ArticleCancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology2015
Evaluation of human papillomavirus type replacement postvaccination must account for diagnostic artifacts: masking of HPV52 by HPV16 in anogenital specimens.
Article in Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes.Emerging infectious diseases · 2016Pooled it
- Evaluation of Type Replacement Following HPV16/18 Vaccination: Pooled Analysis of Two Randomized Trials.Journal of the National Cancer Institute · 2017Trial
- Population-Based First Estimates of the Effect of HPV Vaccination in Three Italian Areas Covered by Organised Cervical Screening.International journal of cancer · 2026Article
- Epidemiological approaches to evaluate clinical unmasking of HPV-associated cervical lesions in the HPV vaccination era.International journal of cancer · 2026Review
- HPV Type Replacement After HPV Vaccination.Current topics in microbiology and immunology · 2026Review
- HPV vaccine impact: genotype-specific changes in cervical pre-cancer share similarities with changes in cervical screening cytology.Journal of the National Cancer Institute · 2025Article
- Human papillomavirus genotype-specific prevalence and infection risks: a 10-year population-based study from the United States.Journal of the National Cancer Institute · 2025Article
- Predictable changes in the accuracy of human papillomavirus tests after vaccination: review with implications for performance monitoring in cervical screening.British journal of cancer · 2024Review
- Incidence and Types of Human Papillomavirus Infections in Adolescent Girls and Young Women Immunized With the Human Papillomavirus Vaccine.JAMA network open · 2021Article
- NanoString Technology for Human Papillomavirus Typing.Viruses · 2021Article
- Estimating the direct effect of human papillomavirus vaccination on the lifetime risk of screen-detected cervical precancer.International journal of cancer · 2021Article
- Evidence for Missing Positive Results for Human Papilloma Virus 45 (HPV-45) and HPV-59 with the SPFJournal of clinical microbiology · 2020Article
- Human Papillomavirus Viral Load and Transmission in Young, Recently Formed Heterosexual Couples.The Journal of infectious diseases · 2019Article
- Capturing multiple-type interactions into practical predictors of type replacement following human papillomavirus vaccination.Philosophical transactions of the Royal Society of London. Series B, Biological sciences · 2019Article
- Human Papillomavirus Infection and Transmission Among Couples Through Heterosexual Activity (HITCH) Cohort Study: Protocol Describing Design, Methods, and Research Goals.JMIR research protocols · 2019Article
- Clinical performance of Anyplex II HPV28 by human papillomavirus type and viral load in a referral population.PloS one · 2019Article
- Article
- HPV genotype-specific concordance between EuroArray HPV, Anyplex II HPV28 and Linear Array HPV Genotyping test in Australian cervical samples.Papillomavirus research (Amsterdam, Netherlands) · 2017Article
- Cervical Infection With Vaccine-Associated Human Papillomavirus (HPV) Genotypes as a Predictor of Acquisition and Clearance of Other HPV Infections.The Journal of infectious diseases · 2016Article
- Epidemiologic Evaluation of Human Papillomavirus Type Competition and the Potential for Type Replacement Post-Vaccination.PloS one · 2016Article
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Authors and funding
9 authors.
Funding
Abstract
It has been hypothesized that, following a reduction in human papillomavirus (HPV) vaccine-targeted genotypes, an increase in prevalence of other HPV types may occur due to reduced competition during natural infection. Any apparent postvaccination increase must be distinguished from diagnostic artifacts consequent to consensus PCR assays failing to detect HPV types present in low copy numbers in coinfected specimens (under the assumption that with a drop in vaccine-preventable types there may be increased detection of previously "masked" types). We reanalyzed anogenital specimens to evaluate unmasking of HPV52 that may be caused by elimination of HPV16. Using highly sensitive type-specific real-time HPV52 PCR, we retested 1,200 anogenital specimens (all HPV52 negative according to consensus PCR assays) from six epidemiologic studies (200 specimens/study; 100 HPV16(+)/study). Multivariate logistic regression, with adjustment for age and number of sexual partners, was used to evaluate the association between HPV16 positivity and detection of HPV52. In our pooled analysis (n = 1,196), the presence of HPV16 was positively associated with HPV52 detection [adjusted OR, 1.47; 95% confidence interval (CI), 0.76-2.82]. In our separate (study specific) analyses, a statistically significant association was observed in one study that included HIV-infected males (HIPVIRG study; adjusted OR, 3.82; 95% CI, 1.19-12.26). We observed a positive association between HPV16 viral load (tertiles) and detection of HPV52 (P for trend = 0.003). These results indicate that diagnostic artifacts, resulting from unmasking of HPV52, may occur in some settings in the evaluation of HPV type replacement. Additional studies exploring the extent and severity of unmasking are needed.
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