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Ng K, Morais S, Wissing MD, Burchell AN, Tellier PP, Coutlée F, Waterboer T, El-Zein M, Franco EL. Empirical sample-specific approaches to define HPV16 and HPV18 seropositivity in unvaccinated, young, sexually active women. Microbiol Spectr 2024; 12:e0022924. [PMID: 38687066 DOI: 10.1128/spectrum.00229-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
Given low seroconversion rates following human papillomavirus (HPV) infection, fixed external cutoffs may lead to errors in estimating HPV seroprevalence. We evaluated finite mixture modeling (FMM) and group-based trajectory modeling (GBTM) among unvaccinated, sexually active, HPV-exposed women to determine study-specific HPV16 and HPV18 seropositivity thresholds. We included 399 women (aged 18-24 years) enrolled in the HPV Infection and Transmission Among Couples Through Heterosexual Activity (HITCH) cohort study between 2005 and 2011 in Montreal, Canada. Participants' blood samples from up to six visits spanning 2 years were tested by multiplex serology for antibodies [median fluorescence intensity (MFI)] specific to bacterially expressed HPV16 and HPV18 L1 glutathione S-transferase fusion proteins. We applied FMM and GBTM to baseline and longitudinal antibody titer measurements, respectively, to define HPV type-specific seronegative and seropositive distributions. Study-specific thresholds were generated as five standard deviations above the mean seronegative antibody titers, mimicking cutoffs (HPV16: 422 MFI; HPV18: 394 MFI) derived from an external population of sexually inactive, HPV DNA-negative Korean women (aged 15-29 years). Agreement (kappa) of study-specific thresholds was evaluated against external cutoffs. Seroprevalence estimates using FMM (HPV16: 27.5%-43.2%; HPV18: 21.7%-49.5%) and GBTM (HPV16: 11.8%-11.8%; HPV18: 9.9%-13.4%) thresholds exceeded those of external cutoffs (HPV: 10.2%; HPV18: 9.7%). FMM thresholds showed slight-to-moderate agreement with external cutoffs (HPV16: 0.26%-0.46%; HPV18: 0.20%-0.56%), while GBTM thresholds exhibited high agreement (HPV16: 0.92%-0.92%; HPV18: 0.82%-0.99%). Kappa values suggest that GBTM, used for longitudinal serological data, and otherwise FMM, for cross-sectional data, are robust methods for determining the HPV serostatus without prior classification rules.IMPORTANCEWhile human papillomavirus (HPV) seropositivity has been employed as an epidemiologic determinant of the natural history of genital HPV infections, only a fraction of women incidentally infected with HPV respond by developing significant antibody levels. HPV seropositivity is often determined by a dichotomous fixed cutoff based on the seroreactivity of an external population of women presumed as seronegative, given the lack of evidence of HPV exposure. However, considering the variable nature of seroreactivity upon HPV infection, which arguably varies across populations, such externally defined cutoffs may lack specificity to the population of interest, causing inappropriate assessment of HPV seroprevalence and related epidemiologic uses of that information. This study demonstrates that finite mixture modeling (FMM) and group-based trajectory modeling (GBTM) can be used to independently estimate seroprevalence or serve as the basis for defining study-specific seropositivity thresholds without requiring prior subjective assumptions, consequently providing a more apt internally valid discrimination of seropositive from seronegative individuals.
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Affiliation(s)
- Kristy Ng
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Samantha Morais
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Michel D Wissing
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - François Coutlée
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
- Laboratoire de Virologie Moléculaire, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Départements de Microbiologie, Infectiologie et Immunologie, et de Gynécologie-Obstétrique, Université de Montréal, Montreal, Quebec, Canada
- Départements de Médecine, de Médecine clinique de Laboratoire et d'Obstétrique-Gynécologie, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center, Heidelberg, Germany
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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López-Codony V, de Andrés-Pablo Á, Ferrando-Díez A, Fernández-Montolí ME, López-Querol M, Tous S, Ortega-Expósito C, Torrejón-Becerra JC, Pérez Y, Ferrer-Artola A, Sole-Sedeno JM, Grau C, Rupérez B, Saumoy M, Sánchez M, Peremiquel-Trillas P, Bruni L, Alemany L, Bosch FX, Pavón MA. Assessing the reduction of viral infectivity in HPV16/18-positive women after one, two, and three doses of Gardasil-9 (RIFT): Study protocol. PLoS One 2024; 19:e0304080. [PMID: 38768231 PMCID: PMC11104652 DOI: 10.1371/journal.pone.0304080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Human Papillomavirus (HPV) prophylactic vaccination has proven effective in preventing new infections, but it does not treat existing HPV infections or associated diseases. Hence, there is still an important reservoir of HPV in adults, as vaccination programs are mainly focused on young women. The primary objective of this non-randomized, open-label trial is to evaluate if a 3-dose regimen of Gardasil-9 in HPV16/18-positive women could reduce the infective capacity of their body fluids. We aim to assess if vaccine-induced antibodies could neutralize virions present in the mucosa, thus preventing the release of infective particles and HPV transmission to sexual partners. As our main endpoint, the E1^E4-HaCaT model will be used to assess the infectivity rate of cervical, anal and oral samples, obtained from women before and after vaccination. HPV DNA positivity, virion production, seroconversion, and the presence of antibodies in the exudates, will be evaluated to attribute infectivity reduction to vaccination. Our study will recruit two different cohorts (RIFT-HPV1 and RIFT-HPV2) of non-vaccinated adult women. RIFT-HPV1 will include subjects with an HPV16/18 positive cervical test and no apparent cervical lesions or cervical lesions eligible for conservative treatment. RIFT-HPV2 will include subjects with an HPV16/18 positive anal test and no apparent anal lesions or anal lesions eligible for conservative treatment, as well as women with an HPV16/18 positive cervical test and HPV-associated vulvar lesions. Subjects complying with inclusion criteria for both cohorts will be recruited to the main cohort, RIFT-HPV1. Three doses of Gardasil-9 will be administered intramuscularly at visit 1 (0 months), visit 2 (2 months) and visit 3 (6 months). Even though prophylactic HPV vaccines would not eliminate a pre-existing infection, our results will determine if HPV vaccination could be considered as a new complementary strategy to prevent HPV-associated diseases by reducing viral spread. Trial registration: https://clinicaltrials.gov/ct2/show/NCT05334706.
