Genotype-specific HPV persistence

Genotype-specific HPV persistence is the most important determinant of cervical cancer risk in women who test HPV-positive, regardless of HPV genotype^1-4

If a woman tests positive for HPV during routine screening, there are three possible outcomes for her next HPV test result:

Clearance

the next test result will be HPV negative. This is the most likely outcome as over 90% of HPV infections are cleared by the immune system within 6-18 months⁵

Type switch

the next test result will be HPV positive, but for a different HPV genotype

Genotype-specific HPV persistence

the next test result will be HPV positive for the same HPV genotype

If the immune system does not clear the infection, it is important to determine if it is a “type switch” or “type persistence”, because studies have found that women who switch HPV genotype are at a reduced risk of developing cervical cancer as compared to women who have genotype-specific persistence.²

All women (40/40)

with persistent genotype-specific HPV infection developed CIN2+ disease

No women (0/35)

who switched HPV genotypes or cleared the infection developed CIN2+ disease

Cumulative proportion of ≥CIN2 among women with genotype-specific HPV persistence*

Adapted from Elfgren et al. Am J Obstet Gynecol. 2017;216:264.e1-7.
*12,527 women aged 32-38 years with follow up of 195 women attending colposcopy who were cytologically normal but persistently HPV positive for at least 1 year.
However, not all HPV assays allow for tracking of genotype-specific persistence.

Monitoring genotype-specific HPV persistence is key to identifying your patients at most risk for developing cervical disease.^2,4,6

Extended genotyping provides individual results for at least 5 hr-HPV genotypes⁷ meaning that from one HPV test to the next, it is possible to get the specific HPV genotype result and therefore determine if it is genotype-specific HPV persistence or type switch.

Partial genotyping
cannot identify genotype-specific persistence beyond HPV 16 & 18

Extended genotyping
can identify genotype-specific persistence beyond HPV 16 & 18, and type switch

CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; hr, high risk

1. Bonde JH et al. J Low Genit Tract Dis. 2020;24(1):1–13.
2. Elfgren et al. Am J Obstet Gynecol. 2017;216:264.e1–7.
3. Radley D et al. Hum Vaccin Immunother. 2016;12(3):768–72.
4. Bodily J, Laimins LA. Trends Microbiol. 2011;19(1):33–9.
5. Mitra A et al. Microbiome. 2016;4:58.
6. Perkins RB et al. J Low Genit Tract Dis. 2020;24:102–31.
7. Bonde J et al. J Clin Virol. 2018;108:64–71.