NATURAL HISTORY OF GENITAL HUMAN PAPILLOMAVIRUS IN RENAL TRANSPLANTS

生殖器人类乳头瘤病毒(HPV)感染非常常见。 这种性传播疾病可能会影响多达70%的 性生活活跃的女性在她们生命中的某个时刻。疾病 表现因HPV类型、感染部位和 寄主因素。HPV 6型和11型导致生殖器尖锐湿疣和低级别 上皮内肿瘤。有令人信服的证据表明，16型， 18和31参与高级别上皮内病变的发生 肿瘤和侵袭性肛门生殖器癌作为多步骤的一部分 致癌过程。出现针对HPV的主要主机防御 是一种细胞免疫。以损害为特征的状况 细胞免疫，如器官的医源性免疫抑制 移植和人类免疫缺陷病毒感染是 与生殖器频率和严重程度的增加有关 尖锐湿疣和肛门恶性肿瘤。在这项研究中，我们将建立 当时60名女性生殖器HPV感染的患病率 他们在手术前接受同种异体肾移植 以及三组妇女，每组30人，她们已经建立了 同种异体移植期限：一年以下、一至五年和大于 分别是五年。这些队列将在四个月后进行跟踪 每隔一年确定发病数据。患者将接受 常规盆腔检查，包括外部检查 肛门生殖器和窥镜检查。宫颈涂片、宫颈涂片 衣原体和单纯疱疹病毒培养以及HPV检测的宫颈洗涤液将 将被获得。聚合酶链式反应(PCR)将用于 HPV的检测和分型将通过标准技术进行。 此外，患者将被要求在每次治疗时都完成性史 参观。免疫抑制数据将从患者的 医疗表。有外部病变的患者将接受 标准疗法。有异常宫颈涂片的患者将被转介 到妇产科做进一步的评估和治疗。数据 从这项研究中将提供对自然历史的重要见解 在选定的免疫受损人群中发现生殖器HPV感染。

Genital human papillomavirus (HPV) infection is exceedingly common. This sexually transmitted disease may affect as many as 70% of all sexually active women at some time in their lives. Disease manifestations vary depending on the HPV type, the site of infection and host factors. HPV types 6 and 11 cause genital warts and low grade intraepithelial neoplasias. There is compelling evidence that types 16, 18 and 31 contribute to the development of high grade intraepithelial neoplasias and invasive anogenital cancers as part of the multistep process of carcinogenesis. The primary host defense against HPV appears to be cell mediated immunity. Conditions characterized by impairment of cellular immunity such as the iatrogenic immunosuppression of organ transplantation and human immunodeficiency virus infection are associated with an increase in the frequency and severity of genital warts and anogenital malignancies. In this study, we will establish the prevalence of genital HPV infection in a group of 60 women at the time they receive their renal allografts in the immediate preoperative period; and three groups of 30 women each who have had established allografts for: less than one year, one to five years, and greater than five years respectively. These cohorts will be followed at four month intervals for a year to determine incidence data. Patients will undergo routine pelvic examination including inspection of the external anogenital areas and speculum examination. A pap smear, cervical culture for chlamydia and HSV and cervical washings for HPV testing will be obtained. The polymerase chain reaction (PCR) will be used for detection of HPV and typing will be performed by standard techniques. In addition, patients will be asked to complete a sexual history at each visit. Immunosuppression data will be obtained from the patient's medical chart. Patients with external lesions will be treated with standard therapies. Patients with abnormal pap smears will be referred to the Department of OB/GYN for further evaluation and treatment. Data from this study will provide important insights into the natural history of genital HPV infection in a select immunocompromised population.