Clearance, persistence and recurrence of HPV infection

for you ladies who have had LEEP or cone for treatment of CIN2-3, this abstract may be of interest. (bearing in mind that medical studies sometimes contradict their findings, I have found that most studies argue that HPV negative status 6 months after the conization has 100% of negative predictive value of recurrence, while I found one article that said that some HPV negative women still had recurrence). Anyway, this abstract lists the factors related to presistence of HPV, but more importantly, it says "that "recurrent" HPV infections offer no evidence that the recurrent episode is correlated with reemergence of the same strain or another strain of the same genotype (wild or variant), but the sequential detection of other HPV type is common. The studies offer no evidence of competition between HPV types but frequently show an increased risk of acquisition of new HPV types in patients already infected compared with those who are HPV-negative."
Seems that this study gives some support to the vaccination after LEEP, b/c it found no evidence of recurrence with the same strain of virus (no evidence of dormant virus "waking up"), but they think recurrence is caused by new infection of different strain, while women who have had precistent HPV in tha past, are more in higher risk to get a new infection. I think this confirms that if vaccination protects from other strains than the one you had, it makes sense as it would protect your from getting new infection in the future. What are your thoughts?



Denis F, Hanz S, Alain S.
Service de bactériologie-virologie-hygiène, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France. francois.denis@unilim.fr

Cervical HPV infection is a common sexually transmitted infection. Most women are infected shortly after beginning their first relationship, with the highest prevalence seen in women under 25 years of age. Thereafter, prevalence decreases rapidly. HPV infections are usually transient; but several factors increasing persistence were identified as host factors (genetic or acquired as age, immunodepression, oral contraception, smoking) and viral factors (genotype, variants, viral load, integration...). Although it is now widely admitted that a persistent infection with a high-risk HPV type is necessary for the development of high-grade cervical intraepithelial neoplasia and invasive disease, whether persistent HPV infections are characterized by the continuing detection of HPV, or by a state of viral latency during which the virus remains undetectable only to reappear later remains unknown. The distinction between a persistent and transient infection is arbitrary depending from both the time of sampling in relation to the natural history of the infection and the interval between samples. The longitudinal studies show that "recurrent" HPV infections offer no evidence that the recurrent episode is correlated with reemergence of the same strain or another strain of the same genotype (wild or variant), but the sequential detection of other HPV type is common. The studies offer no evidence of competition between HPV types but frequently show an increased risk of acquisition of new HPV types in patients already infected compared with those who are HPV-negative.

http://www.ncbi.nlm.nih.gov/pubmed/18417407?ordinalpos=34&itool=EntrezSyste m2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDo cSum