HPV Redetection Commonly Attributable to the Reactivation of Latent Infection

The redetection of human papillomavirus (HPV) infection may be the reactivation of a latent infection rather than a new infection from recent sexual activity. These study results were published in The Journal of Infectious Disease.

This longitudinal cohort study was conducted in São Paulo, Brazil between 1993 and 1997 to assess the incidence and risk factors associated with the first detection and redetection of the same HPV genotype. Study participants were adult women (N=2184) at a maternal and child health program for low-income families. Researchers observed participants every 4 months during year 1 and then twice yearly for up to 10 years thereafter. Participants completed a questionnaire on behavioral, socioeconomic, and demographic risk factors associated with HPV infection and provided cervical samples for cytology and HPV DNA testing. Cox proportional hazards models were used to determine the cumulative incidence of HPV detection.

Participants included in the analysis were aged between 18 and 60 years, and the median follow-up period was 6.5 years. A total of 308 genotype-specific redetections of the same HPV genotype were evaluated, of which 256 were second detections and 52 were third or more detections.

The cumulative incidence of redetection of the same HPV genotype was 6.6% (95% CI, 5.5%-7.7%) for the first year and 14.8% (95% CI, 13.0%-16.6%) in year 5. For additional redetections of the same HPV genotype, the cumulative incidence was 15.8% (95% CI, 10.1%-21.1%) and 42.0% (95% CI, 30.3%-51.7%) at years 1 and 5, respectively.

Although a relationship was observed between older age (≥45 vs <25 years) and a lower incidence of first detections, age was not a significant predictor higher redetection risk (adjusted hazards ratio [aHR], 0.90; 95% CI, 0.54-1.47). There also was no significant association between redetection rate and new sexual partner acquisition (aHR, 0.98; 95% CI, 0.70-1.35). However, new sexual partner acquisition was significantly associated with increased first detection incidence (HR, 2.04; 95% CI, 1.74-2.40).  

Further analysis showed that a higher number of lifetime sexual partners was significantly associated with increased incidence of both first HPV detection and redetections of the same HPV genotype. In addition, active smoking status was associated with increased first detection incidence 1.32 (incidence rate, 1.32; 95% CI, 0.99-1.76).

Limitations of this study include insufficient data and potential misclassification bias, as the researchers noted that some first incident detections may have been redetections. In addition, these findings may not be generalizable as participants were not representative of the general population.

According to the researchers, “These results may help in de-stigmatizing a positive HPV test result, as they suggest that many HPV detections may be a reactivated past infection, rather than a new infection from recent sexual behaviors or partner infidelity.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Infectious Disease Advisor