Longitudinal Study of Human Papillomavirus Persistence and Cervical Intraepithelial Neoplasia Grade 2/3: Critical Role of Duration of Infection
Longitudinal Study of Human Papillomavirus Persistence and Cervical Intraepithelial Neoplasia Grade 2/3: Critical Role of Duration of Infection
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DOI：
10.1093/jnci/djq001
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发表时间：
2010-03-03
影响因子：
10.3
通讯作者：
Burk, Robert D.
中科院分区：
文献类型：
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作者：
Cecilia Rodriguez, Ana;Schiffman, Mark;Burk, Robert D.
背景：老年妇女人乳头瘤病毒(HPV)感染的自然病史对预防策略至关重要，包括疫苗接种和筛查间隔，但人们对此知之甚少。在哥斯达黎加瓜纳卡斯特的一项为期7年的人群队列研究中，我们检查了女性的年龄和致癌HPV感染的持续时间是否影响随后感染的持续性和宫颈上皮内瘤变2级(CIN 2)或更严重疾病的风险。方法在登记时，9466名符合盆腔检查资格的参与者中，9175人被用多种方法筛查宫颈肿瘤；那些CIN 2或更严重疾病的人被审查和治疗。CIN 2或更严重的低风险参与者(n=6029)在5-7年(被动随访)后重新筛查，而高风险参与者(n=2115)以及低风险女性(n=540)和初始性不活跃女性(n=410)的子组每年或每半年(积极跟踪)重新筛查长达7年。HPV检测是使用基于聚合酶链式反应的方法进行的。我们根据四个年龄组(18-25岁、26-33岁、34-41岁和42岁)确定了连续1年持续存在的流行感染(基线发现)和新发现感染(首次发现)的比例，并计算了在随访期间CIN 2和CIN 3(CIN 3)或更严重的绝对风险。结果无论女性的年龄如何，新发现的感染与持续性、CIN 2或更严重疾病的绝对风险非常低相关。对于新发现的感染，经过3年的随访，34岁及以上的女性进展到CIN 2+(或CIN 3+)的比率并不高于年轻女性。此外，新发现的感染率随年龄的增长而急剧下降(在积极关注组中，18-25岁、26-33岁、34-41岁和=42岁的感染率分别为35.9%、30.6%、18.1%和13.5%；P=42)高于任何年龄组的年轻人群或新感染人群(P
Background The natural history of human papillomavirus (HPV) infections in older women is critical for preventive strategies, including vaccination and screening intervals, but is poorly understood. In a 7-year population-based cohort study in Guanacaste, Costa Rica, we examined whether women's age and the duration of carcinogenic HPV infections influenced subsequent persistence of infection and risk of cervical intraepithelial neoplasia grade 2 (CIN 2) or worse disease.Methods At enrollment, of the 9466 participants eligible for pelvic examination, 9175 were screened for cervical neoplasia using multiple methods; those with CIN 2 or worse disease were censored and treated. Participants at low risk of CIN 2 or worse (n = 6029) were rescreened at 5-7 years (passively followed), whereas higher-risk participants (n = 2115) and subsets of low-risk women (n = 540) and initially sexually inactive women (n = 410) were rescreened annually or semiannually (actively followed) for up to 7 years. HPV testing was done using a polymerase chain reaction-based method. We determined, by four age groups (18-25, 26-33, 34-41, and >= 42 years), the proportion of prevalent infections (found at baseline) and newly detected infections (first found during follow-up) that persisted at successive 1-year time points and calculated absolute risks of CIN 2 and CIN grade 3 (CIN 3) or worse during follow-up. P values are two-sided.Results Regardless of the woman's age, newly detected infections were associated with very low absolute risks of persistence, CIN 2, or worse disease. For newly detected infections, the rate of progression to CIN 2+ (or CIN 3+), after 3 years of follow-up, was not higher for women aged 34 years and older than for younger women. Moreover, rates of newly detected infections declined sharply with age (in the actively followed group, at ages 18-25, 26-33, 34-41, and >= 42 years, rates were 35.9%, 30.6%, 18.1%, and 13.5%, respectively; P = 42 years) was higher than that among younger age groups or new infections at any age (P