Re: Longitudinal Study of Human Papillomavirus Persistence and Cervical Intraepithelial Neoplasia Grade 2/3: Critical Role of Duration of Infection

Extract

In the report by Rodriguez et al. ( 1 ), two important concepts regarding incident persistent human papillomavirus (HPV) infection and subsequent progression to cervical intraepithelial neoplasia (CIN)2+ among older women should be clarified to avoid misinterpretations of the data. The first of these two concepts concerns the rate of progression of new HPV persistent infections to CIN2+. The authors reported that “Newly detected HPV infections, regardless of the woman's age at the time of first detection, were associated with very low absolute risk of subsequent CIN2+ diagnosis” ( 1 ; page 321). The authors cited positive predictive values (PPVs) and showed no real difference between PPVs in younger vs older women. We agree that the use of PPV, which is highly dependent on the prevalence of the disease being studied, is nevertheless adequate for showing age-specific rates of progression of new infections to CIN2+ because the prevalence of CIN2+ varies with age. Merck's clinical trial studies ( 2–4 ) data show that the rate of progression of incident persistent HPV16/18-related persistent infection to HPV16/18-related CIN2+ in women 16–26 years old (2.6 per 100 person-years, 95% confidence interval [CI] = 2.0 to 3.3) is similar to that in women 27–45 years old (2.9 per 100 person-years, 95% CI = 1.9 to 4.3) with no statistically significant difference (O. M. Bautista, unpublished data), which is consistent with authors’ PPV data.