Human papillomavirus genotypes in high grade cervical lesions in the United States

Background. Two vaccines protect against human papillomaviruses (HPV) 16 and 18, which cause 70% of cervical cancer and 50% of cervical intraepithelial neoplasia 2/3 and adenocarcinoma in situ (CIN2+). Monitoring HPV types in CIN2+ may be used to assess HPV vaccine impact. Methods. As part of a multisite vaccine impact monitoring project (HPV-IMPACT), biopsy specimens used to diagnose CIN2+ were obtained for HPV DNA typing for women aged 18–39 years. Results. Among 4,121 CIN2+ cases reported during 2008–2009 in 18- to 39-year-old women 3058 (74.2%) were tested; 96% were HPV DNA positive. HPV 16 was most common (49.1%), followed by HPV 31 (10.4%) and HPV 52 (9.7%). HPV 18 prevalence was 5.5% overall. Proportion of CIN2+ cases associated with HPV 16/18 was highest (56.3%) in 25- to 29-year-old women. HPV 16/18-associated lesions were less common in non-Hispanic blacks (41.9%) and Hispanics (46.3%) compared with non-Hispanic whites (59.1%) (P< .0001); the difference remained significant when adjusted for covariates. Compared to non-Hispanic whites, HPV 35 and 58 were significantly more common in non-Hispanic blacks (14.5% vs 4.2%; 12.3% vs 3.4%) and HPV 45 was higher in Hispanics (3.7% vs 1.5%). Conclusions. Age and racial/ethnic differences in HPV type distribution may have implications for vaccine impact and should be considered in monitoring trends. Human papillomavirus (HPV) types 16 and 18 [1–3] are causally related to 70% of cervical cancers and 50% of cervical precancerous lesions worldwide. Since 2006, 2 vaccines directed against these HPV types have become commercially available [1–3]. Cervical cancer develops slowly, over decades, and is often preceded by high-grade cervical lesions that can be detected through routine cervical cancer screening [4]. Histologically