Human Papillomavirus Infection with Multiple Types: Pattern of Coinfection and Risk of Cervical Disease

• Published in: The Journal of infectious diseases 2011-04, Vol.203 (7), p.910-920
• Main Authors: Chaturvedi, Anil K., Katki, Hormuzd A., Hildesheim, Allan, Rodríguez, Ana Cecilia, Quint, Wim, Schiffman, Mark, Van Doorn, Leen-Jan, Porras, Carolina, Wacholder, Sholom, Gonzalez, Paula, Sherman, Mark E., Herrero, Rolando
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Cervix Uteri - virology; Coinfection; Costa Rica - epidemiology; Cytology; Disease risk; DNA, Viral - genetics; Epidemiology; Female; Fundamental and applied biological sciences. Psychology; Genitalia; Genotype; Genotypes; Human papillomavirus; Humans; Immunology; Incidence; Infections; Infectious diseases; Lesions; Major and Brief Reports; Medical sciences; Microbiology; Miscellaneous; Papillomaviridae - classification; Papillomaviridae - genetics; Papillomaviridae - isolation & purification; Papillomavirus Infections - complications; Papillomavirus Infections - epidemiology; Papillomavirus Infections - virology; Risk Assessment; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - virology; Vaccination; Virology; VIRUSES; Young Adult
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiq139

Objective. We investigated coinfection patterns for 25 human papillomavirus (HPV) types and assessed the risk conferred by multiple HPV types toward cervical disease. Methods. Sexually active women (n= 5,871) in the NCI-sponsored Costa Rica HPV Vaccine Trial's prevaccination enrollment visit were analyzed. Genotyping for 25 HPVs was performed using SPF₁₀/LiPA₂₄. We calculated odds ratios (ORs) to assess coinfection patterns for each genotype with 24 other genotypes. These ORs were pooled and compared with pair-specific ORs to identify genotype combinations that deviated from the pooled OR. We compared risk of CIN2+/HSIL+ between multiple and single infections and assessed additive statistical interactions. Results. Of the 2478 HPV-positive women, 1070 (43.2%) were infected with multiple types. Multiple infections occurred significantly more frequently than predicted by chance. However, this affinity to be involved in a coinfection (pooled OR for 300 type-type combinations= 2.2; 95% confidence interval [CI] = 2.1-2.4) was not different across HPV type-type combinations. Compared with single infections, coinfection with multiple oe9 species was associated with significantly increased risk of CIN2+(OR= 2.2; 95% CI = 1.1-4.6) and HSIL+(OR= 1.6; 95% CI = 1.1-2.4). However, diseas risk was similar to the sum of estimated risk from individual types, with little evidence for synergistic interactions. Conclusions. Coinfecting HPV genotypes occur at random and lead to cervical disease independently.