Natural History of Anal Human Papillomavirus Infection in Heterosexual Women and Risks Associated With Persistence

• Published in: Clinical infectious diseases 2014-03, Vol.58 (6), p.804-811
• Main Authors: Moscicki, Anna-Barbara, Ma, Yifei, Farhat, Sepideh, Jay, Julie, Hanson, Evelyn, Benningfield, Susanna, Jonte, Janet, Godwin-Medina, Cheryl, Wilson, Robert, Shiboski, Stephen
• Format: Article
• Language: English
• Subjects: Adult; Alcohol use; Alcohols; and Commentaries; Anus Diseases - virology; Anus neoplasms; ARTICLES AND COMMENTARIES; Biological and medical sciences; Cervix uteri; Cohort Studies; Condoms; Female; Heterosexuality; Human papillomavirus; Human papillomavirus 16; Human sexual behavior; Humans; Infections; Infectious diseases; Kaplan-Meier Estimate; Medical sciences; Papillomaviridae - classification; Papillomaviridae - isolation & purification; Papillomavirus Infections - virology; Proportional Hazards Models; Regression analysis; Risk assessment; Sexual Behavior; Sexual intercourse; Uterine Cervical Diseases - virology; Womens health; Womens history; Young Adult
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cit947

Background. Anal cancer is more common in women than in men, yet little is known about the natural history of human papillomavirus (HPV) in women. The objective was to examine the natural history of anal HPV in heterosexual women. Methods. Young women participating in an HPV cohort study were seen at 4-month intervals for cervical and anal HPV testing. Time to clearance was estimated using the Kaplan-Meier approach; risks for persistence were assessed using Cox regression models. Results. Seventy-five women (mean age, 23.5 ± 4.1 years) who tested positive for anal HPV were followed for a mean of 84.5 ± 44.9 months. By 3 years, 82.5% of anal non-16 high-risk (HR) HPV, 82.6% of low-risk (LR) HPV, and 76.2% of HPV-16 infections had cleared. By 3 years, only 36.4% of women had become negative for all HPV types. In the multivariable model, concurrent cervical HPV-16 (P < .001), weekly alcohol use (P = .015), anal touching during sex (P = .045), recent anal sex (P = .04), and no condom use during anal sex (P = .04) were associated with HPV-16 persistence. Greater number of new sex partners (P = .024) and condom use during vaginal sex (P = .003) were associated with clearance. Similar associations were found for clearance in all HR-HPV infections. Only concomitant cervical HPV was associated with non-16 HR-HPV persistence. Conclusions. The majority of anal HPV infections cleared within 3 years. HPV-16 infections were slower to clear than other HR-HPV infections, consistent with its role in anal cancer. Specific sexual behaviors were associated with persistence, suggesting that education and behavioral interventions may decrease persistence.