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MESH Headings
- Humans
- Female
- Papillomavirus Infections/prevention & control
- Papillomavirus Infections/virology
- Papillomavirus Infections/immunology
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/administration & dosage
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/immunology
- Human papillomavirus 16/immunology
- Human papillomavirus 18/immunology
- Adult
- Young Adult
- Adolescent
- Antibodies, Viral/immunology
- Papillomavirus Vaccines/administration & dosage
- Papillomavirus Vaccines/immunology
- DNA, Viral
- Vaccination/methods
- Cervix Uteri/virology
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Affiliation(s)
- Victoria López-Codony
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
- Programa de Doctorat en Biomedicina, Universitat de Barcelona (UB), Barcelona, Spain
| | - Álvaro de Andrés-Pablo
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
- Programa de Doctorat en Biomedicina, Universitat de Barcelona (UB), Barcelona, Spain
| | - Angelica Ferrando-Díez
- Medical Oncology Department, Catalan Institute of Oncology, Germans Trias i Pujol University Hospital (HGTiP), Badalona, Barcelona, Spain
| | | | - Marta López-Querol
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sara Tous
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carlos Ortega-Expósito
- Department of Gynaecology, Bellvitge University Hospital (HUB), L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Yolanda Pérez
- Department of Gynaecology, Bellvitge University Hospital (HUB), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Ferrer-Artola
- Bellvitge Biomedical Research Institute (IDIBELL), Pharmacy Unit, Bellvitge University Hospital (HUB), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Sole-Sedeno
- Department of Obstetrics and Gynaecology, Hospital del Mar–Mar Health Park, Barcelona, Spain
| | - Clara Grau
- Sexual and Reproductive Health Care Center–ASSIR, Delta del Llobregat, Barcelona, Spain
| | - Blas Rupérez
- Sexual and Reproductive Health Care Center–ASSIR, Delta del Llobregat, Barcelona, Spain
| | - Maria Saumoy
- HIV and STD Unit, Bellvitge University Hospital (HUB), Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Sánchez
- HIV and STD Unit, Bellvitge University Hospital (HUB), Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
- Programa de Doctorat en Biomedicina, Universitat de Barcelona (UB), Barcelona, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laia Bruni
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laia Alemany
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Francesc Xavier Bosch
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Faculty of Health Sciences, Open University of Catalonia (UOC), Barcelona, Spain
| | - Miquel Angel Pavón
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Arthur AW, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Detection and Clearance of Type-Specific and Phylogenetically Related Genital Human Papillomavirus Infections in Young Women in New Heterosexual Relationships. J Infect Dis 2024; 229:691-706. [PMID: 37824429 PMCID: PMC10938200 DOI: 10.1093/infdis/jiad450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Understanding the natural history of human papillomavirus (HPV) infections is essential to cervical cancer prevention planning. We estimated HPV type-specific infection detection and clearance in young women. METHODS The HPV Infection and Transmission among Couples through Heterosexual activity (HITCH) study is a prospective cohort of 502 college-age women who recently initiated a heterosexual relationship. We tested vaginal samples collected at 6 clinical visits over 24 months for 36 HPV types. Using rates and Kaplan-Meier analysis, we estimated time-to-event statistics with 95% confidence intervals (CIs) for detection of incident infections and clearance of incident and present-at-baseline infections (separately). We conducted analyses at the woman- and HPV-levels, with HPV types grouped by phylogenetic relatedness. RESULTS By 24 months, we detected incident infections in 40.4% (CI, 33.4%-48.4%) of women. Incident subgenus 1 (43.4; CI, 33.6-56.4), 2 (47.1; CI, 39.9-55.5), and 3 (46.6; CI, 37.7-57.7) infections cleared at similar rates per 1000 infection-months. We observed similar homogeny in HPV-level clearance rates among present-at-baseline infections. CONCLUSIONS Our analyses provide type-specific infection natural history estimates for cervical cancer prevention planning. HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections persist longer than their low oncogenic risk subgenera 1 and 3 counterparts.
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Affiliation(s)
- Andrew W Arthur
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St.Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - François Coutlée
- Département Clinique de Médecine de Laboratoire, Service de Diagnostique Moléculaire, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
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4
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Arthur AW, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Epidemiology of genital human papillomavirus infections in sequential male sex partners of young females. Clin Microbiol Infect 2024; 30:247-253. [PMID: 37981060 DOI: 10.1016/j.cmi.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Couple-based studies have considered human papillomavirus (HPV) transmission between current heterosexual partners (male↔female). Using data from young women and their sequential male partners, we analysed HPV transmission from upstream sexual partnerships (male 1↔female) to downstream sex partners (→male 2). METHODS Among 502 females enrolled in the HPV Infection and Transmission among Couples through Heterosexual activity study (2005-2011, Montréal, Canada), 42 brought one male sex partner at baseline (male 1) and another during follow-up (male 2). Female genital samples, collected at six visits over 24 months, and male genital samples, collected at two visits over 4 months, were tested for 36 HPV types (n = 1512 detectable infections). We calculated observed/expected ratios with 95% CIs for type-specific HPV concordance between males 1 and 2. Using mixed-effects regression, we estimated ORs with 95% CIs for male 2 testing positive for the same HPV type as male 1. RESULTS Detection of the same HPV type in males 1 and 2 occurred 2.6 (CI 1.9-3.5) times more often than chance (29 instances observed vs. 10.95 instances expected). The OR for male 2 positivity was 4.2 (CI 2.5-7.0). Adjusting for the number of times the linking female tested positive for the same HPV type attenuated the relationship between male 1 and 2 positivity, suggesting mediation. CONCLUSIONS High type-specific HPV concordance between males 1 and 2 confirms HPV's transmissibility in chains of sequential sexual partnerships. HPV positivity in an upstream partnership predicted positivity in a downstream male when the linking female partner was persistently positive.
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Affiliation(s)
- Andrew W Arthur
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Pierre-Paul Tellier
- Department of Family Medicine, McGill University, Montréal, Québec, H3S 1Z1, Canada
| | - François Coutlée
- Départements de Clinique de Médecine de Laboratoire et de Médecine, Services de Biologie Moléculaire et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, H2X 0C1, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada.
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5
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Morais S, Wissing MD, Khosrow-Khavar F, Burchell AN, Tellier PP, Coutlée F, Waterboer T, El-Zein M, Franco EL. Serologic response to human papillomavirus genotypes following vaccination: findings from the HITCH cohort study. Infect Dis (Lond) 2024; 56:66-72. [PMID: 37994805 DOI: 10.1080/23744235.2023.2277390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection contributes to approximately 5% of the worldwide cancer burden. The three-dose HPV vaccine has demonstrated immunogenicity and efficacy. Humoral responses may be critical for preventing, controlling, and/or eliminating HPV infection. Using data from the HITCH cohort, we analysed humoral immune response to HPV vaccination among women in relation to the phylogenetic relatedness of HPV genotypes. METHODS We included 96 women aged 18-24 years attending college or university in Montreal, Canada. Participants provided blood samples at enrolment and five follow-up visits. Antibody response to bacterially expressed L1 and E6 glutathione S-transferase fusion proteins of multiple Alphapapillomavirus types, and to virus-like particles (VLP-L1) of HPV16 and HPV18 were measured using multiplex serology. We assessed correlations between antibody seroreactivities using Pearson correlations (r). RESULTS At enrolment, 87.7% of participants were unvaccinated, 2.4% had received one, 3.2% two, and 6.7% three doses of HPV vaccine. The corresponding L1 seropositivity to any HPV was 41.2%, 83.3%, 100%, and 97.0%. Between-type correlations for L1 seroreactivities increased with the number of vaccine doses, from one to three. Among the latter, the strongest correlations were observed for HPV58-HPV33 (Pearson correlation [r] = 0.96; α9-species); HPV11-HPV6 (r = 0.96; α10-species); HPV45-HPV18 (r = 0.95; α7-species), and HPV68-HPV59 (r = 0.95; α7-species). CONCLUSIONS Correlations between HPV-specific antibody seroreactivities are affected by phylogenetic relatedness, with anti-L1 correlations becoming stronger with the number of vaccine doses received.
