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The age prevalence of human papillomavirus (HPV) cervical infections is high in young age groups, declining sharply thereafter, reaching a steady state after age 40.1 Women who remain persistent carriers of HPV DNA are considered at high risk for cervical cancer. To investigate viral persistence over an extended period of time, we re-contacted, in 1997–8, a group of women who participated in case-control studies between 1988–91 in Spain, Colombia, and Brazil.2–,4 Among women with confirmed normal cervical smears, follow up was scheduled for all women positive for HPV cervical detection (n=91) and for a group of age matched women who were HPV negative (n=254). All but one HPV infection were of high risk types. Husbands of these women in Colombia and in Spain, initially detected to be HPV positive (n=110), were also re-contacted. Follow up data were obtained from personal interview and from HPV DNA tested in cervical and urethral (men) exfoliated cells. The follow up protocol was approved by the institution’s ethics committee and participants signed an informed consent. Finally, 198 women (57.4%) and 42 (38.2%) men were re-interviewed. Of them, 99 women provided cervical samples and 14 men provided urethral samples. HPV detection was carried out in the same laboratories that tested the initial samples. The Spanish and Colombian samples were tested using the PMY09/11 PCR L1 based method and the Brazilian samples were tested using the GP5+/6+ PCR system.
The average age at entry was 50.8 years for women and 51.9 for men (range 27–79 years). After an average of 9 years of follow up (range 7–11), none of the women examined harboured HPV DNA irrespective of their initial HPV status (table 1⇓). The follow up cervical smear identified three women in Colombia and one in Brazil with a cervical intraepithelial neoplasm grade I. All were HPV negative. Among the HPV positive husbands who were re-examined, two remained positive (14.3%, 95% CI 3.7 to 32.6), one for low risk type HPV 6 and one for high risk type HPV 16. No penile lesions were detected upon clinical examination. An active search in the corresponding cancer registries did not identify any case of invasive cervical or penile cancer in the target population.
The data, albeit limited by small size, suggest that HPV infection in middle age is subject to clearance as is commonly observed in young women.4 All women with follow up information had no HPV infection after an average follow up period of 9 years. None of the women developed advanced cervical disease in the interval as would be expected in some cases of chronic carriers of HPV infection.