Micronutrients and prevention of cervical pre-cancer in HPV vaccinated women: a cross-sectional study

Chandrika J Piyathilake; Suguna Badiga; Nongnut Thao; Pauline E Jolly

doi:10.5720/kjcn.2023.28.1.61

Micronutrients and prevention of cervical pre-cancer in HPV vaccinated women: a cross-sectional study

Korean J Community Nutr. 2023 Feb;28(1):61-73. doi: 10.5720/kjcn.2023.28.1.61. Epub 2023 Feb 28.

Authors

Chandrika J Piyathilake¹, Suguna Badiga², Nongnut Thao³, Pauline E Jolly⁴

Affiliations

¹ Department of Nutrition Sciences, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
² Department of Nutrition Sciences, UAB, Birmingham, AL, USA.
³ Awardee of the Minority Health Research Training grant, St. Olaf college, Birmingham, AL, USA.
⁴ Department of Epidemiology, UAB, Birmingham, AL, USA.

Abstract

Objectives: Prophylactic vaccines against high-risk human papillomaviruses (HR-HPVs) hold promise to prevent the development of higher grade cervical intraepithelial neoplasia (CIN 2+) and cervical cancer (CC) that develop due to HR-HPV genotypes that are included, in HPV vaccines, but women will continue to develop CIN 2+ and CC due to HR-HPV genotypes that are not included in the quadrivalent HPV vaccine (qHPV) and 9-valent HPV vaccine (9VHPV). Thus, the current vaccines are likely to decrease but not entirely prevent the development of CIN 2+ or CC. The purpose of the study was to determine the prevalence and determinants of CIN 2+ that develop due to HR-HPVs not included in vaccines.

Methods: Study population consisted of 1476 women tested for 37 HPVs and known to be negative for qHPVs (6/11/16/18, group A, n = 811) or 9VHPVs (6/11/16/18/31/33/45/52/58, group B, n = 331), but positive for other HR-HPVs. Regression models were used to determine the association between plasma concentrations of micronutrients, socio-demographic, lifestyle factors and risk of CIN 2+ due to HR-HPVs that are not included in vaccines.

Results: The prevalence of infections with HPV 31, 33, 35 and 58 that contributed to CIN 2+ differed by race. In group A, African American (AA) women and current smokers were more likely to have CIN 2 (OR = 1.76, P = 0.032 and 1.79, P = 0.016, respectively) while in both groups of A and B, those with higher vitamin B12 were less likely to have similar lesions (OR = 0.62, P = 0.036 and 0.45, P = 0.035, respectively).

Conclusions: We identified vitamin B12 status and smoking as independent modifiable factors and ethnicity as a factor that needs attention to reduce the risk of developing CIN 2+ in the post vaccination era. Continuation of tailored screening programs combined with non-vaccine-based approaches are needed to manage the residual risk of developing HPV-related CIN 2+ and CC in vaccinated women.

Keywords: cervical intraepithelial neoplasia (CIN); cervix; human papillomaviruse (HPV); micronutrients; vaccine.

Grants and funding

T37 MD001448/MD/NIMHD NIH HHS/United States