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Affiliation(s)
- Samantha Morais
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Michel D Wissing
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | | | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - François Coutlée
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
- Laboratoire de Virologie Moléculaire, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, Canada
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center, Heidelberg, Germany
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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Bruni L, Albero G, Rowley J, Alemany L, Arbyn M, Giuliano AR, Markowitz LE, Broutet N, Taylor M. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis. Lancet Glob Health 2023; 11:e1345-e1362. [PMID: 37591583 PMCID: PMC10447222 DOI: 10.1016/s2214-109x(23)00305-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The epidemiology of human papillomavirus (HPV) in women has been well documented. Less is known about the epidemiology of HPV in men. We aim to provide updated global and regional pooled overall, type-specific, and age-specific prevalence estimates of genital HPV infection in men. METHODS We conducted a systematic review and meta-analysis to assess the prevalence of genital HPV infection in the general male population. We searched Embase, Ovid MEDLINE, and the Global Index Medicus for studies published between Jan 1, 1995, and June 1, 2022. Inclusion criteria were population-based surveys in men aged 15 years or older or HPV prevalence studies with a sample size of at least 50 men with no HPV-related pathology or known risk factors for HPV infection that collected samples from anogenital sites and used PCR or hybrid capture 2 techniques for HPV DNA detection. Exclusion criteria were studies conducted among populations at increased risk of HPV infection, exclusively conducted among circumcised men, and based on urine or semen samples. We screened identified reports and extracted summary-level data from those that were eligible. Data were extracted by two researchers independently and reviewed by a third, and discrepancies were resolved by consensus. We extracted only data on mucosal α-genus HPVs. Global and regional age-specific prevalences for any HPV, high-risk (HR)-HPV, and individual HPV types were estimated using random-effects models for meta-analysis and grouped by UN Sustainable Development Goals geographical classification. FINDINGS We identified 5685 publications from database searches, of which 65 studies (comprising 44 769 men) were included from 35 countries. The global pooled prevalence was 31% (95% CI 27-35) for any HPV and 21% (18-24) for HR-HPV. HPV-16 was the most prevalent HPV genotype (5%, 95% CI 4-7) followed by HPV-6 (4%, 3-5). HPV prevalence was high in young adults, reaching a maximum between the ages of 25 years and 29 years, and stabilised or slightly decreased thereafter. Pooled prevalence estimates were similar for the UN Sustainable Development Goal geographical regions of Europe and Northern America, Sub-Saharan Africa, Latin America and the Caribbean, and Australia and New Zealand (Oceania). The estimates for Eastern and South-Eastern Asia were half that of the other regions. INTERPRETATION Almost one in three men worldwide are infected with at least one genital HPV type and around one in five men are infected with one or more HR-HPV types. Our findings show that HPV prevalence is high in men over the age of 15 years and support that sexually active men, regardless of age, are an important reservoir of HPV genital infection. These estimates emphasise the importance of incorporating men in comprehensive HPV prevention strategies to reduce HPV-related morbidity and mortality in men and ultimately achieve elimination of cervical cancer and other HPV-related diseases. FUNDING Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020. TRANSLATIONS For the Spanish and French translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Laia Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain.
| | - Ginesa Albero
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Jane Rowley
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Marc Arbyn
- Unit of Cancer Epidemiology-Belgian Cancer Centre, Sciensano, Belgium
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Melanie Taylor
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland; Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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7
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Xu J, Abudurusuli G, Rui J, Li Z, Zhao Z, Xia Y, Guo X, Abudunaibi B, Zhao B, Guo Q, Cui JA, Zhou Y, Chen T. Epidemiological characteristics and transmissibility of HPV infection: A long-term retrospective study in Hokkien Golden Triangle, China, 2013-2021. Epidemics 2023; 44:100707. [PMID: 37480747 DOI: 10.1016/j.epidem.2023.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023] Open
Abstract
OBJECTIVE Multiple human papillomavirus (HPV)-associated diseases have put a significant disease burden on the world. Therefore, we conducted a study to explore the epidemiological characteristics of HPV and the transmissibility of its genotypes. METHODS HPV testing data was collected from Hospital. A transmission dynamics model of HPV was constructed to simulate and compare the transmissibility of different HPV genotypes, which was quantitatively described by the basic reproduction number (R0). RESULTS The collected HPV subjects were mainly from Xiamen City, Zhangzhou City and Quanzhou City, together, they are known as the Hokkien golden triangle. There were variations in the distribution of HPV infections by age groups. Among all HPV genotypes, 13 of them had R0 > 1, with 10 of them being high-risk types. The top five were HPV56, 18, 58, 52 and 53, among which, HPV56, 18, 58 and 42 were of high risk, whereas HPV53 was not, and the R0 values for the five were 3.35 (CI: 0.00-9.99), 3.20 (CI: 0.00-6.46), 3.19 (CI: 1.27-6.94), 3.19 (CI: 1.01-8.42) and 2.99 (CI: 0.00-9.39), respectively. In addition, HPV52 had R0 > 1 for about 51 months, which had the longest duration. CONCLUSION Most high-risk HPV types in the Hokkien golden triangle could transmit among the population. Therefore, there is a need of further optimization for developing HPV vaccines and better detection methods in the region.
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Affiliation(s)
- Jingwen Xu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University; Health Emergency Office, Hefei Center for Disease Control and Prevention, Hefei City, Anhui Province, People's Republic of China
| | - Guzainuer Abudurusuli
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Jia Rui
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Zhuoyang Li
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Zeyu Zhao
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Yilan Xia
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Xiaohao Guo
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Buasiyamu Abudunaibi
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Benhua Zhao
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Qiwei Guo
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University
| | - Jing-An Cui
- Department of Mathematics, School of Science, Beijing University of Civil Engineering and Architecture, Beijing 102616, People's Republic of China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian 361102, People's Republic of China.
| | - Tianmu Chen
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Public Health, Xiamen University.
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8
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Morais S, Wissing MD, Khosrow-Khavar F, Burchell AN, Tellier PP, Coutlée F, Waterboer T, El-Zein M, Franco EL. Serologic Response to Human Papillomavirus Genotypes Among Unvaccinated Women: Findings From the HITCH Cohort Study. J Infect Dis 2023; 227:1173-1184. [PMID: 36322543 PMCID: PMC10175069 DOI: 10.1093/infdis/jiac437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Humoral immune responses may be critical for preventing, controlling, and/or eliminating human papillomavirus (HPV) infection. We analyzed humoral response to natural HPV infection considering phylogenetic relatedness among unvaccinated women. METHODS We included 399 young women attending university/college in Montreal, Canada who were participants of the HITCH cohort. Participants provided blood samples at baseline and 5 follow-up visits. Antibody response to bacterially expressed L1 and E6 glutathione S-transferase (GST) fusion proteins, and virus-like particles (VLP-L1) of Alphapapillomavirus types were measured using multiplex serology. We assessed correlations and associations between HPV types at baseline using Pearson correlation coefficients (r) and univariable linear regressions. RESULTS At baseline, > 40% were seropositive for GST-L1 antibodies of at least 1 HPV type. Strong correlations between GST-L1 were observed for α9 HPV types: 58-52 (r = 0.86), 58-33 (r = 0.75), 33-52 (r = 0.72), and between GST-E6: 52-11 (r = 0.84), 52-18 (r = 0.79), 58-33 (r = 0.78), 35-11 (r = 0.76). HPV16 VLP-L1 moderately explained variability in HPV16 GST-L1 (regression coefficient [b] = 0.38, R2 = 43.1%), and HPV45 GST-L1 in HPV18 GST-L1 (b = 0.68, R2 = 42.8%). GST-E6 antibodies accounted for a low to moderate proportion of variability in HPV16 and HPV18 GST-E6 (R2 = 6.4%-62.2%). CONCLUSIONS Associations between naturally induced HPV-specific antibodies depend on phylogenetic relatedness.
