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Type: Artigo de periódico
Title: Risk estimates for persistent high-risk human papillomavirus infections as surrogate endpoints of progressive cervical disease critically depend on reference category: analysis of the combined prospective cohort of the New Independent States of the Former Soviet Union and Latin American Screening Studies
Author: Syrjanen, K
Shabalova, I
Naud, P
Kozachenko, V
Derchain, S
Zakharchenko, S
Roteli-Martins, C
Nerovjna, R
Longatto, A
Kljukina, L
Tatti, S
Branovskaja, M
Hammes, LS
Branca, M
Grunjberga, V
Erzen, M
Juschenko, A
Costa, S
Sarian, L
Podistov, J
Syrjanen, S
Abstract: To make feasible future clinical trials with new-generation human papillomavirus (HPV) vaccines, novel virological surrogate endpoints of progressive disease have been proposed, including high-risk HPV (HR-HPV) persistence for six months (6M+) or 12 months (12M+). The risk estimates (relative risks [RRs]) of these 'virological endpoints' are influenced by several variables, not yet validated adequately. We compared the impact of three referent groups: (i) HPV-negative, (ii) HPV-transient, (iii) HPV-mixed outcome on the risk estimates for 6M+ or 12M+ HR-HPV persistence as predictors of progressive disease. Generalized estimating equation models were used to estimate the strength of 6M+ and 12M+ HR-HPV persistence with disease progression to squamous intraepithelial lesions (SILs), cervical intraepithelial neoplasia (GIN) grade 1+, CIN2+, CIN/SIL endpoints, comparing three optional reference categories (i)-(iii) in a prospective sub-cohort of 1865 women from the combined New Independent States of the Former Soviet Union (NIS) and Latin American Screening (LAMS) studies cohort (n = 15,301). The RRs of these viral endpoints as predictors of progressive disease are affected by the length of viral persistence (6M+ or 12M+) and the surrogate endpoint (SIL, CIN1, CIN2, CIN/SIL). Most dramatic is the effect of the referent group used in risk estimates, with the HPV-negative referent group giving the highest and most consistent RRs for both 6M+ and 12M+ viral persistence, irrespective of which surrogate is used. In addition to deciding on whether to use 6M+ or 12M+ persistence criteria, and cytological, histological or combined surrogate endpoints, one should adopt the HPV-negative referent group as the gold standard in all future studies using viral persistence as the surrogate endpoint of progressive disease.
Subject: HPV persistence
disease progression
prospective follow-up
surrogate endpoint
reference category
NIS Cohort
LAMS Study
new-generation HPV vaccines
Country: Inglaterra
Editor: Royal Soc Medicine Press Ltd
Citation: International Journal Of Std & Aids. Royal Soc Medicine Press Ltd, v. 22, n. 6, n. 315, n. 323, 2011.
Rights: fechado
Identifier DOI: 10.1258/ijsa.2009.009365
Date Issue: 2011
Appears in Collections:Unicamp - Artigos e Outros Documentos

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