Natural History of HPV Infection across the Lifespan: Role of Viral Latency.

Natural History of HPV Infection across the Lifespan: Role of Viral Latency.
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DOI:
10.3390/v9100267
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发表时间:
2017-09-21
期刊:
Viruses
影响因子:
--
通讯作者:
Winer RL
Winer RL
中科院分区:
其他
文献类型:
--
作者:
Gravitt PE;Winer RL

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大规模流行病学研究对于阐明生殖器人乳头瘤病毒(HPV)感染的持续检测与浸润性宫颈癌的发展之间的因果关系非常有价值。然而,这些研究提供的数据有限,无法充分告知一生中 HPV 感染的个体水平自然史模型,并且特别忽略了 HPV 阴性检测和缺乏感染之间的生物学区别(即潜在的、不可检测的 HPV 感染的可能性)。本综述利用最近的流行病学研究数据,提出了生殖器 HPV 整个生命周期自然史的替代模型。我们认为,更完整地阐明替代转变的年龄特异性概率与 HPV 检测在宫颈癌筛查中的广泛使用高度相关。在宫颈癌筛查中进行常规 HPV 检测时,女性通常会进出 HPV 可检测性,这引起了患者和提供者对阳性检测结果的来源、其预后以及预防未来复发的有效策略的担忧。提出了替代研究设计和分析框架,以更好地理解这些转变路径的频率和决定因素。
Large-scale epidemiologic studies have been invaluable for elaboration of the causal relationship between persistent detection of genital human papillomavirus (HPV) infection and the development of invasive cervical cancer. However, these studies provide limited data to adequately inform models of the individual-level natural history of HPV infection over the course of a lifetime, and particularly ignore the biological distinction between HPV-negative tests and lack of infection (i.e., the possibility of latent, undetectable HPV infection). Using data from more recent epidemiological studies, this review proposes an alternative model of the natural history of genital HPV across the life span. We argue that a more complete elucidation of the age-specific probabilities of the alternative transitions is highly relevant with the expanded use of HPV testing in cervical cancer screening. With routine HPV testing in cervical cancer screening, women commonly transition in and out of HPV detectability, raising concerns for the patient and the provider regarding the source of the positive test result, its prognosis, and effective strategies to prevent future recurrence. Alternative study designs and analytic frameworks are proposed to better understand the frequency and determinants of these transition pathways.
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