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Affiliation(s)
- Samantha Morais
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Michel D Wissing
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | | | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - François Coutlée
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
- Laboratoire de Virologie Moléculaire, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, Québec, Canada
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center, Heidelberg, Germany
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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9
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Arthur AW, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Detection and clearance of type-specific and phylogenetically related genital human papillomavirus infections in young women in new heterosexual relationships. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.24.23286387. [PMID: 36865299 PMCID: PMC9980228 DOI: 10.1101/2023.02.24.23286387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Understanding the natural history of human papillomavirus (HPV) infections is essential to effective cervical cancer prevention planning. We examined these outcomes in-depth among young women. Methods The HPV Infection and Transmission among Couples through Heterosexual Activity (HITCH) study is a prospective cohort of 501 college-age women who recently initiated a heterosexual relationship. We tested vaginal samples collected at six clinical visits over 24 months for 36 HPV types. Using rates and Kaplan-Meier analysis, we estimated time-to-event statistics with 95% confidence intervals (CIs) for detection of incident infections and liberal clearance of incident and present-at-baseline infections (separately). We conducted analyses at the woman- and HPV-levels, with HPV types grouped by phylogenetic relatedness. Results By 24 months, we detected incident infections in 40.4%, CI:33.4-48.4 of women. Incident subgenus 1 (43.4, CI:33.6-56.4), 2 (47.1, CI:39.9-55.5) and 3 (46.6, CI:37.7-57.7) infections cleared at similar rates per 1000 infection-months. We observed similar homogeny in HPV-level clearance rates among present-at-baseline infections. Conclusions Our woman-level analyses of infection detection and clearance agreed with similar studies. However, our HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections take longer to clear than their low oncogenic risk and commensal subgenera 1 and 3 counterparts.
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Affiliation(s)
- Andrew W Arthur
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Pierre-Paul Tellier
- Department of Family Medicine, McGill University, Montréal, Québec, H3S 1Z1, Canada
| | - Francois Coutlée
- Départements de Clinique de Médecine de Laboratoire et de Médecine, Services de Biologie Moléculaire et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, H2X 0C1, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
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10
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Shapiro SB, Wissing MD, Khosrow-Khavar F, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Male Circumcision and Genital Human Papillomavirus (HPV) Infection in Males and Their Female Sexual Partners: Findings From the HPV Infection and Transmission Among Couples Through Heterosexual Activity (HITCH) Cohort Study. J Infect Dis 2022; 226:1184-1194. [PMID: 35429378 PMCID: PMC10233487 DOI: 10.1093/infdis/jiac147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND Previous studies examining the association between male circumcision (MC) and human papillomavirus (HPV) infections have reported inconsistent results. We used data from the HPV Infection and Transmission Among Couples Through Heterosexual Activity (HITCH) cohort study to examine the association between MC and HPV infections in males and their female sexual partners. METHODS We enrolled monogamous couples in a longitudinal study between 2005 and 2011 in Montreal, Canada. We used logistic and Poisson regression models with propensity score adjustment to estimate odds ratios (ORs) and rate ratios for the association between MC and the prevalence, transmission, and clearance of HPV infections. RESULTS Four hundred thirteen couples were included in our study. The prevalence OR for the association between MC and baseline infections was 0.81 (95% confidence interval [CI], .56-1.16) in males and 1.05 (95% CI, .75-1.46) in females. The incidence rate ratio for infection transmission was 0.59 (95% CI, .16-2.20) for male-to-female transmission and 0.77 (95% CI, .37-1.60) for female-to-male transmission. The clearance rate ratio for clearance of infections was 0.81 (95% CI, .52-1.24). CONCLUSIONS We found little evidence of an association between MC and HPV infection prevalence, transmission, or clearance in males and females. Further longitudinal couple-based studies are required to investigate this association.
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Affiliation(s)
- Samantha B Shapiro
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
| | - Michel D Wissing
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
| | - Farzin Khosrow-Khavar
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - François Coutlée
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
- Laboratoire de virologie moléculaire, Centre de recherche du Centre hospitalier de l’Université de Montréal, et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
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11
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Louvanto K, Baral P, Burchell A, Ramanakumar A, El-Zein M, Tellier PP, Coutlée F, Roger M, Franco EL. Role of Human Leukocyte Antigen Allele Sharing in Human Papillomavirus Infection Transmission Among Heterosexual Couples: Findings From the Hitch Cohort Study. J Infect Dis 2022; 226:1175-1183. [PMID: 35363864 PMCID: PMC9518836 DOI: 10.1093/infdis/jiac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 11/12/2022] Open
Abstract
Background Human leukocyte antigen (HLA) polymorphism influences innate and adaptive immune responses. Among heterosexual couples in the HPV Infection and Transmission Among Couples Through Heterosexual Activity (HITCH) cohort study, we examined whether allele sharing in a couple predicted the partners’ infections with the same human papillomavirus (HPV) type. Methods We tested genital samples from 271 couples for 36 HPV genotypes by polymerase chain reaction. We used direct DNA sequencing to type HLA-B07, -DRB1, -DQB1 and -G. Generalized estimating equations were used to examine the associations between the extent of allele sharing and HPV type concordance in which at least 1 of the partners was HPV positive. Results We identified 106 different HLA alleles. The most common HLA alleles among couples were G*01:01:01 (95.6%), G*01:01:02 (60.1%), DQB1*03:01 (57.2%), and DRB1*07:01 (46.9%). Allele sharing was as follows: 19.6% shared none, 43.2% shared 1 only, 25.1% shared 2, and 12.5% shared 3–5. Irrespective of HLA class, grouped or in combination, the extent of allele sharing was not a significant predictor of type-specific HPV concordance in a couple (odds ratio, 1.1 [95% confidence interval, .5–2.1], for 3–5 vs none). Conclusions We found no evidence that the extent of HLA allele concordance influences the likelihood of HPV transmission in newly formed heterosexual couples.
