Viral Load in the Natural History of Human Papillomavirus Type 16 Infection: A Nested Case-control Study
Viral Load in the Natural History of Human Papillomavirus Type 16 Infection: A Nested Case-control Study
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DOI：
10.1093/infdis/jir049
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发表时间：
2011-05-15
影响因子：
6.4
通讯作者：
Schiffman, Mark
中科院分区：
文献类型：
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作者：
Xi, Long Fu;Hughes, James P.;Schiffman, Mark
方法.这项病例对照研究嵌套在为期2年的意义不明的非典型鳞状细胞和低度鳞状上皮内病变分类研究中，该研究每半年对女性进行一次HPV和宫颈上皮内瘤变（CIN）随访。病例患者（n = 62）是在随访时HPV-16阳性检测后诊断为CIN 3的女性。HPV-16阳性对照组（n = 152），无CIN 2或CIN 3，与基于随访访视的病例匹配，其中测量了病毒载量。采用实时荧光定量聚合酶链反应检测HPV-16 DNA。在随访时，随着HPV-16 DNA载量的增加，CIN 3的风险增加（比值比，1.63; 95%置信区间，每增加1 log（10）单位1.33-1.99）;该关联不受入组时是否存在HPV-16的影响。当HPV-16在入组和随访时均存在时，病例中的病毒载量仍然很高（P = .77），但对照组中的病毒载量大幅下降（P = .004）。在随访期间首次发现HPV-16感染的女性中，首次HPV-16阳性样本中的病毒载量与短期持续性相关;在首次阳性后1次访视时，感染者的载量高于未感染者（P = .001）。新检测感染的病毒载量和病毒载量的变化可预测HPV-16感染的持续性和进展。
Methods. This case-control study was nested within the 2-year Atypical Squamous Cells of Undetermined Significance and Low-Grade Squamous Intraepithelial Lesion Triage Study, in which women were followed semiannually for HPV and cervical intraepithelial neoplasia (CIN). Case patients (n = 62) were women diagnosed with CIN3 following HPV-16-positive detection at a follow-up visit. HPV-16-positive controls (n = 152) without CIN2 or CIN3 were matched to cases based on the follow-up visit in which viral load was measured. Real-time polymerase chain reaction was used for HPV-16 DNA quantification.Results. The risk of CIN3 increased with increasing HPV-16 DNA load at the follow-up visit (odds ratio, 1.63; 95% confidence interval, 1.33-1.99 per 1 log(10) unit increase); the association was not affected by whether HPV-16 was present at enrollment. When HPV-16 was present at both enrollment and follow-up, viral load remained high among cases (P = .77) but decreased substantially among controls (P = .004). Among women with HPV-16 found initially during follow-up, viral load in the first HPV-16-positive sample was associated with short-term persistence; load was higher in those with infection, compared with those without infection, 1 visit after the initial positivity (P = .001).Conclusions. Viral load of newly detected infections and changes in viral load predict persistence and progression of HPV-16 infections.