Risk of cervical HPV infection and prevalence of vaccine-type and other high-risk HPV types among sexually active teens and young women (13–26 years) enrolled in the VALHIDATE study

Abstract

HPV vaccination is expected to reduce the incidence of cervical cancer. The greatest and the earliest health gains will be ensured by high vaccine coverage among all susceptible people. The high costs and the risk of a reduced cost/effectiveness ratio in sexually active girls still represent the main obstacles for a more widespread use of HPV vaccination in many countries. Data on the rate, risk factors, and HPV types in sexually active women could provide information for the evaluation of vaccination policies extended to broader age cohorts.

Sexually active women aged 13–26 years enrolled in an Italian cohort study were screened for cervical HPV infections; HPV-DNA positive samples were genotyped by InnoLipa HPV Genotyping Extra or by RFLP genotype analysis.

Among the 796 women meeting the inclusion criteria, 10.80% (95% CI 8.65–12.96) were HPV-DNA infected. Age >18 years, lifetime sexual partners >1, and history of STIs were associated to higher risk of HPV infection in the multivariable models adjusted for age, lifetime sexual partners, and time of sexual exposure. The global prevalence of the four HPV vaccine-types was 3.02% (95% CI 1.83–4.20) and the cumulative probability of infection from at least one vaccine-type was 12.82% in 26-years-old women and 0.78% in 18-years-old women.

Our data confirm most of the previously reported findings on the risk factors for HPV infections. The low prevalence of the HPV vaccine-types found may be useful for the evaluation of the cost/efficacy and the cost/effectiveness of broader immunization programs beyond the 12-years-old cohort.

Keywords: :

• HPV infection
• HPV vaccine
• HR-HPV
• sexually active girls
• risk factors

10.4161/hv.27682

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

Acknowledgments

This study was funded by the Health General Direction, Regione Lombardia, Italy (DGR 10813/2009). The authors thank Emanuele Castelli who developed and provided technical support for the eCRF, Liliane Chatenoud, and Paola Bertuccio for the optimisation and data quality control of the database.

Author Contributions

G.O. conceived, coordinated, and supervised the study. M.F., S.E., I.C., and G.V.Z. contributed to the recruitment of the participants contributing substantially to the acquisition of the clinical and epidemiological data. M.F., E.T., and E.F. coordinated and contributed to the laboratory testing for HPV-DNA and HPV genotyping. G.O. and M.F. conducted the first statistical analyses. Ricci E refined and performed the final statistical analysis. G.O., E.T., F.M., and M.F. evaluated the results and wrote the manuscript. M.G. contributed to the conception and design of the study, secured study funding, and critically revised the manuscript. All the authors read, revised, and approved the final manuscript.

VALHIDATE study group

The VALHIDATE study group contributes substantially to the acquisition of clinical and epidemiological data and evaluated cervical and urine samples according to the study protocol. Members of this group are listed as follows: Maria Concetta Antonacci, Irene Arcidiacono, Silvia Bianchi, Veronica Boero, Giuseppe Cambiè, Elena Casolati, Valentina Montinaro, Marcella Falchetti, Marianna Martinelli, Carlo Galli, Emanuela Bertazzoli, Giovanna Lunghi, Alberto Matteelli, Giancarlo Tisi, Anna Maria Villa, Nadia Zanchetta, Laura Pogliani.