Human papillomavirus infections with multiple types and risk of cervical neoplasia
Human papillomavirus infections with multiple types and risk of cervical neoplasia
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DOI：
10.1158/1055-9965.epi-06-0129
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发表时间：
2006-07-01
影响因子：
3.8
通讯作者：
Franco, Eduardo L.
中科院分区：
文献类型：
--
作者：
Trottier, Helen;Mahmud, Salaheddin;Franco, Eduardo L.
背景：除了某些人类乳头瘤病毒(HPV)基因型别在宫颈癌的病因中已被确定的作用外，关于多型HPV感染对宫颈病变风险的影响还知之甚少。我们研究了2462名巴西妇女的HPV多种类型与宫颈病变的关系，这些妇女参加了路德维希-麦吉尔研究小组对HPV自然史和宫颈肿瘤的调查。队列的重复测量设计允许评估HPV类型累积和并发数量与任何级别的鳞状上皮内病变(SIL)和高度SIL(HSIL)之间的关系。结果：在个别访问中，1.9%到3.2%的妇女感染了多个HPV。在第1年和前4年的累计随访中，分别有12.3%和22.3%的人感染了多种类型的病毒。随着感染类型的增多，单纯疱疹病毒感染的风险显著增加[单型感染的优势比(OR)为41.5；95%可信区间(95%CI)为5.3~323.2；2~3型的OR为91.7；95%CI为11.6~728.1；4~6型的OR为424.0；95%CI为31.8~5651.8，相对于第一年HPV持续阴性的女性]。在排除感染HPV-16、高危HPV类型或持续感染的妇女后，多重感染的额外风险仍然存在，特别是对于任何级别的sIL。HPV-16和HPV-58混合感染似乎特别容易增加风险。结论：多种类型的HPV感染似乎在宫颈癌的发生中起协同作用。这些发现对宫颈病变的治疗和预测HPV感染的结局具有重要意义。
Background: Besides an established role for certain human papillomavirus (HPV) genotypes in the etiology of cervical cancer, little is known about the influence of multiple-type HPV infections on cervical lesion risk. We studied the association between multiple HPV types and cervical lesions among 2,462 Brazilian women participating in the Ludwig-McGill study group investigation of the natural history of HPVs and cervical neoplasia.Methods: Cervical specimens were typed by a PCR protocol. The cohort's repeated-measurement design permitted the assessment of the relation between the cumulative and concurrent number of HPV types and any-grade squamous intraepithelial lesions (SIL) and high-grade SIL (HSIL).Result: At individual visits, 1.9% to 3.2% of the women were infected with multiple HPVs. Cumulatively during the first year and the first 4 years of follow-up, 12.3% and 22.3% Introduction were infected with multiple types, respectively. HSIL risk markedly increased with the number of types [odds ratio (OR), 41.5; 95% confidence interval (95% Cl), 5.3-323.2 for single-type infections; OR, 91.7; 95% Cl, 11.6-728.1 for two to three types; and OR, 424.0; 95% Cl, 31.8-5651.8 for four to six types, relative to women consistently HPV-negative during the first year of follow-up]. The excess risks for multiple-type infections remained after exclusion of women infected with HPV-16, with high-risk HPV types, or persistent infections, particularly for any-grade SIL. Coinfections involving HPV-16 and HPV-58 seemed particularly prone to increase risk.Conclusion: Infections with multiple HPV types seem to act synergistically in cervical carcinogenesis. These findings have implications for the management of cervical lesions and prediction of the outcome of HPV infections.