Determinants of high-risk HPV persistence in female college students at USC

宫颈癌在南卡罗来纳州仍然是一个严重的问题，非裔美国女性 不成比例地受到这种疾病的影响。这项建议调查了南卡罗来纳大学(USC)和历史上的黑人学院/大学(HBCU)克拉夫林大学(CU)的女大学生中持续高危人乳头状瘤病毒(HR-HPV)感染的决定因素。这项研究的基本原理是：虽然HR-HPV感染是宫颈癌的主要原因，但大多数HPV感染在几个月内就会自发消失，只有持续感染HR-HPV的女性才有真正的癌症风险。然而，为了诊断HPV感染是持续性的，必须每隔六个月进行多次HPV检测，最长可达两年，而且每次都必须确定特定的HPV类型。 因此，这种方法不适用于大规模筛查。如果在第一次就诊时就能确定HPV持久性的标志，那么就可以以具有成本效益和效率的方式，对那些真正需要它的妇女进行认真的后续治疗。我们打算从南加州大学和加州大学招收300名女大学生参加这项研究。非裔美国人和高加索女性在这一群体中都有很好的代表性。研究参与者将从大一开始和整个大学学习过程中接受跟踪，每六个月进行一次巴氏涂片和宫颈粘液采集。具体地说，我们将监测：细胞学，按特定类型划分的HPV感染，病毒载量，巴氏涂片材料中HPVE7mRNA的表达，以及 宫颈粘液中有16种细胞因子。每次访问时进行的问卷调查收集有关生活方式因素、压力、吸烟、饮食和体力活动的信息。研究问题：1.特定的细胞因子谱与HR-HPV持续性是否相关？2.病毒载量与HR-HPV持续性是否相关？3.E7高表达与持续性相关吗？4.HPV DNA病毒载量与E7 mRNA表达是否相关？HR-HPV持久性与饮食、压力、生活方式因素、体力活动是否相关？通过比较在接受相同护理标准的非裔美国人和高加索女性中决定HPV持久性的因素，我们将 找出可能有助于确定南卡罗来纳州这两个种族之间宫颈癌发病率和死亡率差异的因素，再加上获得护理的机会。

Cervical cancer is still a serious problem in South Carolina, and African American women are disproportionately affected by this disease. This proposal investigates the determinants of persistent high-risk human papillomavirus (HR-HPV) infection in female college students from the University of South Carolina (USC) and from Claflin University (CU), a Historically Black College/University (HBCU). The rationale for this study is: while HR-HPV infection is the major cause of cervical cancer, most HPV infections clear spontaneously in a matter of months, and only women who have persistent HR-HPV infection are truly at risk for cancer. However, in order to diagnose HPV infection as persistent, multiple HPV tests must be conducted at six month intervals for up to two years, and the specific HPV type must be identified each time. Hence, this approach is not applicable to large scale screening. If markers of HPV persistence could be identified at a first visit, then careful follow-up could be directed to those women that really need it, in a cost-effective and efficient fashion. We propose to recruit 300 female college students from USC and CU into this study. Both African American and Caucasian women are well represented in this cohort. Study participants will be followed from their freshman year and throughout the course of their college studies, with Pap smears and cervical mucus collections performed every six months. Specifically, we will monitor: cytology, HPV infection by specific type, viral load, HPV E7 mRNA expression in the Pap smear material, and the profile of 16 cytokines in the cervical mucus. Questionnaires administered at each visit collect information concerning lifestyle factors, stress, smoking, diet, and physical activity. Study Questions: 1. Is there a correlation between specific cytokine profiles and HR-HPV persistence? 2. Is there a correlation between viral load and HR-HPV persistence? 3. Is high E7 mRNA expression correlated with persistence? 4. Is there a relationship between HPV DMA viral loads and E7 mRNA expression? And 5. Is there a correlation between HR-HPV persistence and diet, stress, lifestyle factors, physical activity? By comparing the factors that determine HPV persistence in African American and Caucasian women who receive the same standard of care, we will identify factors that, together with access to care, may contribute to determining the disparity in cervical cancer incidence and mortality rates observed between these two ethnic groups in South Carolina.