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Affiliation(s)
- Karolina Louvanto
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.,Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Technology, Tampere, Finland.,Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
| | - Prativa Baral
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Ann Burchell
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | | | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | | | - Francois Coutlée
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.,Centre de recherche du CHUM et Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Quebec, Canada
| | - Michel Roger
- Centre de recherche du CHUM et Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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12
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Coutlée F, Pokomandy AD, Burchell AN, El‐Zein M, Mayrand M, Rodrigues‐Coutlée S, Money D, Comète É, McClymont E, Rouleau D, Franco EL. Human Papillomavirus genotype concordance between Anyplex II HPV28 and Linear array HPV genotyping test in anogenital samples. J Med Virol 2022; 94:2824-2832. [DOI: 10.1002/jmv.27605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/08/2022]
Affiliation(s)
- François Coutlée
- Laboratoire de Virologie Moléculaire, Centre de recherche du Centre Hospitalier de l’Université de Montréal, Centre Hospitalier de l’Université de MontréalMontréalQCCanada
- Départements de MicrobiologieInfectiologie et Immunologie, et de Gynécologie‐Obstétrique, Université de MontréalMontréalQCCanada
- Départements de Médecinede Médecine clinique de Laboratoire et d’Obstétrique‐Gynécologie, Centre Hospitalier de l’Université de MontréalMontréalQCCanada
- Division of Cancer EpidemiologyMcGill UniversityMontrealQCCanada
| | - Alexandra de Pokomandy
- Department of Family MedicineMcGill UniversityMontrealQCCanada
- Chronic Viral Illness Service, McGill University Health Centre (MUHC)MontrealQCCanada
| | - Ann N. Burchell
- Department of Family and Community Medicine and Centre for Urban Health SolutionsSt. Michael’s Hospital, Unity Health Toronto and Department of Family and Community Medicine, Faculty of Medicine, University of TorontoONCanada
| | - Mariam El‐Zein
- Division of Cancer EpidemiologyMcGill UniversityMontrealQCCanada
| | - Marie‐Hélène Mayrand
- Départements de MicrobiologieInfectiologie et Immunologie, et de Gynécologie‐Obstétrique, Université de MontréalMontréalQCCanada
- Départements de Médecinede Médecine clinique de Laboratoire et d’Obstétrique‐Gynécologie, Centre Hospitalier de l’Université de MontréalMontréalQCCanada
| | - Sophie Rodrigues‐Coutlée
- Laboratoire de Virologie Moléculaire, Centre de recherche du Centre Hospitalier de l’Université de Montréal, Centre Hospitalier de l’Université de MontréalMontréalQCCanada
| | - Deborah Money
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBCCanada
| | - Émilie Comète
- Laboratoire de Virologie Moléculaire, Centre de recherche du Centre Hospitalier de l’Université de Montréal, Centre Hospitalier de l’Université de MontréalMontréalQCCanada
| | - Elisabeth McClymont
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBCCanada
| | - Danielle Rouleau
- Départements de MicrobiologieInfectiologie et Immunologie, et de Gynécologie‐Obstétrique, Université de MontréalMontréalQCCanada
- Départements de Médecinede Médecine clinique de Laboratoire et d’Obstétrique‐Gynécologie, Centre Hospitalier de l’Université de MontréalMontréalQCCanada
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13
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Malagón T, MacCosham A, Burchell AN, El-Zein M, Tellier PP, Coutlée F, Franco EL. Proportion of incident genital human papillomavirus detections not attributable to transmission and potentially attributable to latent infections: Implications for cervical cancer screening. Clin Infect Dis 2021; 75:365-371. [PMID: 34849640 DOI: 10.1093/cid/ciab985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infections with human papillomaviruses (HPV) may enter a latent state, and eventually become reactivated following loss of immune control. It is unclear what proportion of incident HPV detections are reactivations of previous latent infections versus new transmissions. METHODS The HITCH cohort study prospectively followed young newly-formed heterosexual partners recruited between 2005-2011 in Montréal, Canada. We calculated the fraction of incident HPV detections non-attributable to sexual transmission risk factors with a Bayesian Markov model. Results are the median (2.5-97.5 th percentiles) of the estimated posterior distribution. RESULTS 544 type-specific incident HPV detection events occurred in 849 participants; 33% of incident HPV detections occurred in participants whose HITCH partners were negative for that HPV type and who reported no other sex partners over follow-up. We estimate that 43% (38-48%) of all incident HPV detections in this population were not attributable to recent sexual transmission and might be potentially reactivation of latent infections. CONCLUSIONS A positive HPV test result in many cases may be a reactivated past infection, rather than a new infection from recent sexual behaviors or partner infidelity. The potential for reactivation of latent infections in previously HPV-negative women should be considered in the context of cervical cancer screening.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Aaron MacCosham
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | | | - François Coutlée
- Service de Biologie moléculaire du département de Médecine de laboratoire et Service d'infectiologie du département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
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14
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Franco EL, El-Zein M. Reply to Feng et al. J Infect Dis 2021; 225:924-925. [PMID: 34536280 DOI: 10.1093/infdis/jiab471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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15
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Waheed DEN, Schiller J, Stanley M, Franco EL, Poljak M, Kjaer SK, Del Pino M, van der Klis F, Schim van der Loeff MF, Baay M, Van Damme P, Vorsters A. Human papillomavirus vaccination in adults: impact, opportunities and challenges - a meeting report. BMC Proc 2021; 15:16. [PMID: 34384438 PMCID: PMC8359761 DOI: 10.1186/s12919-021-00217-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
For more than a decade human papillomavirus (HPV) vaccine have been implemented in most high-income countries, and more recently also in several low- and middle-income countries. The vaccines are safe and their impact and effectiveness in preventing HPV vaccine type infection and associated diseases has been thoroughly established. Currently, the primary recommended cohorts for immunisation are adolescents, 9-15 years of age but HPV is an ubiquitous infection that is mainly (but not exclusively) sexually transmitted. Sexually active adults remain susceptible to infection and continued transmission of the virus, representing a reservoir of infection in the population. A recent meeting, conducted by the HPV Prevention and Control Board (HPV-PCB), reviewed the current status of HPV vaccination of adults, discussed limitations, challenges and benefits of HPV vaccination of adults, evaluated the effectiveness of HPV vaccination after treatment of post cervical cancer and precancerous lesions, and discussed the potential impact of adult vaccination on cervical cancer elimination strategies in light of the current and future HPV vaccine shortage. HPV-PCB is an independent multidisciplinary board of international experts that disseminates relevant information on HPV to a broad array of stakeholders and provides guidance on strategic, technical and policy issues in the implementation of HPV prevention and control programs. The HPV-PCB concluded that, given the current data available on adult HPV vaccination and the ongoing vaccine supply constraints, it is too early to implement routine vaccination of adults. Many research gaps need to be filled before we have a better understanding of the efficacy and broader public health impact of HPV vaccination in adult women.
