Longitudinal outcomes of high-risk human papillomavirus (HPV) infections as competing-risks events following cervical HPV test at baseline visit in the *NIS-LAMS** cohort

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art_LONGATTO-FILHO_Longitudinal_outcomes_of_high_risk_human_papillomavirus_(HPV)_2012.PDF (101 KB)
Citações na Scopus
1
Tipo de produção
article
Data de publicação
2012
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
I R O G CANADA, INC
Autores
SYRJANEN, K.
SHABALOVA, I.
SARIAN, L.
NAUD, P.
DERCHAIN, S.
KOZACHENKO, V.
ZAKHARCHENKO, S.
ROTELI-MARTINS, C.
NEROVJNA, R.
Citação
EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY, v.33, n.4, p.341-352, 2012
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: 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 compet ng 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 covariaies 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 of ASCUS+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.
Palavras-chave
HPV, Outcomes, Competing events, Competing-risks regression model, Transient infection, Persistent infection, Prospective follow-up, NIS Cohort, LAMS Study
URI
https://observatorio.fm.usp.br/handle/OPI/1626
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Coleções
Artigos e Materiais de Revistas Científicas - LIM/14