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Open Access Highly Accessed Research article

Persistence, clearance and reinfection regarding six high risk human papillomavirus types in Colombian women: a follow-up study

Sara C Soto-De León12, Luisa Del Río-Ospina12, Milena Camargo13, Ricardo Sánchez4, Darwin A Moreno-Pérez13, Antonio Pérez-Prados5, Manuel E Patarroyo14 and Manuel A Patarroyo12*

Author Affiliations

1 Molecular Biology and Immunology Department, Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá, Colombia

2 School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24#63C-69, Bogotá, Colombia

3 Faculty of Natural and Mathematical Sciences, Universidad del Rosario, Carrera 24#63C-69, Bogotá, Colombia

4 School of Medicine, Universidad Nacional de Colombia, Carrera 45#26-85, Bogotá, Colombia

5 Mathematics Department, Universidad Pública de Navarra, 31006 Pamplona, Spain

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BMC Infectious Diseases 2014, 14:395  doi:10.1186/1471-2334-14-395

Published: 16 July 2014

Abstract

Background

The design of new healthcare schemes which involve using molecular HPV screening means that both persistence and clearance data regarding the most prevalent types of HR-HPV occurring in cities in Colombia must be ascertained.

Methods

This study involved 219 HPV positive women in all of whom 6 types of HR-HPV had been molecularly identified and quantified; they were followed-up for 2 years. The Kaplan-Meier survival function was used for calculating the time taken for the clearance of each type of HPV. The role of a group of independent variables concerning the time taken until clearance was evaluated using a Cox proportional-hazards regression model or parametric (log-logistic) methods when necessary. Regarding viral load, the Wilcoxon rank-sum test was used for measuring the difference of medians for viral load for each type, according to the state of infection (cleared or persistent). The Kruskal-Wallis test was used for evaluating the change in the women’s colposcopy findings at the start of follow-up and at the end of it (whether due to clearance or the end of the follow-up period).

Results

It was found that HPV-18 and HPV-31 types had the lowest probability of becoming cleared (1.76 and 2.75 per 100 patients/month rate, respectively). Women from Colombian cities other than Bogotá had a greater probability of being cleared if they had HPV-16 (HR 2.58: 1.51–4.4 95% CI) or HPV-58 (1.79 time ratio: 1.33-2.39 95% CI) infection. Regarding viral load, HPV-45-infected women having 1 × 106 to 9.99 × 109 viral copies had better clearance compared to those having greater viral loads (1.61 time ratio: 1.01-2.57 95% CI). Lower HPV-31 viral load values were associated with this type’s persistence and changes in colposcopy findings for HPV-16 gave the worst prognosis in women having low absolute load values.

Conclusions

HPV infection clearance in this study was related to factors such as infection type, viral load and the characteristics of the cities from which the women came. Low viral load values would indicate viral persistence and a worse prognosis regarding a change in colposcopy findings.

Keywords:
HR-HPV; Persistence; Clearance time; Colombia; Follow-up study; Viral load