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Affiliation(s)
- Dur-E-Nayab Waheed
- Centre for Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - John Schiller
- Center for Cancer Research National Cancer Institute, Bethesda, MD, 20814, USA
| | - Margaret Stanley
- Division of Cellular and Molecular Pathology, University of Cambridge, Cambridge, UK
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Susanne K Kjaer
- Danish Cancer Society Research Center, Unit of Virus, Lifestyle and Genes, and Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marta Del Pino
- Gynecology Oncology Unit. Institute Clinic of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Fiona van der Klis
- National Institute for Public Health and the Environment (RIVM)
- RIVM and Centre for Infectious Disease Control (CIb), Utrecht, Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, and Amsterdam UMC, and University of Amsterdam, and Internal Medicine, Amsterdam institute for Infection and Immunity (AII), and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marc Baay
- P95, Epidemiology and Pharmacovigilance Consulting and Services, Leuven, Belgium
| | - Pierre Van Damme
- Centre for Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Alex Vorsters
- Centre for Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
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16
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Trevisan A, Wissing MD, Dagenais C, Forest P, Ramanakumar AV, Burchell AN, Franco EL, Coutlée F, Couillard M. Development and evaluation of a new non-competitive Luminex immunoassay detecting antibodies against human papillomavirus types 6, 11, 16 and 18. J Gen Virol 2021; 102. [PMID: 34043499 DOI: 10.1099/jgv.0.001610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Serum antibody levels can be used to measure the humoral immune response against human papillomaviruses (HPV). We developed and validated a rapid, technically simple and relatively inexpensive multiplex non-competitive Luminex-based immunoassay (ncLIA) to measure total IgG antibody levels against four HPV types. For the assay's solid phase, virus-like particles (VLPs) of HPV6, 11, 16 and 18 were bound to heparin-coated beads. HPV serum antibody levels binding to the VLPs were quantified using a phycoerithrin-conjugated secondary polyclonal donkey anti-human IgG antibody. Standardization and validation of the ncLIA were performed using 96 paired serum and genital samples from participants in the HITCH cohort study, including young women (aged 18-24 years) and their male sexual partners (aged 18+) in Montreal, Canada. Results from the ncLIA were compared to a validated Luminex immunoassay from PPD laboratories using Pearson's correlation coefficients, receiver operating characteristic curves and logistic regression. Our assay had good inter- and intra-assay variability. The correlation of serum antibody levels between the ncLIA and validation assay was highest for HPV16 and HPV11 (r=0.90), followed by HPV6 (r=0.86) and HPV18 (r=0.67). The ncLIA was better able to predict HPV DNA positivity in genital samples than the validation assay for HPV16 [area under the curve (AUC) 0.65 versus 0.52, P=0.001] and HPV18 [AUC 0.71 versus 0.57, P=0.024]. AUCs for HPV6 and HPV11 were similar between the two assays (0.70 versus 0.71, P=0.59, and 0.88 versus 0.96, P=0.08, respectively). The developed ncLIA is useful for measuring total IgG antibody response following natural infection or vaccination against four HPV VLPs included in the quadrivalent vaccine.
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Affiliation(s)
- Andrea Trevisan
- Laboratoire de santé publique du Québec, Institut national de santé publique Québec, 20045 Sainte-Marie Road, Sainte-Anne-de-Bellevue, Quebec, Canada.,Sainte-Justine Hospital Research Center, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, Quebec, Canada
| | - Michel D Wissing
- Division of Cancer Epidemiology, McGill University, 5100 Boulevard de Maisonneuve West, Suite 720, Quebec H4A 3T2, Montreal, Canada
| | - Carole Dagenais
- Laboratoire de santé publique du Québec, Institut national de santé publique Québec, 20045 Sainte-Marie Road, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Pierre Forest
- Laboratoire de virologie moléculaire, centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Saint Denis Street, Montreal, Quebec H2X 0A9, Canada
| | - Agnihotram V Ramanakumar
- Division of Cancer Epidemiology, McGill University, 5100 Boulevard de Maisonneuve West, Suite 720, Quebec H4A 3T2, Montreal, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto M5B 1T8, Ontario
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, 5100 Boulevard de Maisonneuve West, Suite 720, Quebec H4A 3T2, Montreal, Canada
| | - François Coutlée
- Laboratoire de virologie moléculaire, centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Saint Denis Street, Montreal, Quebec H2X 0A9, Canada
| | - Michel Couillard
- Laboratoire de santé publique du Québec, Institut national de santé publique Québec, 20045 Sainte-Marie Road, Sainte-Anne-de-Bellevue, Quebec, Canada
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17
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El-Zein M, Khosrow-Khavar F, Burchell AN, Tellier PP, Eintracht S, McNamara E, Coutlée F, Franco EL. Association of Serum 25-Hydroxyvitamin D With Prevalence, Incidence, and Clearance of Vaginal HPV Infection in Young Women. J Infect Dis 2021; 224:492-502. [PMID: 33306088 DOI: 10.1093/infdis/jiaa758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/08/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We assessed the association between serum 25-hydroxyvitamin D levels and genital human papillomavirus (HPV) prevalence, incidence, and clearance among female participants in the HPV Infection and Transmission among Couples through Heterosexual activity (HITCH) Cohort Study. METHODS We genotyped HPV DNA in vaginal samples and quantified baseline serum 25-hydroxyvitamin D levels using Roche's Linear Array and Total vitamin D assay, respectively. We used logistic and Cox proportional hazards models, respectively, to estimate adjusted odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS There was no association between vitamin D levels (every 10-ng/mL increase) at baseline and HPV prevalence (OR, 0.88; 95% CI, .73-1.03) or incidence (HR, 0.88; 95% CI, .73-1.06), but we observed a modest negative association with HPV clearance (HR, 0.76; 95% CI, .60-.96). Vitamin D levels <30 ng/mL, compared with those ≥30 ng/mL, were not associated with HPV prevalence (OR, 0.98; 95% CI, .57-1.69) or incidence (HR, .87; 95% CI, .50-1.43), but they were associated with a marginally significant increased clearance (OR, 2.14; 95% CI, .99-4.64). We observed consistent results with restricted cubic spline modeling of vitamin D levels and clinically defined categories. HPV type-specific analyses accounting for multiple HPV infections per participant showed no association between vitamin D levels and all study outcomes. CONCLUSIONS This study provided no evidence of an association between low vitamin D levels and increased HPV prevalence, acquisition, or clearance.
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Affiliation(s)
- Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montréal, Québec, Canada
| | | | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Shaun Eintracht
- Department of Diagnostic Medicine, Jewish General Hospital, Montréal, Québec, Canada
| | - Elizabeth McNamara
- Department of Diagnostic Medicine, Jewish General Hospital, Montréal, Québec, Canada
| | - Francois Coutlée
- Départements de Clinique de Médecine de Laboratoire et de Médecine, Services de Biologie Moléculaire et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montréal, Québec, Canada
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Malagón T, MacCosham A, Burchell AN, El-Zein M, Tellier PP, Coutlée F, Franco EL. Sex- and Type-specific Genital Human Papillomavirus Transmission Rates Between Heterosexual Partners: A Bayesian Reanalysis of the HITCH Cohort. Epidemiology 2021; 32:368-377. [PMID: 33625158 PMCID: PMC8012224 DOI: 10.1097/ede.0000000000001324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is unclear whether sexual transmission rates of human papillomaviruses (HPV) differ between sexes and HPV types. We estimate updated transmission rates from the final HITCH cohort study and propose an estimation method that accounts for interval-censored data and infection clearance. METHODS We enrolled young women 18-24 years old and their male sex partners ≥18 years old in Montréal, Canada, between 2005 and 2011. We followed women over 24 months and men over 4 months. We tested genital samples with Linear Array for HPV DNA detection and genotyping. We calculated infection transmission rates between partners using a multistate Markov model via a Bayesian approach. We report the posterior median and 2.5%-97.5% percentile intervals (95% PI). RESULTS We observed 166 type-specific incident HPV transmission events in 447 women and 402 men. The estimated median transmission rate from an HPV-positive to a negative partner was 4.2 (95% PI = 3.1 to 5.3) per 100 person-months. The transmission rate from men-to-women was 3.5 (95% PI = 2.5 to 4.7) and from women-to-men was 5.6 (95% PI = 3.8 to 7.0) per 100 person-months, corresponding to a rate ratio of 1.6 (95% PI = 1.0 to 2.5). Partners reporting always using condoms had a 0.22 (95% PI = 0.05 to 0.61) times lower HPV transmission rate than those reporting never using condoms. HPV16/18 did not have particularly high transmission rates relative to other HPV types. CONCLUSION Our updated analysis supports previous research suggesting higher women-to-men than men-to-women HPV transmission rates and a protective effect of condoms in heterosexual partnerships. Our results also suggest that crude incidence rates underestimate HPV transmission rates due to interval-censoring. See video abstract at http://links.lww.com/EDE/B794.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Aaron MacCosham
