post-vaccination era might perform better if restricted to the HPV types in the nonavalent vaccine and screening for all 14 HPV types might result in suboptimal balance of harms and benefits.

KEYWORDS:

• Denmark
• high-risk HPV
• Iceland
• liquid-based cytology
• low-risk HPV
• Norway
• population-based prevalence
• Sweden

Acknowledgments

Editorial support was provided by Emily Cullinan, PhD, CMPP of The Lockwood Group. This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. We would like to thank Jon E. Stek, MS, and Karyn Davis, BA, of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA for editorial assistance.

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

Disclosure statement

Mari Nygård has received research grants through her affiliating institute from MSD Norway. Bo T. Hansen and Suzanne Campbell report that their affiliating institute received grants from MSD Norway during the conduct of the study. Susanne K. Kjaer reports lecture fees from Sanofi Pasteur, MSD, and Merck & Co., Inc., Kenilworth, NJ, USA, and scientific advisory board fee and unrestricted research grants through her institution from Merck & Co., Inc., Kenilworth, NJ, USA. Maria Hortlund, Camilla Lagheden, and Joakim Dillner report that their affiliating institute received grants from Sanofi Pasteur, MSD, and Merck & Co., Inc., Kenilworth, NJ, USA. Christian Munk reports that he received lecture fees and support for conference participation from Sanofi Pasteur, MSD. Laufey Tryggvadóttir and Lara G. Sigurdardottir report that their affiliating institute received research grants from MSD Denmark ApS. Kai-Li Liaw is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Kenilworth, NJ, USA.

Supplementary materials

Supplemental data for this article can be accessed online at http://doi.org/10.1080/21645515.2020.1814097.

Additional information

Funding

Financial support from Merck Sharp & Dohme Corp. a subsidiary of Merck & Co., Inc., Kenilworth, NJ USA (NCT01077856).