Persistent HPV may put women at risk for other HPV infections

Human papillomavirus virus (HPV) infections that persist for a long time appear to leave women more susceptible to other HPV infections, especially longer-term ones, than infections that clear up, a recent study suggests.

Researchers investigated long-term persistence of HPV without apparent cervical precancer and cancer in a subset of 810 Costa Rican women with 1,403 prevalently detected HPV infections from a large population-based study. The women underwent 3 or more years of active follow-up and 3 or more screening visits. Cervical specimens were tested using polymerase chain reaction. Fifty-eight of the 810 women had 72 long-term HPV infections (5%) that persisted until the end of the follow-up period (median, 7 years). A logistic regression model showed that women with long-term HPV were more likely than women whose infections cleared to have another newly-detected HPV infection when assessed at 3 or more office visits (odds ratio, 2.6).

The study was published in the Journal of Infectious Diseases (2011;203(6):814-822).

“The clinical implications and best patient management for the approximately 1 in 20 HPV-positive women who, by our definition, will have long-term viral persistence without evidence of cervical disease among those with an index-positive HPV test are uncertain,” the authors note.

The authors observe that although immediate excision of cervical tissue “provides the greatest safety, almost 90% of women would be overtreated” with this approach. An alternative approach would be “a more aggressive colposcopic exam, including 4-quadrant microbiopsies and endocervical curettage to maximize disease ascertainment without excision,” they write.

Women with long-term persistence of HPV infection were older than women with other outcomes, the researchers found (mean age, 54.4 years [median, 58.5 years] vs mean age, 35.8 years [median, 32.0 years]). They speculate that some older women may not be able to clear HPV infection because of age-related immunologic decline.