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Ann N. Burchell
- Department of Family and Community Medicine and Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | | | - François Coutlée
- Département de microbiologie et infectiologie, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Département de microbiologie et immunologie, Université de Montréal, Montréal, Canada
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
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19
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Kim CJ, Campbell SP, Allkanjari A, Lentz AC. Update on the Medical and Surgical Management of Urethral Condyloma. Sex Med Rev 2021; 10:240-254. [PMID: 33752995 DOI: 10.1016/j.sxmr.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Condyloma acuminata (CA) of the urethra presents a management challenge due to high recurrence rates, difficulty in accessing urethral lesions, risk of stricture formation, and potential for sexual dysfunction. While standard treatment modalities are acceptable for some external genital condyloma, they are not always feasible or appropriate for urethral lesions. OBJECTIVES We sought to review the literature on epidemiology, presentation, diagnosis and treatment of urothelial CA with a focus on surgical treatment options. METHODS We performed a comprehensive literature search of PubMed to identify all studies pertaining to urethral CA through November 2020. RESULTS Urethral CA is a relatively rare, but challenging disease to manage with a considerable amount of treatment side effects and downstream morbidity associated. In our comprehensive review we have found a wide selection of treatment modalities ranging from minimally invasive strategies to surgical reconstructive techniques. Proper follow-up to monitor for disease recurrence at the 3-4 month mark is appropriate and will determine subsequent treatment strategies as needed. Future studies and treatment directions include novel drug delivery models to optimize minimally invasive topical drug efficacy. CONCLUSION Treatment of urethral CA should be approached in a step-wise fashion. Medical therapy would be an appropriate option for asymptomatic or minimally symptomatic patients with small lesions who desire to avoid any interventions. If patient is symptomatic, has extensive disease burden or has failed medical therapy intervention should be considered with options including PDT, laser ablation or surgical excision with or without urethral reconstruction. Appropriate selection depends on patient characteristics and preferences along with prior treatment history. Kim CJ, Campbell SP, Allkanjari A, et al. Update on the Medical and Surgical Management of Urethral Condyloma. Sex Med Rev 2021;xxx:xxx-xxx.
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Affiliation(s)
- Christopher J Kim
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Scott P Campbell
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Armand Allkanjari
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Aaron C Lentz
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
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20
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Kombe Kombe AJ, Li B, Zahid A, Mengist HM, Bounda GA, Zhou Y, Jin T. Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation. Front Public Health 2021; 8:552028. [PMID: 33553082 PMCID: PMC7855977 DOI: 10.3389/fpubh.2020.552028] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022] Open
Abstract
Diagnosed in more than 90% of cervical cancers, the fourth deadliest cancer in women, human papillomavirus (HPV) is currently the most common pathogen responsible for female cancers. Moreover, HPV infection is associated with many other diseases, including cutaneous and anogenital warts, and genital and upper aerodigestive tract cancers. The incidence and prevalence of these pathologies vary considerably depending on factors including HPV genotype, regional conditions, the study population, and the anatomical site sampled. Recently, features of the cervicovaginal microbiota are found to be associated with the incidence of HPV-related diseases, presenting a novel approach to identify high-risk women through both blood and cervical samples. Overall, the HPV repartition data show that HPV infection and related diseases are more prevalent in developing countries. Moreover, the available (2-, 4-, and 9-valent) vaccines based on virus-like particles, despite their proven effectiveness and safety, present some limitations in terms of system development cost, transport cold chain, and oncogenic HPV variants. In addition, vaccination programs face some challenges, leading to a considerable burden of HPV infection and related diseases. Therefore, even though the new (9-valent) vaccine seems promising, next-generation vaccines as well as awareness programs associated with HPV vaccination and budget reinforcements for immunization are needed.
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Affiliation(s)
- Arnaud John Kombe Kombe
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Gabonese Scientific Research Consortium, Libreville, Gabon
| | - Bofeng Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ayesha Zahid
- Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hylemariam Mihiretie Mengist
- Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Guy-Armel Bounda
- Gabonese Scientific Research Consortium, Libreville, Gabon.,Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Sinomedica Co., Ltd., Mong Kok, Hong Kong
| | - Ying Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Tengchuan Jin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Chinese Academy of Science Center for Excellence in Molecular Cell Science, Shanghai, China
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21
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Gonçalves HM, Silva J, Pintado Maury I, Tavares A, Campos C, Sousa H, Jacinto A, Aguiar P, Caldeira L, Medeiros R. The prevalence and risk-factors of oral HPV DNA detection among HIV-infected men between men who have sex with men and heterosexual men. Infect Dis (Lond) 2020; 53:19-30. [PMID: 32915107 DOI: 10.1080/23744235.2020.1811373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-associated oropharyngeal carcinomas are becoming more common with epidemiological impact on human immunodeficiency virus (HIV)- positive individuals. Objective: We evaluated prevalence and risk factors for oral HPV DNA among HIV-infected men who have sex with men (MSM) or heterosexual men. Methods: This cross-sectional hospital-based study included 255 HIV-infected men with different sexual orientation 142 MSM and 113 heterosexual men, who answered a self-administered questionnaire on sociodemographic, clinical and behavioural data. Oral swab and mouthwash samples were analysed by polymerase chain reaction and genotyped by AnyplexTM II 28 (Seegene®). Results: Oral HPV was detected in 17.6% (95% Confidence Interval (CI) 13.5-22.8%), 17.6% in MSM and 17.7% in heterosexual men (p = .984). Multiple HPV infections were detected in 86.7% of HPV-positive men. HPV 56 (13.7%) was the most prevalent high-risk genotype, HPV 66 (7.8%) and HPV 70 (12.3%) were the most prevalent probable HR and low-risk HPV genotypes (12.3% and 7.1%, respectively). At multivariable analysis models, oral HPV was associated with >100 lifetime sexual partners (Odds Ratio (OR) 3.73; 95% CI 1.42-9.77) or lifetime tongue-kissing partners (OR 3.20; 95% CI 1.22-8.39) and lower education level (OR 2.90; 95% CI 1.08-7.78 and 2.74; 95% CI 1.04-7.27, respectively). Conclusions: Oral HPV prevalence was similar between HIV-infected MSM and heterosexual men. Oral HPV was associated with lifetime sexual partners, lifetime tongue-kissing partners and being undergraduate, independently of sexual orientation.
