Order of HPV/Chlamydia infections and cervical high‐grade precancer risk: A case‐cohort study

Interactions of carcinogenic human papillomaviruses (most notably HPV types 16/18/31/33/45), and HPV6 or Chlamydia trachomatis are not well understood. We have used seroconversions to study effects the order of these infections has on the risk of high‐grade cervical precancer. In a cohort of 94,349 Finnish women with paired sera from consecutive pregnancies within an average of 2.4 years, 490 were diagnosed with cervical CIN3/AIS. Serum antibodies to HPV6/16/18/31/33/45 and C. trachomatis were measured in paired sera of the cases and a subcohort of 2,796 women with a minimum of two pregnancies. HPV16‐adjusted rate ratios (RR) and confidence intervals were estimated by stratified Cox model. Compared to dual seropositivity already at the first serum sampling, RRs related to HPV6 seropositivity before and after HPV31 seroconversion were 0.4 (95% CI 0.0, 4.4) and 10 (95% CI 1.8, 57). Furthermore, RR related to seroconversions of both HPV18/45 and C.trachomatis between the consecutive pregnancies was 28 (95% CI 4.3, 190). Virtually concomitant HPV18/45 and C.trachomatis infections are associated with very high CIN3 risk.

[1]  F. Wiklund,et al.  Prospective Seroepidemiologic Study of Human Papillomavirus and Other Risk Factors in Cervical Cancer , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[2]  M. Lehtinen,et al.  Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia , 2011, Sexually Transmitted Infections.

[3]  M. Lehtinen,et al.  Differences in incidence and co‐occurrence of vaccine and nonvaccine human papillomavirus types in Finnish population before human papillomavirus mass vaccination suggest competitive advantage for HPV33 , 2011, International journal of cancer.

[4]  N. Muñoz,et al.  Incident Cervical HPV Infections in Young Women: Transition Probabilities for CIN and Infection Clearance , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[5]  N. Muñoz,et al.  Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. , 2010, The Lancet. Oncology.

[6]  M. Stanley.  HPV - immune response to infection and vaccination , 2010, Infectious Agents and Cancer.

[7]  M. Lehtinen,et al.  Population dynamics of serologically identified coinfections with human papillomavirus types 11, 16, 18 and 31 in fertile‐aged Finnish women , 2009, International journal of cancer.

[8]  E. Pirog,et al.  Comprehensive analysis of Human Papillomavirus and Chlamydia trachomatis in in-situ and invasive cervical adenocarcinoma. , 2009, Gynecologic oncology.

[9]  M. Lehtinen,et al.  Is smoking an independent risk factor for invasive cervical cancer? A nested case-control study within Nordic biobanks. , 2008, American journal of epidemiology.

[10]  Bryan Langholz,et al.  Computational methods for case-cohort studies , 2007, Comput. Stat. Data Anal..

[11]  J. Berkhof,et al.  High-risk HPV type-specific clearance rates in cervical screening , 2007, British Journal of Cancer.

[12]  Chien-Jen Chen,et al.  Seroprevalence of human papillomaviruses and Chlamydia trachomatis and cervical cancer risk: nested case-control study. , 2007, The Journal of general virology.

[13]  Pär Stattin,et al.  Nordic biological specimen banks as basis for studies of cancer causes and control – more than 2 million sample donors, 25 million person years and 100 000 prospective cancers , 2007, Acta oncologica.

[14]  R. DeSalle,et al.  The carcinogenicity of human papillomavirus types reflects viral evolution. , 2005, Virology.

[15]  M. Hakama,et al.  Survival of in situ carcinoma of cervix uteri: A 50‐year follow‐up in Finland , 2004, International journal of cancer.

[16]  P. Saikku,et al.  Serotypes of Chlamydia trachomatis and risk for development of cervical squamous cell carcinoma. , 2001, JAMA.

[17]  T. Bjørge,et al.  No excess risk of cervical carcinoma among women seropositive for both HPV16 and HPV6/11 , 1999, International journal of cancer.

[18]  F. Wiklund,et al.  Sexual behaviour and papillomavirus exposure in cervical intraepithelial neoplasia: a population-based case-control study. , 1999, The Journal of general virology.

[19]  P. Namujju.  Occurrence of infections with multiple human papillomavirus (HPV) types among Finnish and Ugandan women , 2012 .

[20]  Infectious Agents and Cancer BioMed Central , 2008 .