Hernández-Girón Carlos, Smith Jennifer S, Lorincz Attila, Lazcano Eduardo, Hernández-Avila Mauricio, Salmerón Jorge
Centro de Investigaciones en Salud Poblacional, INSP, Cuernavaca, México.
Sex Transm Dis. 2005 Oct;32(10):613-8. doi: 10.1097/01.olq.0000179888.47309.db.
Significant differences in human papillomavirus (HPV) prevalence between pregnant and nonpregnant women have been reported. Some studies suggest that physiological processes during pregnancy modify the host-immune response, increasing detectability of high-risk HPV infection as a result of viral reactivation. It remains uncertain, however, whether pregnancy has an effect on HPV DNA positivity as a result of a general lack of data and based on contradictory results found in previous epidemiologic studies. We conducted an epidemiologic study to identify differences in the prevalence of HPV infection between pregnant and nonpregnant women in Mexico. We also investigated the relationship of HPV DNA positivity with socioeconomic, gynecologic, and obstetric risk factors.
We screened pregnant and age-matched nonpregnant women for high-risk HPV infection. The study population was clients of the family medicine healthcare services of the Mexican Institute of Social Security in Cuernavaca, Morelos, Mexico. A total of 274 pregnant and 1060 nonpregnant study participants were screened for the presence of high-risk HPV DNA in self-collected specimens by the Hybrid Capture 2 test (HC2; Digene Corp., Gaithersburg, MD).
High-risk HPV DNA was detected in 37.2% (95% confidence interval [CI], 31-43%) of pregnant women and in 14.2% (95% CI, 12-16%) of nonpregnant women. Combining both groups for the multivariate analysis, pregnancy was associated with an increased risk for HPV infection (odds ratio, 3.5; CI, 2.7-4.9).
Our results are consistent with other studies reporting increased high-risk HPV detection rates among pregnant women. HPV-positive status in pregnant and nonpregnant women appears to be influenced by age. The decrease in HPV positivity by number of pregnancies in both currently pregnant and nonpregnant women is consistent with a possible effect of immune protection as a result of earlier HPV infections. Despite lack of information about a woman's history of sexual behavior, these data support the hypothesis that an alteration of immunologic responses during pregnancy may be associated with an increased risk of HPV acquisition or reactivation.
已有报道称孕妇与非孕妇之间人乳头瘤病毒（HPV）感染率存在显著差异。一些研究表明，孕期的生理过程会改变宿主免疫反应，因病毒再激活而增加高危HPV感染的可检测性。然而，由于普遍缺乏数据且基于既往流行病学研究中相互矛盾的结果，孕期是否会影响HPV DNA阳性仍不确定。我们开展了一项流行病学研究，以确定墨西哥孕妇与非孕妇之间HPV感染率的差异。我们还调查了HPV DNA阳性与社会经济、妇科和产科危险因素之间的关系。
我们对孕妇和年龄匹配的非孕妇进行了高危HPV感染筛查。研究人群为墨西哥莫雷洛斯州库埃纳瓦卡市墨西哥社会保障局家庭医学医疗服务的客户。通过杂交捕获2试验（HC2；Digene公司，马里兰州盖瑟斯堡）对274名孕妇和1060名非孕妇研究参与者的自行采集标本进行高危HPV DNA检测。
37.2%（95%置信区间[CI]，31 - 43%）的孕妇检测到高危HPV DNA，14.2%（95%CI，12 - 16%）的非孕妇检测到高危HPV DNA。将两组合并进行多变量分析，怀孕与HPV感染风险增加相关（比值比，3.5；CI，2.7 - 4.9）。
我们的结果与其他报道孕妇中高危HPV检测率增加的研究一致。孕妇和非孕妇的HPV阳性状态似乎受年龄影响。当前孕妇和非孕妇中HPV阳性率随妊娠次数的降低与早期HPV感染导致的免疫保护可能作用一致。尽管缺乏关于女性性行为史的信息，但这些数据支持以下假设：孕期免疫反应的改变可能与HPV感染或再激活风险增加有关。
