Watts D Heather, Fazzari Melissa, Minkoff Howard, Hillier Sharon L, Sha Beverly, Glesby Marshall, Levine Alexandra M, Burk Robert, Palefsky Joel M, Moxley Michael, Ahdieh-Grant Linda, Strickler Howard D
National Institute of Child Health and Human Development, NIH, Bethesda, Maryland 20892-7510, USA.
J Infect Dis. 2005 Apr 1;191(7):1129-39. doi: 10.1086/427777. Epub 2005 Feb 21.
Whether the natural history of human papillomavirus (HPV) infection is affected by bacterial vaginosis (BV) or Trichomonas vaginalis (TV) infection has not been adequately investigated in prospective studies.
Human immunodeficiency virus 1 (HIV-1)-infected (n=1763) and high-risk HIV-1-uninfected (n=493) women were assessed semiannually for BV (by Nugent's criteria), TV infection (by wet mount), type-specific HPV (by polymerase chain reaction with MY09/MY11/HMB01 HPV primers), and squamous intraepithelial lesions (SIL) (by cytological examination). Sexual history was obtained from patient report at each visit. Risk factors for prevalent and incident HPV infection and SIL were evaluated by use of multivariate models.
BV was associated with both prevalent and incident HPV infection but not with duration of HPV infection or incidence of SIL. TV infection was associated with incident HPV infection and with decreased duration and lower prevalence of HPV infection. TV infection had no association with development of SIL. Effects of BV and TV infection were similar in HIV-1-infected and high-risk HIV-1-uninfected women. HIV-1 infection and low CD4(+) lymphocyte count were strongly associated with HPV infection and development of SIL.
BV and TV infection may increase the risk of acquisition (or reactivation) of HPV infection, as is consistent with hypotheses that the local cervicovaginal milieu plays a role in susceptibility to HPV infection. The finding that BV did not affect persistence of HPV infection and that TV infection may shorten the duration of HPV infection helps explain the lack of effect that BV and TV infection have on development of SIL.
在前瞻性研究中，尚未充分调查细菌性阴道病（BV）或滴虫性阴道炎（TV）感染是否会影响人乳头瘤病毒（HPV）感染的自然病程。
每半年对1763名感染人类免疫缺陷病毒1型（HIV-1）的女性和493名高危未感染HIV-1的女性进行评估，检测BV（根据纽金特标准）、TV感染（通过湿片法）、型特异性HPV（通过使用MY09/MY11/HMB01 HPV引物的聚合酶链反应）以及鳞状上皮内病变（SIL，通过细胞学检查）。每次就诊时从患者报告中获取性病史。使用多变量模型评估HPV感染和SIL流行及新发的危险因素。
BV与HPV感染的流行和新发均相关，但与HPV感染的持续时间或SIL的发生率无关。TV感染与HPV感染的新发相关，且与HPV感染持续时间缩短和患病率降低有关。TV感染与SIL的发生无关。在感染HIV-1的女性和高危未感染HIV-1的女性中，BV和TV感染的影响相似。HIV-1感染和低CD4(+)淋巴细胞计数与HPV感染及SIL的发生密切相关。
BV和TV感染可能会增加HPV感染获得（或再激活）的风险，这与局部宫颈阴道微环境在HPV感染易感性中起作用的假设一致。BV不影响HPV感染的持续存在以及TV感染可能缩短HPV感染持续时间这一发现，有助于解释BV和TV感染对SIL发生缺乏影响的原因。
