HPV Type Distribution in Females with High Grade Cervical Disease in the United States: The HPV-IMPACT Project

Hariri, Susan

Wednesday, March 14, 2012: 10:50 AM

Greenway Ballroom F/G

Susan Hariri, PhD¹, Suzanne Powell, MPH¹, Martin Steinau, PhD², Heidi Bauer, MD, MPH, MS³, Nancy Bennett, MD, MS⁴, Karen Bloch, MD, MPH⁵, Sean Schafer, MD⁶, Linda Niccolai, PhD⁷, Elizabeth Unger, MD, PhD² and Lauri Markowitz, MD⁸, 1Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 2CDC, Atlanta, GA, 3Program Development and Evaluation, California Department of Public Health, STD Control Branch, Richmond, CA, 4Center for Community Health, University of Rochester Medical Center, Rochester, NY, 5Department of Medicine (Infectious Diseases) and Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN, 6Department of Human Services, Oregon Department of Health, Portland, OR, 7Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 8Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA

Background:

Cervical intraepithelial neoplasia (CIN) grade 2 or 3 and adenocarcinoma in situ (AIS) (CIN2+) are caused by HPV and detected through routine cervical cancer screening. Of the 40 genital HPV types, ~50% of CIN2+ are associated with HPV 16 or 18 (HPV16/18)- the types included in HPV vaccines.

Objectives: We describe HPV type distribution among defined populations of females diagnosed with CIN2+ prior to wide-scale vaccine introduction.

Methods: As part of a vaccine impact monitoring project (HPV-IMPACT), females 18-39 years diagnosed with CIN2+ were reported in 5 catchment areas (CA, CT, NY, OR, TN). Demographic information including age, race, and insurance status was obtained from medical records or patient interviews. One diagnostic block was selected and unstained serial sections were prepared for PCR. Extracts from samples with residual lesion on both H&Es were used to detect and type HPV by the Roche Linear Array.

Results: Among 5,768 CIN2+ cases aged 18-39 years, 2,569 (45%) specimens were tested; 96% were HPV DNA positive. HPV16 was most prevalent (47%), followed by HPV31 (10%) and HPV52 (9%). HPV18 prevalence was 5.5%. Higher grade lesions were more likely to be associated with HPV16/18 (81.5%) than CIN2 (40.9%) (p<.0001). HPV16/18-associated CIN2+ was more common (54.2%) in females aged 18-29 years than in females aged 30-39 years (48.1%) (p<.003). Significantly less non-Hispanic blacks (n=323) had HPV16/18-associated lesions (43.0%; 95% confidence interval [CI]: 37.6, 48.4) compared to non-Hispanic whites (59.4%; 95% CI: 56.5-62.2); the difference remained significant when stratified by other variables. HPV35, 52, and 58 were significantly more common in blacks compared to whites.

Conclusions: HPV16/18 was present in ~52% of lesions and highest in higher grade lesions. Non-Hispanic blacks were significantly less likely to have HPV16/18-related CIN2+ compared to non-Hispanic whites. Racial differences in HPV type distribution may have implications for vaccine impact and merit further examination.

Implications for Programs, Policy, and Research: HPV vaccine policy

C4.3 HPV Type Distribution in Females with High Grade Cervical Disease in the United States: The HPV-IMPACT Project