Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/2226
Type: Artigo de periódico
Title: 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
Author: Syrjanen, K.
Shabalova, I.
Sarian, L.
Naud, P.
Longatto-Filho, A.
Derchain, S.
Kozachenko, V.
Zakharchenko, S.
Roteli-Martins, C.
Nerovjna, R.
Kljukina, L.
Tatti, S.
Branovskaja, M.
Branca, M.
Grunjberga, V.
Erzen, M.
Juschenko, A.
Serpa Hammes, L.
Podistov, J.
Costa, S.
Syrjanen, S.
Abstract: 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.
Subject: HPV
Natural history
Outcomes
Competing events
Competing-risks regression model
Transient infection
Persistent infection
Prospective follow-up
NIS Cohort
LAMS Study
Editor: I R O G Canada, Inc
Rights: fechado
Date Issue: 2012
Appears in Collections:FCM - Artigos e Outros Documentos

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