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Affiliation(s)
- Helena M Gonçalves
- Public Health Unit, Agrupamento de Centros de Saúde (ACES), Lisboa Ocidental e Oeiras, Lisbon, Portugal
| | - Jani Silva
- Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Inês Pintado Maury
- Infectious Disease Service, Centro Hospitalar Lisboa Norte, EPE, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana Tavares
- Virology Service, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Carla Campos
- Virology Service, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Hugo Sousa
- Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal.,Virology Service, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Amado Jacinto
- Public Health Unit, Agrupamento de Centros de Saúde (ACES), Lisboa Ocidental e Oeiras, Lisbon, Portugal
| | - Pedro Aguiar
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Luís Caldeira
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui Medeiros
- Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal.,Infectious Disease Service, Centro Hospitalar Lisboa Norte, EPE, Hospital de Santa Maria, Lisbon, Portugal.,Virology Service, Portuguese Oncology Institute of Porto, Porto, Portugal.,Nacional School of Public Heath, New University of Lisbon, Lisbon, Portugal.,FP-ENAS Research Unit, UFP Energy, Environment and Health Research Unit, CEBIMED Fernando Pessoa University, Porto, Portugal.,LPCC, Research Department, Portuguese League Against Cancer (LPPC - NRN), Porto, Portugal
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22
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MacCosham A, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Transmission reduction and prevention with HPV vaccination (TRAP-HPV) study protocol: a randomised controlled trial of the efficacy of HPV vaccination in preventing transmission of HPV infection in heterosexual couples. BMJ Open 2020; 10:e039383. [PMID: 32788190 PMCID: PMC7422656 DOI: 10.1136/bmjopen-2020-039383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is a causal agent of malignancies including cervical, vulvar, vaginal, penile, anal and oropharyngeal cancer, as well as benign conditions such as anogenital warts. HPV vaccination protects individuals against infections with the target HPV types and their clinical outcomes. However, little is known about the protection an immunised individual confers to their sexual partner or its impact on HPV transmission dynamics. In this context, the Transmission Reduction and Prevention with HPV vaccination (TRAP-HPV) study was designed to determine the efficacy of an HPV vaccine in reducing transmission of genital and oral HPV infection in sexual partners of vaccinated individuals. METHODS AND ANALYSIS The TRAP-HPV study is an ongoing randomised controlled trial among heterosexual couples living in Montreal, Canada. Sexually active couples, aged between 18 and 45 years, who have been in a relationship no longer than 6 months are considered eligible. Participants are independently randomised to receive either the intervention HPV vaccine, Gardasil 9, or a placebo hepatitis A vaccine, Avaxim, creating four vaccination groups among couples: intervention-intervention, intervention-placebo, placebo-intervention and the placebo-placebo. Participants provide genital (vaginal/penile) and oral samples at baseline and five follow-up visits over a 1-year duration. Linear Array HPV genotyping is used to detect 36 HPV types. Cox proportional hazard regression models will be used to estimate the effect of vaccination on HPV transmission. ETHICS AND DISSEMINATION The TRAP-HPV study received ethical approval by institutional review boards McGill University, Concordia University and Centre Hospitalier de l'Université de Montréal. Before enrolment, all participants provide informed written consent. Results will be published in peer-reviewed journals and presented at national and international conferences. The generated empirical evidence could be used in mathematical models of vaccination to inform policymakers in Canada and elsewhere. TRIAL REGISTRATION NUMBER NCT01824537.
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Affiliation(s)
- Aaron MacCosham
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | | | - François Coutlée
- Service de Microbiologie Médicale et Service d'Infectiologie, Départements de Médecine et de Médecine de Laboratoire, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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23
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Wissing MD, Burchell AN, El-Zein M, Tellier PP, Coutlée F, Franco EL. Vaccination of Young Women Decreases Human Papillomavirus Transmission in Heterosexual Couples: Findings from the HITCH Cohort Study. Cancer Epidemiol Biomarkers Prev 2019; 28:1825-1834. [PMID: 31488413 DOI: 10.1158/1055-9965.epi-19-0618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Vaccination against human papillomaviruses (HPV) prevents HPV infections and, consequently, cervical lesions. However, the effect of vaccination on HPV transmission within couples is unknown. METHODS We used data from HITCH, a prospective cohort study of heterosexual couples (women ages 18-24 years) in Montreal, 2005 to 2013. Vaccination history was self-reported. Genital samples were tested for HPV DNA by PCR (linear array). Type-specific viral loads were quantified using real-time PCR. OR and HR were estimated using multilevel mixed-effects logistic regression and a parametric model for interval- censored survival-time data, respectively. Differences in viral loads were evaluated using the Friedman ANOVA test. RESULTS Among 497 couples, 12, 16, and 35 women received 1, 2, or 3 vaccination doses at baseline, respectively. Median age at vaccination was 18 years. Most women (92.1%) had their first coitus before vaccination. At baseline, partner concordance of persistent HPV6/11/16/18 infections was lower in vaccinated than unvaccinated women [adjusted OR = 0.10; 95% confidence interval (CI), 0.01-0.65] but not for non α7/α9/α10-HPV types (adjusted OR = 1.00; 95% CI, 0.44-2.29). Incidence of persistent α7/α9/α10 HPV types in women was inversely associated with vaccination status at baseline (adjusted HR = 0.12; 95% CI, 0.03-0.47). Likewise, male partners of vaccinated women had a lower incidence of α7/α9/α10 HPV infections (adjusted OR = 0.22; 95% CI, 0.05-0.95). Vaccinated women with HPV 6/11/16/18 infections had lower viral loads (P = 0.001) relative to unvaccinated women. CONCLUSIONS Vaccination of sexually active women significantly reduced transmission of α7/α9/α10 HPV types in heterosexual couples. IMPACT These results underscore and quantify the positive effect of HPV vaccination on HPV transmission within heterosexual couples.
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Affiliation(s)
- Michel D Wissing
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada.
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
| | | | - François Coutlée
- Departement de Biologie médicale et service de microbiologie, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
- Departement de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Québec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada.
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24
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Wissing MD, Louvanto K, Comète E, Burchell AN, El-Zein M, Rodrigues A, Tellier PP, Coutlée F, Franco EL. Human Papillomavirus Viral Load and Transmission in Young, Recently Formed Heterosexual Couples. J Infect Dis 2019; 220:1152-1161. [PMID: 31063542 DOI: 10.1093/infdis/jiz238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/06/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We studied the association between human papillomavirus (HPV) viral load (VL) and HPV concordance. METHODS The HITCH cohort study included young, heterosexual, recently formed, sexually active couples. Questionnaires and genital samples were collected at 0 and 4 months. Samples were tested for HPV DNA by polymerase chain reaction (PCR; Linear Array). VLs of HPV6/11/16/18/31/42/51 were quantified using type-specific real-time PCR. Correlations between VL and type-specific HPV prevalence and incidence were evaluated using multilevel, mixed-effects linear/logistic regression models. RESULTS We included 492 couples. VLs were higher in penile than vaginal samples. VL at subsequent visits correlated significantly within men (r, 0.373), within women (r, 0.193), and within couples (r range: 0.303-0.328). Men with high VL had more type-specific persistent HPV infections (odds ratio [OR], 4.6 [95% confidence interval {CI}, 2.0-10.5]). High VL in men was associated with prevalent (OR, 5.3 [95% CI, 2.5-11.2]) and incident (OR, 6.7 [95% CI, 1.5-30.7]) type-specific HPV infections in their partner. Women's VL was associated with type-specific HPV prevalence in their partner at the same (OR, 5.9) and subsequent (OR, 4.7) visit. CONCLUSIONS Persistent HPV infections have limited VL fluctuations. VL between sex partners are correlated and seem predictive of transmission episodes.
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Affiliation(s)
- Michel D Wissing
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Karolina Louvanto
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.,Department of Gynaecology and Obstetrics, Helsinki University Hospital, Finland
| | - Emilie Comète
- Departement de Biologie médicale et service de microbiologie, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Quebec
| | - Ann N Burchell
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.,Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario
| | - Mariam El-Zein
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Allita Rodrigues
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | | | - François Coutlée
- Departement de Biologie médicale et service de microbiologie, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Quebec
| | - Eduardo L Franco
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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