The age-specific prevalence of human papillomavirus and risk of cytologic abnormalities in rural Nigeria: Implications for screen-and-treat strategies
The age-specific prevalence of human papillomavirus and risk of cytologic abnormalities in rural Nigeria: Implications for screen-and-treat strategies
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DOI：
10.1002/ijc.26211
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发表时间：
2012-05-01
影响因子：
6.4
通讯作者：
Schiffman, Mark
中科院分区：
文献类型：
--
作者：
Gage, Julia C.;Ajenifuja, Kayode O.;Schiffman, Mark
低收入国家正在考虑对致癌的人类乳头瘤病毒(HPV)感染进行宫颈筛查。有效性需要在老年妇女中进行有针对性的筛查，在这些妇女中，流行的感染更有可能是持续性的，并预示着癌症前期。西非的一些研究发现，所有成年人的HPV感染率都异常高，这可能会降低基于HPV的筛查的阳性预测价值(PPV)，如果老年妇女的阳性不足以预测风险增加。我们在尼日利亚农村地区进行了一项以人群为基础的研究，以确定HPV的患病率和相关的宫颈异常。我们采用分层随机抽样的方法，招募了15岁以上的女性。非处女者接受了宫颈检查，包括液基细胞学和残留细胞学样本的PCRHPVDNA检测。三分之二的受邀女性参与，14.7%的人感染了可检测到的致癌HPV，这一比例不会随着年龄的增长而下降(p-趋势=0.36)，并且在1529和6069年龄组中略有高峰。在通常考虑进行筛查和治疗计划的年龄(3049岁)的女性中，12.8%的人乳头瘤病毒阳性，而细胞学分级高或更差的PPV为16.4%。相比之下，年龄<30岁的女性HPV阳性的可能性更大(18.9%，p=0.03)，PPV较低(4.2%p=0.05)。在50岁以上的女性中(通常被排除在资源匮乏的环境中，因为无法获得廉价的治疗而被排除在筛查之外)，HPV阳性率为14.2%，PPV为13.9%。在Irun和类似的环境中，HPV不会随着年龄的增长而下降，基于HPV的筛查和治疗计划对中年女性可能是可行的，因为患病率足够低，阳性预测癌症前病变更容易治疗的风险增加。
Cervical screening for carcinogenic human papillomavirus (HPV) infection is being considered for low-income countries. Effectiveness requires targeted screening in older women in whom prevalent infections are more likely to be persistent and predictive of precancer. Some studies in West Africa have found unusually high HPV prevalences across all adult ages, which may reduce the positive predictive value (PPV) of HPV-based screening, if positivity in older women does not sufficiently predict elevated risk. We conducted a population-based study in rural Nigeria to identify HPV prevalence and associated cervical abnormalities. Using stratified random sampling, we enrolled women age 15+. Nonvirgins had a cervical exam including liquid-based cytology and PCR HPV DNA testing from residual cytology specimens. Two-thirds of invited women participated, and 14.7% had detectable carcinogenic HPV, a proportion that did not decline with age (p-trend = 0.36) and showed slight peaks in the 1529 and 6069 age groups. Among women of the age typically considered for screen-and-treat programs (3049 years), 12.8% were HPV positive, and the PPV for high-grade or worse cytology was 16.4%. Comparatively, women age < 30 were more likely to be HPV positive (18.9%, p = 0.03) with a lower PPV (4.2% p = 0.05). Among women age 50+ (typically excluded from screening in resource-poor settings because inexpensive treatment is not available), HPV positivity was 14.2% with a PPV of 13.9%. In Irun and similar settings where HPV does not decline with age, HPV-based screen-and-treat programs might be feasible for mid-adult women because prevalence is sufficiently low and positivity predicts elevated risk of more easily treated precancer.