The significance of human papillomavirus viral load in prediction of histologic severity and size of squamous intraepithelial lesions of uterine cervix

Objectives. Persistence of high-risk types of human papillomavirus (HPV) in cervical scrapes is responsible for the development, maintenance, and prog ression of squamous intraepithelial lesions (SILs). Previous studies of vir al load and histologic severity ave ended with controversial results. This study evaluated the relationships of HPV viral load with size and histologi c severity of cervical lesions, which has not been reported previously. Methods. By using Hybrid Capture II, DNA level of high-risk HPVs was determ ined in cervical scrapes and correlated with lesion size and histologic con firmation for 73 women referred for colposcopy. The lesion size was classif ied as nonvisible (n=12), small (less than or equal to2/5 of the 12x colpos copic visual filed, n=36), and large (>2/5 of the 12 x field, n=25) lesions . The final disease status was categorized as high-grade SIL (HSIL)/squamou s cell carcinoma (SCC) (designated HSIL+) (n=32), low-grade SIL (LSIL) (n=1 9), and no detectable SIL (n=22). Results. A distinct upward trend of high-risk HPV DNA levels paralleled inc reasing size and histologic severity of cervical lesions (P=0.003 and 0.001 , respectively). With respect to relative risk, women who had high viral lo ad of HPV were at significantly greater risk for large lesion size (odds ra tio [OR] = 5.3, 95% confidence interval [CI] = 1.1-24.9) and HSIL+ (OR = 35 .0,95% CI = 4.2-294.5). Of particular note, the risk of developing large le sion size and HSIL+ significantly increased with increasing viral load of H PV (P values for trend test were 0.008 and 0.0004, respectively). In contra st, there were no significant associations of trend in viral load with risk in small lesion size and LSIL. Conclusions. The present study revealed that the effect of HPV infection on SIL development is highly influenced by high viral load and highlighted a potential application of viral load testing in predicting the size and seve rity of lesions of the uterine cervix. (C) 2001 Academic Press.