Evaluation of Human Papillomavirus Type Replacement Postvaccination Must Account for Diagnostic Artifacts: Masking of HPV52 by HPV16 in Anogenital Specimens

摘要: It has been hypothesized that, following a reduction in human papillomavirus (HPV) vaccine-targeted genotypes, an increase prevalence of other HPV types may occur due to reduced competition during natural infection. Any apparent postvaccination must be distinguished from diagnostic artifacts consequent consensus PCR assays failing detect present low copy numbers coinfected specimens (under the assumption that with drop vaccine-preventable there increased detection previously "masked" types). We reanalyzed anogenital evaluate unmasking HPV52 caused by elimination HPV16. Using highly sensitive type-specific real-time PCR, we retested 1,200 (all negative according assays) six epidemiologic studies (200 specimens/study; 100 HPV16(+)/study). Multivariate logistic regression, adjustment for age and number sexual partners, was used association between HPV16 positivity HPV52. In our pooled analysis (n = 1,196), presence positively associated [adjusted OR, 1.47; 95% confidence interval (CI), 0.76-2.82]. separate (study specific) analyses, statistically significant observed one study included HIV-infected males (HIPVIRG study; adjusted 3.82; CI, 1.19-12.26). positive viral load (tertiles) (P trend 0.003). These results indicate artifacts, resulting HPV52, some settings evaluation type replacement. Additional exploring extent severity are needed.