Plummer Martyn, Schiffman Mark, Castle Philip E, Maucort-Boulch Delphine, Wheeler Cosette M
International Agency for Research on Cancer, Lyon, France.
J Infect Dis. 2007 Jun 1;195(11):1582-9. doi: 10.1086/516784. Epub 2007 Apr 16.
Cervical cancer is caused by persistent infection with human papillomavirus (HPV). Most infections and associated lesions clear spontaneously. It is important to define the determinants and timing of clearance, so that viral persistence can be recognized and managed.
We investigated HPV natural history among 4504 subjects from ALTS (Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study). A discrete-time Markov model was used to simultaneously describe the prevalence, incidence, and persistence of type-specific HPV infection over 24 months in women with equivocal or mildly abnormal cytological results. Interactions between multiple HPV types infecting the same woman were examined for incidence of new infection (after an HPV-16 infection) and persistence of a current infection within groups defined by phylogenetic relatedness or by carcinogenicity.
Ninety-one percent (95% credible interval [CI], 90%-92%) of prevalent HPV infections at enrollment cleared within 24 months. The probability that an infection would persist for a further 6 months increased with the duration of infection, from 37% (95% CI, 35%-39%) for a newly observed infection to 65% (95% CI, 61%-70%) for an infection that had already persisted for > or =18 months. No consistent evidence of interactions was found between multiple HPV types regarding the incidence of new infection after an HPV-16 infection or regarding persistence of current HPV infection.
Although virtually all HPV infections clear within 2 years, the remaining infections have a high potential for persistence and, by implication, progression to precancer and cancer. Once biological and behavioral determinants are controlled for, HPV infections with different types seem to be independent of each other.
宫颈癌是由人乳头瘤病毒（HPV）持续感染引起的。大多数感染及相关病变可自发清除。明确清除的决定因素和时间很重要，以便识别和处理病毒持续性感染。
我们在来自非典型鳞状细胞意义不明确/低级别鳞状上皮内病变分流研究（ALTS）的4504名受试者中调查了HPV自然史。采用离散时间马尔可夫模型，同时描述细胞学结果不明确或轻度异常的女性在24个月内特定类型HPV感染的患病率、发病率和持续性。在由系统发育相关性或致癌性定义的组内，检查感染同一女性的多种HPV类型之间关于新感染（HPV-16感染后）的发病率和当前感染持续性的相互作用。
入组时91%（95%可信区间[CI]，90%-92%）的HPV现患感染在24个月内清除。感染再持续6个月的概率随感染持续时间增加，从新发现感染的37%（95%CI，35%-39%）增加到已持续≥18个月感染的65%（95%CI，61%-70%）。未发现多种HPV类型在HPV-16感染后新感染的发病率或当前HPV感染的持续性方面存在一致的相互作用证据。
虽然几乎所有HPV感染在2年内清除，但其余感染有很高的持续可能性，进而可能发展为癌前病变和癌症。一旦控制了生物学和行为决定因素，不同类型的HPV感染似乎相互独立。
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