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The association of anal cancer with human papillomavirus HPV infection is well established; however, little is known about the epidemiology of anal HPV in healthy women.

We investigated patterns of duration and clearance of anal HPV infection in a cohort of healthy women in Hawaii. Viral and nonviral determinants of anal HPV clearance were examined in a longitudinal cohort study of sexually active women. At baseline and at 4-month intervals, interviews were conducted and cervical and anal cell specimens were obtained for detection of HPV DNA.

The clearance rate Longest anal penetration a high-risk anal infection was 9. The median clearance times for HPV and HPV, the predominant types associated with anal cancer, were days Longest anal penetration days, respectively.

Nonviral factors that delayed clearance of anal HPV included douching, long-term tobacco smoking, and anal sex. The majority of anal HPV infections resolve in a relatively short time. Although anal HPV is commonly acquired in healthy women, its rapid clearance suggests limited efficacy of HPV testing as an anal cancer screening tool.

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Anal cancer is an uncommon malignancy and similar to cervical cancer, a causal role for high-risk human papillomavirus HPV infection has been postulated. A key feature of the disease is higher incidence among women compared with among men.

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In the United States, there will be Longest anal penetration estimated new cases of anal cancer inwith cases occurring among women and cases among men [ 1 ]. The reason for this Longest anal penetration difference is uncertain, although women with a history of cervical dysplasia and cervical cancer [ 23 ], a history of anal receptive intercourse [ 45 ], and multiple sexual partners [ 46 ] are at greater risk for this disease.

HPV infection of the anal canal has now been established as a risk factor for anal precursor lesions [ 278 ] and anal cancer [ 9 ]. Only a few investigators have examined prevalence and incidence of anal HPV infection, and the studies have been limited to HIV-infected and immunocompromised populations [ 81011 ]. Little is known regarding the natural history of anal HPV infection among non-HIV infected women, particularly the correlates of HPV clearance among women who are generally healthy and not at high risk of sexually transmitted infections.

Such knowledge is important because anal cancer incidence has increased worldwide during the past several decades [ ]. Invasive anal squamous cell carcinoma rates increased by 1. During the same period, a marked annual increase 2. Age-adjusted Longest anal penetration rates per 1, persons of in situ and invasive anal cancer among women, — Survey epidemiology and end results SEER program data file [ 16 ].

An urgent need exists to improve our understanding of anal HPV epidemiology, to facilitate Longest anal penetration and prevention methods to combat this malignancy.

In a longitudinal cohort study of women in Hawaii, we examined the natural history of anal HPV infection to identify risk factors and patterns of occurrence [ 17 ]. The objective of the present report was to determine viral and nonviral factors associated with the duration and clearance patterns of anal HPV infection.

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Patient recruitment and follow-up. From througha cohort of sexually active women was established [ ] for a longitudinal study of cervical and anal HPV infection.

INTRODUCTION

Cohort participants were recruited among women who attended 5 clinics in Oahu, Hawaii, who were able to read, understand, and sign an informed consent form and a medical release form approved by the University of Hawaii Institutional Review Board. Potentially eligible patients included those with appointments for new or annual gynecological examinations or for family-planning services who were not pregnant or postpartum within the past 6 months and had no plans to relocate within 1 year.

Collection of anal specimens after the gynecological examination was optional. At the first and subsequent visits, anal cell specimens Longest anal penetration obtained among willing Longest anal penetration with use of a Dacron swab moistened with sterile water. The swab was inserted 1. Women who entered the cohort were asked to return every 4 months for repeat examination and testing.

After completion of each clinical examination, the study coordinator administered a study questionnaire Longest anal penetration the participant. The baseline interview included demographic and sexual activity data, history of tobacco and alcohol use. A second, more detailed questionnaire, conducted during the second visit after a four-month interval, included gynecological, menstrual, reproductive and sexual histories, hormone use, medical history, history of sexually transmitted infections, and income.

Information covered in the baseline questionnaire sexual activity, tobacco and alcohol use was also updated. The questionnaire used at subsequent interviews was modified slightly for use during the follow-up period; questions included changes in sexual and reproductive information during the intervening period between clinic visits.

HPV DNA-positive specimens were genotyped using a reverse line blot detection method Roche Molecular Systems [ 24 ] for 36 different Longest anal penetration types, including high-risk HR types 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73, and 82; low-risk LR types 6, 11, 42, 54, 61, Longest anal penetration, 81, and 89; and undetermined-risk types 44, 62, 67, 71, 83, and 84 [ 2526 ]. We defined the risk oncogenic potential associated with various HPV types, using the International Agency for Research on Cancer definition [ 26 ].

HPV-positive specimens that subsequently had negative results of the genotyping assay were considered unclassified HPV-positive specimens.

The specimens Analyses were conducted using SAS, version 9. To prevent bias in estimates due to left censoring, we considered only incident infections—that is, infections first detected at the second visit or a subsequent visit. The duration of infection was the time from the first detection of anal HPV infection until the first negative result for that infection.

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The Kaplan-Meier method was used to calculate the median duration of anal and cervical HPV infections grouped by oncogenic risk and phylogenetic species. HPV type-specific clearance rates per person-months were calculated for all detected anal HPV genotypes and were grouped by the number of other genotypes present at the clinic visit preceding clearance of the index infection.

Clearance rates for 5 age groups were calculated using the same techniques and were used to construct age-specific anal HPV clearance curves. The association of anal HPV clearance with exposures of interest was modeled through Cox regression with days since acquisition of infection as the time metric, after adjustment for age at study entry. Infections with unclassified HPV types were excluded from the analysis.

The proportional hazards assumption for Cox models was verified by plotting scaled Schoenfeld residuals against time to HPV clearance [ 29 ]. Longest anal penetration and follow-up included visits at which Longest anal penetration specimens were collected median, Longest anal penetration.

The cumulative follow-up experience for this cohort was woman-months mean duration of follow-up, days. The cohort had a multiethnic composition, with the majority of patients nonwhite women.

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The median age of cohort participants was 40 years mean age, The rate of clearance of incident anal HPV infections was 8. HR HPV infections cleared faster 9.

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Median duration and clearance rates of anal human papillomavirus HPV infection, by HPV genotype and the number of coinfections. This pattern was observed across most HPV groups. A higher number of coexisting genotypes did not change anal HPV clearance Longest anal penetration. No significant association was observed between the age of participants at baseline and anal HPV clearance table 3.


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