NATURAL HISTORY OF GENITAL HUMAN PAPILLOMAVIRUS IN RENAL TRANSPLANTS

生殖器人乳头瘤病毒（HPV）感染是非常常见的。 这种性传播疾病可能会影响多达70%的所有性活跃的妇女在某些时候在他们的生活。 疾病表现因HPV类型、感染部位和宿主因素而异。 HPV 6型和11型引起生殖器疣和低度上皮内瘤变。 有令人信服的证据表明，类型16，18和31有助于发展高级别上皮内瘤形成和浸润性肛门生殖器癌的多步骤过程的一部分，致癌。 针对HPV的主要宿主防御似乎是细胞介导的免疫。 以细胞免疫功能受损为特征的疾病，如器官移植的医源性免疫抑制和人类免疫缺陷病毒感染，与生殖器疣和肛门生殖器恶性肿瘤的发生频率和严重程度增加相关。在这项研究中，我们将确定一组60名妇女在术前接受肾移植时生殖器HPV感染的患病率;以及三组30名妇女，每组30名妇女已建立同种异体移植：分别为不到一年，一到五年，五年以上。 这些队列将每隔4个月随访一年，以确定发病率数据。 患者将接受常规盆腔检查，包括外部肛门生殖器区域检查和窥器检查。 将对HPV感染引起的外部异常进行活检。 将进行巴氏涂片检查;宫颈衣原体和HSV培养;以及HPV检测的宫颈冲洗液。 将使用聚合酶链反应（PCR）检测HPV，并通过标准技术进行分型。 此外，每次访视时将要求患者填写性史。 免疫抑制数据将从患者的病历中获取。 外部病变患者将接受标准治疗。 子宫颈抹片检查异常的病人会被转介到妇产科作进一步评估及治疗。 将描述HPV感染的临床、细胞学和组织学表现。 这项研究的数据将为特定免疫功能低下人群生殖器HPV感染的自然史提供重要见解。

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 fourth 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. External abnormalities attributed to HPV infection will be biopsied. A pap smear; cervical cultures 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 Obstetrics and Gynecology for further evaluation and treatment. Clinical, cytologic and, when indicated, histologic manifestations of HPV infection will be described. Data from this study will provide important insights into the natural history of genital HPV infection in a select immunocompromised population.