HPV and HTLV Infection in Female Sex Workers in Peru

描述（由申请人提供）：我们建议美国-秘鲁合作研究女性商业性工作者（CSW）中具有重大公共卫生重要性的两种常见感染：人类乳头状瘤病毒（HPV）和人类t细胞嗜淋巴病毒1型和2型（HTLV）。这项研究将在秘鲁的美国海军医学研究中心支队和阿尔伯托·巴顿德尔卡亚奥中心与西尔维亚·蒙塔诺博士合作进行，作为美国国立卫生研究院拨款#R01NS055627-01的延伸，题为“秘鲁神经系统逆转录病毒感染”。妇女遭受性传播感染的风险增加，特别是那些没有得到常规医疗护理或从安第斯山脉其他国家移徙从事性工作的妇女。尽管HPV和HTLV都具有显著的潜在健康后果，如宫颈癌和HTLV相关的脊髓病，但秘鲁目前没有预防方案。本研究的目的是确定女性中HPV和HTLV感染的患病率和决定因素，确定开始性工作的女性中HPV株型的获得，并检查HPV和HTLV感染的宫颈阴道脱落的相关性。拟议的研究将通过以下方式实现这些目标：1)对在CSAB和通过流动诊所接受护理的移徙女工进行横断面研究，以及对同等数量的秘鲁籍女工进行研究。参与者将接受由一名社会工作者安排的结构化面对面访谈，内容涉及人口、移民和经济特征、病史、性行为（包括性网络和性传播感染/艾滋病毒知识）和工作实践。将获得宫颈和血清学样本，以检测HPV， HTLV和其他性传播感染。数码阴道镜将评估宫颈宫外移。2)对最近两个月内从事性工作的女同性恋者进行前瞻性研究。150名参与者每人将接受为期一年的季度HPV检测。3)收集50份保存的宫颈刷检样本进行HPV检测，并与数字阴道镜检查结果和STI信息进行相关性分析。拟议的研究将确定秘鲁CSW中HPV和HTLV的患病率，提供关于HPV和HTLV感染在这些感染的最高风险妇女中获得，脱落和传播的额外信息，并阐明可用于制定秘鲁和其他国家的高危妇女预防政策的危险因素感染这些感染。

DESCRIPTION (provided by applicant): We propose a United States-Peru collaboration to examine two common infections of major public health importance in female commercial sex workers (CSW): human papilloma virus (HPV) and human T-cell lymphotropic virus types 1 and 2 (HTLV). The research would be conducted in Peru at the U.S. Naval Medical Research Center Detachment and the Centra de Salud "Alberto Barton" del Callao in collaboration with Dr. Silvia Montano, as an extension of NIH grant #R01NS055627-01, entitled Retrovirus Infections of the Nervous System in Peru. CSW are at increased risk for sexually transmitted infections (STI), particularly those who do not receive routine medical care or who migrate for sex work from other Andean countries. Although both HPV and HTLV carry significant potential health consequences, such as cervical cancer and HTLV-l-associated myelopathy, no prevention programs currently exist in Peru. The aims of this study are to determine the prevalence and determinants of HPV and HTLV infections in CSW, to define the acquisition of HPV strain types in CSW initiating sex work, and examine the correlates of cervico-vaginal shedding of HPV and HTLV infections. The proposed study would address these aims through: 1) A cross-sectional study of migrant CSW receiving care at CSAB and via a mobile clinic, as well as an equal number of Peruvian CSW. Participants will receive a structured, face-to-face interview administered by a social worker regarding demographic, migration and economic characteristics, medical history, sexual behavior (including sexual networks and STI/HIV knowledge) and work practices. Cervical and serological samples will be obtained to test for HPV, HTLV, and other STI. Digital colposcopy will be performed to evaluate for cervical ectopy. 2) A prospective study of CSW who initiated sex work within the last two months. One hundred fifty participants will each receive quarterly HPV testing for one year. 3) A collection of 50 stored cervical brush samples will be analyzed for HPV and correlated with digital colposcopic findings and STI information. The proposed study would define HPV and HTLV prevalences among CSW in Peru, provide additional information regarding acquisition, shedding and transmission of HPV and HTLV infections in women at highest risk for these infections, and elucidate risk factors that could be used to develop prevention policies in Peru and other countries with women at high risk for these infections.