A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion
A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion
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DOI：
10.1086/516784
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发表时间：
2007-06-01
影响因子：
6.4
通讯作者：
Wheeler, Cosette M.
中科院分区：
文献类型：
--
作者：
Plummer, Martyn;Schiffman, Mark;Wheeler, Cosette M.
背景资料。宫颈癌是由人类乳头瘤病毒(HPV)持续感染引起的。大多数感染和相关病变会自发消失。重要的是要明确决定因素和清除的时间，以便能够识别和管理病毒的持久性。我们调查了4504例ALTS(未确定意义的非典型鳞状细胞/低度鳞状上皮内病变分类研究)受试者的HPV自然病史。离散时间马尔可夫模型被用来同时描述细胞学结果可疑或轻度异常的女性在24个月内特定类型HPV感染的患病率、发病率和持久性。对感染同一女性的多种HPV类型之间的相互作用进行检查，以确定新感染的发生率(在HPV-16感染后)和当前感染在由系统发育相关性或致癌性定义的组内的持久性。登记时91%(95%可信区间[CI]，90%-92%)的流行HPV感染在24个月内清除。感染持续6个月的概率随着感染持续时间的延长而增加，从新观察到的感染的37%(95%可信区间，35%-39%)增加到已经持续类似18个月的感染的65%(95%可信区间，61%-70%)。关于HPV-16感染后新感染的发生率或当前HPV感染的持续性，没有发现多种HPV类型之间相互作用的一致证据。尽管几乎所有的HPV感染在两年内都消失了，但其余的感染具有很高的持久性，并隐含着发展为癌症前病变和癌症的可能性。一旦控制了生物和行为决定因素，不同类型的HPV感染似乎相互独立。
Background. Cervical cancer is caused by persistent infection with human papillomavirus (HPV). Most infections and associated lesions clear spontaneously. It is important to define the determinants and timing of clearance, so that viral persistence can be recognized and managed.Methods. We investigated HPV natural history among 4504 subjects from ALTS (Atypical Squamous Cells of Undetermined Significance/ Low- Grade Squamous Intraepithelial Lesions Triage Study). A discrete- time Markov model was used to simultaneously describe the prevalence, incidence, and persistence of type- specific HPV infection over 24 months in women with equivocal or mildly abnormal cytological results. Interactions between multiple HPV types infecting the same woman were examined for incidence of new infection (after an HPV- 16 infection) and persistence of a current infection within groups defined by phylogenetic relatedness or by carcinogenicity.Results. Ninety-one percent (95% credible interval [CI], 90% - 92%) of prevalent HPV infections at enrollment cleared within 24 months. The probability that an infection would persist for a further 6 months increased with the duration of infection, from 37% (95% CI, 35% - 39%) for a newly observed infection to 65% (95% CI, 61% 70%) for an infection that had already persisted for similar to 18 months. No consistent evidence of interactions was found between multiple HPV types regarding the incidence of new infection after an HPV- 16 infection or regarding persistence of current HPV infection.Conclusion. Although virtually all HPV infections clear within 2 years, the remaining infections have a high potential for persistence and, by implication, progression to precancer and cancer. Once biological and behavioral determinants are controlled for, HPV infections with different types seem to be independent of each other.