Design and methods of the Ludwig-McGill longitudinal study of the natural history of human papillomavirus infection and cervical neoplasia in Brazil

Eduardo Franco, Luisa Villa, Thomas Rohan, Alex Ferenczy, Maria Petzl-Erler, Greg Matlashewski, Maria Baggio, Otávia Caballero, João Candeias, Silvaneide Ferreira, Lenice Galan, José Prado, Paula Rahal, Marcella Ribeiro, Antonio Ruiz, Mônica Santos, Laura Sichero, João Sobrinho, Lara Termini, Marie DésyEliane Duarte-Franco, Juliette Robitaille, Marie Claude Rousseau, Nicolas Schlecht

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Abstract

This article reports on a large longitudinal study, begun in 1993, of the natural history of human papillomavirus (HPV) infection and cervical neoplasia in a population of low-income women in Sao Paulo, Brazil, a city with one of the highest risks worldwide for cervical cancer. Known as the Ludwig-McGill cohort study, the epidemiological investigation focuses on persistent infection with oncogenic HPV types as the precursor event leading to cervical neoplasia. The objectives of this study are to: 1) study the epidemiology of persistent cervical HPV infection in asymptomatic women, 2) investigate whether persistent HPV infection increases risk of low-grade and high-grade cervical lesions, 3) search for determinants of persistent HPV infection, 4) search for molecular variants of HPV that may be associated with an increased risk of lesions, 5) investigate whether viral burden is correlated with persistent infections and with lesion risk, 6) study the antibody response to HPV as a predictor of persistence and lesion progression, and 7) examine the role of HLA typing and codon 72 p53 gene polymorphism in mediating HPV persistence and lesion severity. The study accrued 2 528 female subjects through March 1997. Subjects were followed up every 4 months in the first year, with twice-yearly return visits to take place in subsequent years. Participants undergo a questionnaire-based interview, have a cervical specimen taken for Pap cytology and HPV testing, and have a blood sample drawn for HPV antibody testing. A cervicography is performed once in the first year and every two years thereafter. In this article we describe the design and methods of the study, provide baseline cohort characteristics, and present a preliminary assessment of the prognostic value of baseline HPV status.

Original languageEnglish (US)
Pages (from-to)223-233
Number of pages11
JournalRevista Panamericana de Salud Publica/Pan American Journal of Public Health
Volume6
Issue number4
DOIs
StatePublished - Oct 1999

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ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Franco, E., Villa, L., Rohan, T., Ferenczy, A., Petzl-Erler, M., Matlashewski, G., Baggio, M., Caballero, O., Candeias, J., Ferreira, S., Galan, L., Prado, J., Rahal, P., Ribeiro, M., Ruiz, A., Santos, M., Sichero, L., Sobrinho, J., Termini, L., ... Schlecht, N. (1999). Design and methods of the Ludwig-McGill longitudinal study of the natural history of human papillomavirus infection and cervical neoplasia in Brazil. Revista Panamericana de Salud Publica/Pan American Journal of Public Health, 6(4), 223-233. https://doi.org/10.1590/S1020-49891999000900001