Natural History of HPV Infection across the Lifespan: Role of Viral Latency

Large-scale epidemiologic studies have been invaluable for elaboration of the causal relationship between persistent detection of genital human papillomavirus (HPV) infection and the development of invasive cervical cancer. However, these studies provide limited data to adequately inform models of t...

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Bibliographic Details
Published in:Viruses 2017-09, Vol.9 (10), p.267
Main Authors: Gravitt, Patti E, Winer, Rachel L
Format: Article
Language:English
Subjects:
Adult
Age
Age Factors
Cancer screening
Cervical cancer
Cervical Intraepithelial Neoplasia - diagnosis
Cervical Intraepithelial Neoplasia - epidemiology
Cervical Intraepithelial Neoplasia - virology
Cervix
Female
Human papillomavirus
Human Papillomavirus DNA Tests
Humans
Infections
Invasiveness
Latency
Life span
Longevity
Medical screening
Middle Aged
Natural history
Papillomaviridae - physiology
papillomavirus
Papillomavirus Infections - complications
Papillomavirus Infections - diagnosis
Papillomavirus Infections - epidemiology
Papillomavirus Infections - prevention & control
Papillomavirus Vaccines - therapeutic use
Prognosis
Recurrence
Review
Risk Factors
Studies
Uterine Cervical Neoplasms - diagnosis
Uterine Cervical Neoplasms - epidemiology
Uterine Cervical Neoplasms - virology
Virus Latency
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Summary:Large-scale epidemiologic studies have been invaluable for elaboration of the causal relationship between persistent detection of genital human papillomavirus (HPV) infection and the development of invasive cervical cancer. However, these studies provide limited data to adequately inform models of the individual-level natural history of HPV infection over the course of a lifetime, and particularly ignore the biological distinction between HPV-negative tests and lack of infection (i.e., the possibility of latent, undetectable HPV infection). Using data from more recent epidemiological studies, this review proposes an alternative model of the natural history of genital HPV across the life span. We argue that a more complete elucidation of the age-specific probabilities of the alternative transitions is highly relevant with the expanded use of HPV testing in cervical cancer screening. With routine HPV testing in cervical cancer screening, women commonly transition in and out of HPV detectability, raising concerns for the patient and the provider regarding the source of the positive test result, its prognosis, and effective strategies to prevent future recurrence. Alternative study designs and analytic frameworks are proposed to better understand the frequency and determinants of these transition pathways.
ISSN:1999-4915
1999-4915
DOI:10.3390/v9100267