Castle Philip E, Schiffman Mark, Herrero Rolando, Hildesheim Allan, Rodriguez Ana Cecilia, Bratti M Concepcion, Sherman Mark E, Wacholder Sholom, Tarone Robert, Burk Robert D
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-7234, USA.
J Infect Dis. 2005 Jun 1;191(11):1808-16. doi: 10.1086/428779. Epub 2005 May 2.
Cross-sectional human papillomavirus (HPV) DNA prevalence peaks at young ages, reflecting sexual acquisition and typically rapid clearance. In some populations, HPV prevalence demonstrates a second peak in older women. Longitudinal data may help to explain this second peak.
We followed a population-based cohort of 7237 women in Guanacaste, Costa Rica, in which we had previously observed a second peak in the baseline HPV prevalence in older women. We tested for >40 HPV types by polymerase chain reaction. We analyzed age-specific patterns of acquisition and persistence 5-7 years after enrollment for individual HPV types.
At enrollment and follow-up, cross-sectional data revealed U-shaped age-specific HPV prevalence curves for virtually every type, with higher prevalences in the younger and older women than in the middle-aged women. Prospectively, acquisition of types decreased significantly as women aged (PTrend<.05, for both), with the highest peak in young women and a secondary minor peak in older women. Type-specific persistence of HPV increased with age (PTrend<.0001). Overall, HPV acquisition predominated at younger ages, whereas persistent infections gradually became more prominent with age (PTrend<.0001).
Newly apparent infections decreased, whereas persistence increased, with age; this latter tendency supports the utility of HPV screening in older women.
人乳头瘤病毒(HPV)DNA的横断面流行率在年轻时达到峰值,反映了性传播感染以及通常较快的清除率。在一些人群中,HPV流行率在老年女性中出现第二个峰值。纵向数据可能有助于解释这第二个峰值。
我们对哥斯达黎加瓜纳卡斯特省的7237名女性进行了基于人群的队列研究,我们之前在该队列中观察到老年女性的基线HPV流行率出现第二个峰值。我们通过聚合酶链反应检测了40多种HPV类型。我们分析了入组后5 - 7年个体HPV类型的年龄特异性感染和持续感染模式。
在入组和随访时,横断面数据显示几乎每种类型的HPV流行率都呈U形年龄特异性曲线,年轻女性和老年女性的流行率高于中年女性。前瞻性地,随着女性年龄增长,感染类型显著减少(两者的P趋势均<0.05),年轻女性感染率最高,老年女性有一个次要的感染小高峰。HPV的类型特异性持续感染随年龄增加(P趋势<0.0001)。总体而言,HPV感染在年轻时占主导,而持续感染随年龄增长逐渐变得更加突出(P趋势<0.0001)。
随着年龄增长,新出现的感染减少,而持续感染增加;后一种趋势支持对老年女性进行HPV筛查的实用性。