Human papillomavirus vaccination history and diagnosis of cervical intraepithelial neoplasia grade 2 or more severe lesions among a cohort of colposcoped women in Kaiser Permanente Southern California.

Abstract

BACKGROUND\nRisk of a high-grade lesion in women undergoing colposcopy following an abnormal screening result may be different by human papillomavirus (HPV) vaccination status, since vaccinated women are presumably less likely to harbor HPV 16 and 18.\n\n\nOBJECTIVE\nWe evaluated whether the risk of high-grade cervical lesion diagnosed through colposcopy is lower in women vaccinated for HPV compared with unvaccinated women referred to colposcopy based on equal abnormal screening findings.\n\n\nSTUDY DESIGN\nKaiser Permanente Orange County female patients between age 21-38 were included following abnormal screening if they had one or more colposcopies between July 2017 and August 2018; and had at least one pathology diagnosis from the colposcopy visits. Data on demographic characteristics, clinical and sexual history and HPV vaccination were collected using a colposcopy registry smart form and from electronic medical records. HPV genotyping was performed for tissues from confirmed cervical intraepithelial neoplasm (CIN) 2+ diagnoses. Multilevel generalized linear model with a logic function was used to evaluate the association between HPV vaccination history and the outcome of CIN2+ diagnosis and for HPV16/18 positive CIN2+ as an alternative outcome, adjusting for screening results and potential confounders.\n\n\nRESULTS\nOf 730 women included in the study, 170 had a histologic diagnosis of CIN2+ (23.2%). Of these, 68 cases (40%) were histologically HPV 16 and/or 18 positive. 43% of the 730 women were HPV vaccinated before colposcopy. The majority (69%) of the HPV vaccinated women received the vaccine between age 18-26 years. A history of HPV vaccination overall, before sexual debut, before age 18, or with complete dosing were not associated with lower odds of a CIN2+ diagnosis [odds ratio (95% confidence interval) = 1.07 (0.70-1.64); 1.11 (0.55-2.24); 0.84 (0.53-1.352.45); and 0.96 (0.49-1.91), respectively, in reference to no vaccination]. HPV vaccination history was also not significantly associated with the odds of HPV16/18+ CIN2+ diagnosis. Of note, eight cases (5% of all CIN2+ cases) showed HPV 16 on CIN 2+ histologic PCR analysis despite reported or documented HPV vaccination prior to sexual debut, including 2 cases who started vaccination before age 13.\n\n\nCONCLUSION\nOur study did not support modifying colposcopy management guidelines for abnormal screening results for HPV vaccinated women, especially those vaccinated in the catch-up age range. Our findings on the eight cases of HPV16+ CIN2+ vaccinated prior to sexual debut suggest lowering the recommended age for HPV vaccination may have additional benefits for preventing HPV infection that could occur early in life in some women.