Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia
Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia
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DOI：
10.1001/jama.286.24.3106
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发表时间：
2001-12-26
影响因子：
120.7
通讯作者：
Franco, EL
中科院分区：
文献类型：
--
作者：
Schlecht, NF;Kulaga, S;Franco, EL
背景人乳头瘤病毒（HPV）感染被认为是宫颈癌的主要原因，尽管大多数流行病学证据来自回顾性病例对照研究，目的评估与HPV感染相关的宫颈肿瘤发生的风险。设计和设置居住在巴西圣保罗市的妇女的HPV感染和宫颈瘤变，该研究在1993年11月至1997年3月之间进行，涉及HPV和病变的重复测量，研究对象共1611名妇女，在入组时无细胞学病变，前2次随访时HPV检测结果可用。主要结果第一年每4个月进行一次巴氏细胞学和HPV检测，此后每年两次。结果宫颈鳞状上皮内病变（锡尔斯）的发病率为0.73/1000妇女月（95%置信区间[CII，0.5-0.9），在2次初次访视时无HPV的女性中，（95% CI，2.3-15.1）在两次访视期间持续存在HPV 16或18型感染的女性中。相对于两次初次访视时HPV致癌类型阴性的患者，任何已知致癌HPV类型持续感染发生SIL的相对风险（RR）为10.19（95%CI，5.9-17.6）。高级别SIL事件的等效RR为11.67（95% CI，4.1-33.3）。HPV 16型和18型持续感染者的宫颈癌复发率明显高于HPV 16型和18型持续感染者。结论HPV 16型和18型持续感染与SIL的发生密切相关。
Context Human papillomavirus (HPV) infection is believed to be the central cause of cervical cancer, although most of the epidemiological evidence has come from retrospective, case-control studies, which do not provide information on the dynamics of cumulative or persistent exposure to HPV infection.Objective To assess the risks of cervical neoplasia related to prior persistent HPV infections.Design and Setting Longitudinal study of the natural history of HPV infection and cervical neoplasia in women residing in the city of Sao Paulo, Brazil, which was conducted between November 1993 and March 1997 and involved repeated measurements of HPV and lesions with follow-up until June 2000.Participants A total of 1611 women with no cytological lesions at enrollment and HPV test results available from the first 2 visits.Main Outcome Measure Cervical specimens taken for Papanicolaou cytology and HPV testing every 4 months in the first year and twice yearly thereafter. Incident cervical cancer precursor lesions ascertained by expert review of all cytology smears.Results The incidence rate of squamous intraepithelial lesions (SILs) was 0.73 per 1000 women-months (95% confidence interval [CII, 0.5-0.9) among women free of HPV at the 2 initial visits and 8.68 (95% Cl, 2.3-15.1) among women with HPV type 16 or 18 infections persisting over both visits. Relative to those negative for HPV oncogenic types at both initial visits, the relative risk (RR) of incident SIL was 10.19 (95% Cl, 5.9-17.6) for persistent infections with any known oncogenic HPV types. The equivalent RR of incident high-grade SIL was 11.67 (95% Cl, 4.1-33.3). The RRs of lesions were considerably higher for persistent infections with HPV type 16 or 18.Conclusion A strong relationship exists between persistent HPV infections and SIL incidence, particularly for HPV types 16 and 18.