Population-based study of human papillomavirus infection and cervical neoplasia in rural Costa Rica.
Population-based study of human papillomavirus infection and cervical neoplasia in rural Costa Rica.
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DOI：
10.1097/00006254-200010000-00016
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发表时间：
2000-03
期刊：
影响因子：
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通讯作者：
R. Herrero;A. Hildesheim;Concepcion Bratte;M. Sherman;M. Hutchinson;J. Morales;I. Balmaceda;M. Gre
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文献类型：
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作者：
R. Herrero;A. Hildesheim;Concepcion Bratte;M. Sherman;M. Hutchinson;J. Morales;I. Balmaceda;M. Gre
背景人乳头瘤病毒（HPV）是宫颈癌的主要病因。由于很少有基于人群的研究调查了与宫颈疾病相关的类型特异性感染的患病率，我们研究了高危人群，估计了HPV感染的患病率和与各种HPV类型相关的风险。方法：我们筛选了哥斯达黎加瓜纳卡斯特的9175名妇女，以获得参考标准的最终诊断，并使用基于聚合酶链反应的系统对3024名妇女进行了超过40种HPV的检测。结果在细胞学检查正常的女性中，HPV感染在25岁以下的女性中首先达到峰值，在55岁或以上再次达到峰值，主要是非癌症相关类型的HPV和未特征化的HPV类型。低度鳞状上皮内病变（LSIL）（n = 189）随着年龄的增长而减少。高度鳞状上皮内病变（HSIL）（n = 128）的患病率在30岁左右首次达到峰值，在65岁或以上再次达到峰值。73%的LSIL为HPV阳性，其中HPV 16为主要类型（16%的阳性受试者）。在89%的HSIL和88%的癌症中发现了HPV，其中HPV 16占绝对优势（51%和53%的阳性受试者）。几乎所有HSIL和癌症都有癌症相关的HPV类型，具有高比值比（OR）和约80%的可归因分数。HPV 16的风险特别高（HSIL的OR = 320，95%置信区间[CI] = 97-1000;癌症的OR = 710，95% CI = 110-4500）。结论：我们证实HPV感染随年龄增长而早期下降，但注意到绝经后的患病率增加，这可能与HSIL的第二个高峰有关，这一观察结果值得进一步研究。至少有80%的HPV参与宫颈癌的发生在这个人群中的特点。包括主要癌症相关HPV类型的多价疫苗可能能够预防该地区的大多数宫颈疾病病例。
BACKGROUND Human papillomavirus (HPV) is the main cause of cervical neoplasia. Because few population-based studies have investigated the prevalence of type-specific infection in relation to cervical disease, we studied a high-risk population, estimating the prevalence of HPV infection and the risk associated with various HPV types. METHODS We screened 9175 women in Guanacaste, Costa Rica, to obtain a referent standard final diagnosis, and tested 3024 women for more than 40 types of HPV with a polymerase chain reaction-based system. RESULTS Among women with normal cytology, HPV infections peaked first in women younger than 25 years, and they peaked again at age 55 years or older with predominantly non-cancer-associated types of HPV and uncharacterized HPV types. Low-grade squamous intraepithelial lesions (LSILs) (n = 189) decreased consistently with age. The prevalence of high-grade squamous intraepithelial lesions (HSILs) (n = 128) peaked first around age 30 years and again at age 65 years or older. Seventy-three percent of LSILs were HPV positive, with HPV16 being the predominant type (16% of positive subjects). HPV was found in 89% of HSILs and 88% of cancers, with HPV16 being strongly predominant (51% and 53% of positive subjects). Virtually all HSILs and cancers had cancer-associated HPV types, with high odds ratios (ORs) and attributable fractions around 80%. Risk for HPV16 was particularly high (OR for HSILs = 320, 95% confidence interval [CI] = 97-1000; OR for cancer = 710, 95% CI = 110-4500). CONCLUSIONS We confirm the early decline of HPV infection with age but note increased prevalence after menopause, which could be related to a second peak of HSILs, an observation that warrants further investigation. At least 80% of HPVs involved in cervical carcinogenesis in this population have been characterized. Polyvalent vaccines including the main cancer-associated HPV types may be able to prevent most cases of cervical disease in this region.