Project 1-Preventing cervical cancer in HIV-infected women

摘要 与其他与艾滋病毒相关的癌症相比，宫颈癌的发病率在 抗逆转录病毒疗法(ART)，是肯尼亚和乌干达妇女最常见的癌症。这些 每个国家的艾滋病毒流行率都很高，这极大地加速了宫颈癌的发展，即使在 接受抗逆转录病毒治疗并实现“重组”免疫系统的妇女。更好的筛查方法是 需要，我们需要了解与HPV感染相关的辅助因素，HPV感染是导致宫颈癌的病毒。 我们项目的长期目标是帮助根除感染艾滋病毒的肯尼亚和乌干达人的宫颈癌 女人。我们将在一项针对感染艾滋病毒的妇女的研究中测试我们的方法。首先，我们将评估HR-HPV DNA 自采集阴道拭子联合VIA检测经活检证实的宫颈上皮内病变 居住在肯尼亚或乌干达的HIV感染妇女的肿瘤级别为2级、3级或更差(CIN 2/3)。我们 假设经活检证实的CIN 2/3的检出率在既有HR-2的HIV感染的妇女中更高。 HPVDNA阳性和Via异常与只有一项阳性或两项都不阳性的患者相比。 其次，我们将确定黄曲霉毒素，一种在 被污染的玉米是HIV感染者中致癌HPV检测和宫颈癌的危险因素 肯尼亚和乌干达妇女。我们假设，无论HIV状态如何，黄曲霉毒素都是HR的危险因素。 HPV检测、HR-HPV持久性和活检证实的CIN 2/3，黄曲霉毒素对HR-HPV的影响 HIV感染者的检测、HR-HPV持久性和经活检证实的CIN 2/3将显著增加 黄曲霉毒素的免疫抑制作用损害了宿主的 在使用抗逆转录病毒药物的情况下控制艾滋病毒的能力。我们目标的实现将有助于改善对所有妇女的护理 肯尼亚和乌干达，并帮助抗击艾滋病毒感染妇女的宫颈癌。

Abstract In contrast to other HIV-associated cancers, the incidence of cervical cancer has not declined in the era of antiretroviral therapy (ART), and is the most common cancer among Kenyan and Ugandan women. These countries each have high HIV prevalence, which greatly accelerates the progression of cervical cancer, even in women receiving ART and achieving “reconstituted” immune systems. Better methods of screening are needed, and we need to understand cofactors related to HPV infection, the virus that causes cervical cancer. The long-term objective of our project is to help eradicate cervical cancer in HIV-infected Kenyan and Ugandan women. We will test our approach in a study of HIV-infected women. First, we will evaluate HR-HPV DNA testing of self-collected vaginal swabs combined with VIA in detecting biopsy-proven cervical intraepithelial neoplasia grades 2, 3, or worse (CIN 2/3+) in HIV-infected women living in Kenya or Uganda. We hypothesized that detection of biopsy-proven CIN 2/3+ is higher among HIV-infected women with both HR- HPV DNA positivity and VIA abnormality compared to those with only one or neither of these tests positive. Second, we will determine if aflatoxin, a carcinogenic and immunosuppressive compound found in contaminated corn, is a risk factor for oncogenic HPV detection and cervical cancer among HIV-infected Kenyan and Ugandan women. We hypothesize that regardless of HIV-status, aflatoxin is a risk factor for HR- HPV detection, HR-HPV persistence, and biopsy-proven CIN 2/3+, that the impact of aflatoxin on HR-HPV detection, HR-HPV persistence, and biopsy-proven CIN 2/3+ will be significantly greater in HIV-infected women than in HIV-uninfected women, and that the immunosuppressive effects of aflatoxin impair the host’s ability to control HIV in spite of ART use. Accomplishment of our aims will help improve care for all women in Kenya and Uganda, and help in the battle against cervical cancer in HIV-infected women.