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TitleLongitudinal outcomes of high-risk human papillomavirus (HPV) infections as competing-risks events following cervical HPV test at baseline visit in the *NIS-LAMS** cohort
Author(s)Syrjänen, K.
Shabalova, I.
Sarian, L.
Naud, P.
Filho, A. L.
Derchain, S.
Kozachenko, V
Zakharchenko, S.
Martins, C. Roteli
Nerovjna, R.
Kljukina, L.
Tatti, S.
Branovskaja, M.
Branca, M.
Grunjberga, V.
Eržen, M.
Juschenko, A.
Hammes, L. Serpa
Podistov, J.
Costa, S.
Syrjänen, S.
Natural history
Competing events
Competing-risks regression model
Transient infection
Persistent infection
Prospective follow-up
NIS Cohort
LAMS Study
Issue dateOct-2012
PublisherI.R.O.G. Canada Inc.
JournalEuropean Journal of Gynaecological Oncology
Abstract(s)The complex natural history of human papillomavirus (HPV) infections following a single HPV test can be modeled as competing-risks events (i.e., no-, transient- or persistent infection) in a longitudinal setting. The covariates associated with these competing events have not been previously assessed using competing-risks regression models. OBJECTIVES: To gain further insights in the outcomes of cervical HPV infections, we used univariate- and multivariate competing-risks regression models to assess the covariates associated with these competing events. STUDY DESIGN AND METHODS: Covariates associated with three competing outcomes (no-, transient- or persistent HR-HPV infection) were analysed in a sub-cohort of 1,865 women prospectively followed-up in the NIS (n = 3,187) and LAMS Study (n = 12,114). RESULTS: In multivariate competing-risks models (with two other outcomes as competing events), permanently HR-HPV negative outcome was significantly predicted only by the clearance ofASCUS+ Pap during FU, while three independent covariates predicted transient HR-HPV infections: i) number of recent (< 12 months) sexual partners (risk increased), ii) previous Pap screening history (protective), and history of previous CIN (increased risk). The two most powerful predictors of persistent HR-HPV infections were persistent ASCUS+ Pap (risk increased), and previous Pap screening history (protective). In pair-wise comparisons, number of recent sexual partners and previous CIN history increase the probability of transient HR-HPV infection against the HR-HPV negative competing event, while previous Pap screening history is protective. Persistent ASCUS+ Pap during FU and no previous Pap screening history are significantly associated with the persistent HR-HPV outcome (compared both with i) always negative, and ii) transient events), whereas multiparity is protective. CONCLUSIONS: Different covariates are associated with the three main outcomes of cervical HPV infections. The most significant covariates of each competing events are probably distinct enough to enable constructing of a risk-profile for each main outcome.
DescriptionSpecial thanks are due to Digene Corp. for providing the Hybrid Capture analyzer, samplers and the test kits at our disposal. We express our thanks to all women who participated in these two cohort studies. Finally, all the members of the NIS and LAMS Study research groups are acknowledged for their invaluable contribution to these studies
Publisher version
AccessRestricted access (UMinho)
Appears in Collections:ICVS - Artigos em revistas internacionais / Papers in international journals

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