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Title: Human papillomavirus infection with multiple types: pattern of coinfection and risk of cervical disease.
Authors: Chaturvedi AK,  Katki HA,  Hildesheim A,  Rodríguez AC,  Quint W,  Schiffman M,  Van Doorn LJ,  Porras C,  Wacholder S,  Gonzalez P,  Sherman ME,  Herrero R,  CVT Group,  Alfaro M,  Barrantes M,  Bratti MC,  Cárdenas F,  Cortés B,  Espinoza A,  Estrada Y,  Gonzalez P,  Guillén D,  Herrero R,  Jimenez SE,  Morales J,  Morera LA,  Pérez E,  Porras C,  Rodriguez AC,  Villegas M,  Freer E,  Bonilla J,  Silva S,  Atmella I,  Ramírez M,  Hildesheim A,  Lowy DR,  Macklin N,  Schiffman M,  Schiller JT,  Sherman M,  Solomon D,  Wacholder S,  Pinto L,  Garcia-Pineres A,  Eklund C,  Hutchinson M,  Quint W,  van Doorn LJ
Journal: J Infect Dis
Date: 2011 Apr 1
Branches: BB, CGB, HREB, IIB
PubMed ID: 21402543
PMC ID: PMC3068034
Abstract: 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 SPF(10)/LiPA(25). 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 α9 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, disease 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.