A Cohort Effect of the Sexual Revolution May Be Masking an Increase in Human Papillomavirus Detection at Menopause in the United States
A Cohort Effect of the Sexual Revolution May Be Masking an Increase in Human Papillomavirus Detection at Menopause in the United States
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DOI：
10.1093/infdis/jis660
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发表时间：
2013-01-15
影响因子：
6.4
通讯作者：
Viscidi, Raphael P.
中科院分区：
文献类型：
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作者：
Gravitt, Patti E.;Rositch, Anne F.;Viscidi, Raphael P.
背景队列效应、新的性伴侣关系和人乳头瘤病毒（HPV）再激活已被假定为在某些人群中观察到的双峰年龄特异性HPV患病率的解释;没有研究系统地评估美国缺乏第二个高峰的原因。843名年龄在35-60岁之间的女性被纳入一项为期2年、每半年一次的随访研究。特定年龄的HPV患病率是在既往感染风险较低的分层中估计的（= 5名终生性伴侣）。年龄和终身性伴侣之间的相互作用进行了测试，使用似然比统计。采用Levin公式估计人群归因危险度（PAR）。在有≥ 5个性伴侣的女性中，14种高危HPV基因型（HR-HPV）的年龄特异性患病率随着年龄的增长而下降（相互作用P = 0.01）。与年轻女性（28.0%）相比，老年女性（87.2%）中≥ 5个终生性伴侣导致的HR-HPV的PAR更高。相比之下，与新性伴侣相关的PAR在35-49岁女性中为28%，在50-60岁女性中为7.7%。在美国，在性革命之前有过性行为的女性中HPV感染的累积概率较低，这可能掩盖了HPV再激活的年龄相关性增加。
Background. Cohort effects, new sex partnerships, and human papillomavirus (HPV) reactivation have been posited as explanations for the bimodal age-specific HPV prevalence observed in some populations; no studies have systematically evaluated the reasons for the lack of a second peak in the United States.Methods. A cohort of 843 women aged 35-60 years were enrolled into a 2-year, semiannual follow-up study. Age-specific HPV prevalence was estimated in strata defined by a lower risk of prior infection (= 5 lifetime sex partners). The interaction between age and lifetime sex partners was tested using likelihood ratio statistics. Population attributable risk (PAR) was estimated using Levin's formula.Results. The age-specific prevalence of 14 high-risk HPV genotypes (HR-HPV) declined with age among women with = 5 lifetime sex partners (P = .01 for interaction). The PAR for HR-HPV due to = 5 lifetime sex partners was higher among older women (87.2%), compared with younger women (28.0%). In contrast, the PAR associated with a new sex partner was 28% among women aged 35-49 years and 7.7% among women aged 50-60 years.Conclusions. A lower cumulative probability of HPV infection among women with a sexual debut before the sexual revolution may be masking an age-related increase in HPV reactivation in the United States.