Extended Human Papillomavirus Genotyping to Predict Progression to High-Grade Cervical Precancer: A Prospective Cohort Study in the Southeastern United States

Abstract

Background: High-risk human papillomavirus (hrHPV) testing (HPV16; else HPV18/45; else HPV31/33/35/52/58; else HPV39/ is utilized in primary cervical cancer screening, generally along with 51/56/59/68). cytology, to triage abnormalities to colposcopy. Most screening-Results: At enrollment, median participant age was 30.1 years; based hrHPV testing involves pooled detection of any hrHPV or of most (63%) were hrHPV-positive. Over follow-up, 24 participants HPV16/18. Cervical neoplasia progression risks based on extended progressed to CIN2þ (7.0%). CIN2þ IR among hrHPV-positive hrHPV genotyping—particularly non-16/18 hrHPV types—are not participants was 3.4/1,000 person-months. CIN2þ IRs were highest well characterized. HPV genotype-specific incidence of high-grade for HPV16 (8.3), HPV33 (7.8), and HPV58 (4.9). Five-year CIN2þ cervical intraepithelial neoplasia or more severe (CIN2þ) following risk was higher for HPV16 (0.34) compared with HPV18/45 (0.12), an abnormal screening result was examined. HPV31/33/35/52/58 (0.12), and HPV39/51/56/59/68 (0.16) (P ¼ 0.05). Methods: We assessed a US-based prospective, multiracial, Conclusions: Non-16/18 hrHPV types are associated with difclinical cohort of 343 colposcopy patients with normal histology ferential CIN2þ progression rates. HPV16, 33, and 58 exhibited the (n ¼ 226) or CIN1 (n ¼ 117). Baseline cervical samples underwent highest rates over 5 years. HPV risk groups warrant further invesHPV DNA genotyping, and participants were followed up to 5 years. tigation in diverse US populations. Genotype-specific CIN2þ incidence rates (IR) were estimated with Impact: These novel data assessing extended HPV genotyping in accelerated failure time models. Five-year CIN2þ risks were estia diverse clinical cohort can inform future directions to improve mated nonparametrically for hierarchical hrHPV risk groups screening practices in the general population.