Most human papillomavirus (HPV) infections among younger women are transient and rapidly clear; but a small percentage (<10%) persist beyond 2 to 3 years, and have high risk of progression to cervical intraepithelial neoplasia grade 2 (CIN 2) or worse disease and cervical cancer. The natural history of these infections in older women is poorly understood. This population-based longitudinal cohort study investigated the effect of age and the duration of carcinogenic HPV infections on the subsequent persistence of infection and risk of CIN 2 or worse disease. A total of 10,049 women, 18 years or older were enrolled and screened for CIN 2 or worse disease and cervical cancer. Of the 9094 women included in the final analysis, 2115 at higher risk, a subset of 540 low-risk women, and a subset of 410 initially sexually active 18- to 27-year-old women were actively followed every 6 to 12 months up to 7 years, whereas 6029 at low risk of CIN 2 or worse were passively followed and rescreened at 5 to 7 years. HPV was measured with a polymerase chain reaction-based technique. The proportion of sexually active women with HPV persistence during follow-up and at risk of CIN 2 or worse was determined for groups of younger (≤41 years) and older (≥42 years) women. Both older and younger women with newly detected HPV infections were at very low risk for HPV persistence or a subsequent diagnosis of CIN 2 or worse disease. In addition, there was a sharp steady decline in the rates of newly detected infections with age; the rates of newly found infection at ages 18 to 25, 26 to 33, 34 to 41, and ≥42 years were 35.9%, 30.6%, 18.1%, and 13.5%, respectively (P for trend <0.001). A higher number of prevalent HPV infections were persistent at 1 to 6 years of follow-up among women aged 42 years or older in comparison to younger women or women of any age with newly detected infections. Persistent prevalent infections accounted for most (66/85) of the CIN 2 or worse disease. Only 2.2% (25/1128) of the prevalent persisting infections were not CIN 2 or worse at 7 years. These findings demonstrate that the risk of new HPV infection in older women is low, and that prophylactic vaccination and frequent screening may provide little benefit for preventing or detecting new infections in this population.
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Rodríguez et al. (2010) studied this question.