Type-specific incidence, clearance and predictors of cervical human papillomavirus infections (HPV) among young women: a prospective study in Uganda.
Type-specific incidence, clearance and predictors of cervical human papillomavirus infections (HPV) among young women: a prospective study in Uganda.
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DOI：
10.1186/1750-9378-5-7
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发表时间：
2010-04-09
影响因子：
3.7
通讯作者：
Weiderpass, Elisabete
中科院分区：
文献类型：
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作者：
Banura, Cecily;Sandin, Sven;Weiderpass, Elisabete
背景技术背景：虽然乌干达性活跃的年轻妇女中人乳头瘤病毒感染非常普遍，但关于发病率、清除率及其相关风险因素的信息很少。为了估计HPV感染的发病率，患病率和决定因素，我们在招募时对1，275名年龄在12-24岁之间的女性进行了前瞻性随访研究。妇女回答一份调查问卷，并在每次访问时接受盆腔检查，收集宫颈脱落细胞。通过基于聚合酶链反应（PCR）的检测（SPF 10-DEIA利帕）评估宫颈脱落细胞中42种HPV类型的存在。结果：1，275名妇女中有380名（29.8%）接受了中位时间为18.5个月（四分位数间距9.7-26.6）的随访。在226人-年的随访期间，69名女性发生HPV感染，发病率为30.5/100人-年。新发HPV感染与HIV阳性轻微相关（RR = 2.8，95%CI：0.9 - 8.3）。HPV类型特异性感染的清除率通常在42.3%和100.0%之间（高风险类型）和50%和100%之间（低风险类型）。只有31.2%的妇女清除了所有感染。清除率与HIV阴性相关（校正清除率= 0.2，95% CI：0.1 - 0.7），但与研究入组时的年龄、性伴侣的终生数量和感染的多重性无关。低度鳞状上皮内病变（LSIL）的患病率为53/365（14.5%）。这些妇女都没有高度宫颈病变（HSIL）或癌症。150例基线HPV阴性女性中有22例（14.7%）在随访期间发生了LSIL事件。与未感染HPV 18相关类型的女性相比，HPV 18相关类型的女性LSIL的风险似乎升高（RR = 3.5，95%CI：1.0 - 11.8）。结论：在我们研究的年轻女性人群中，HPV感染事件和特定类型的HPV清除率很高。这些结果强调了在开始性活动之前对青春期前女孩进行疫苗接种的必要性。
BACKGROUND: While infections with human papillomavirus (HPV) are highly prevalent among sexually active young women in Uganda, information on incidence, clearance and their associated risk factors is sparse. To estimate the incidence, prevalence and determinants of HPV infections, we conducted a prospective follow-up study among 1,275 women aged 12-24 years at the time of recruitment. Women answered a questionnaire and underwent a pelvic examination at each visit to collect exfoliated cervical cells. The presence of 42 HPV types was evaluated in exfoliated cervical cells by a polymerase chain based (PCR) assay (SPF10-DEIA LiPA).RESULTS: Three hundred and eighty (380) of 1,275 (29.8%) women were followed up for a median time of 18.5 months (inter-quartile range 9.7-26.6). Sixty-nine (69) women had incident HPV infections during 226 person-years of follow-up reflecting an incidence rate of 30.5 per 100 person-years. Incident HPV infections were marginally associated with HIV positivity (RR = 2.8, 95% CI: 0.9 - 8.3). Clearance for HPV type-specific infections was frequent ranging between 42.3% and 100.0% for high- and 50% and 100% for low-risk types. Only 31.2% of women cleared all their infections. Clearance was associated with HIV negativity (Adjusted clearance = 0.2, 95% CI: 0.1 - 0.7) but not with age at study entry, lifetime number of sexual partners and multiplicity of infections. The prevalence of low-grade squamous intraepithelial lesions (LSILs) was 53/365 (14.5%). None of the women had a high-grade cervical lesion (HSIL) or cancer. Twenty-two (22) of 150 (14.7%) HPV negative women at baseline developed incident LSIL during follow-up. The risk for LSIL appeared to be elevated among women with HPV 18-related types compared to women not infected with those types (RR = 3.5, 95% CI: 1.0 - 11.8).CONCLUSIONS: Incident HPV infections and type-specific HPV clearance were frequent among our study population of young women. These results underscore the need to vaccinate pre-adolescent girls before initiation of sexual activity.