Bosch F Xavier, Burchell Ann N, Schiffman Mark, Giuliano Anna R, de Sanjose Silvia, Bruni Laia, Tortolero-Luna Guillermo, Kjaer Susanne Kruger, Muñoz Nubia
Cancer Epidemiology Research Program (CERP), Institut Català d'Oncologia - Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Spain.
Vaccine. 2008 Aug 19;26 Suppl 10:K1-16. doi: 10.1016/j.vaccine.2008.05.064.
Worldwide human papillomavirus (HPV) prevalence in women with normal cytology at any given point in time is approximately 10% indicating that HPV is one of the most common sexually transmitted infections. HPV-16 is consistently the most common type and HPV-18 the second with some minor regional differences. Furthermore, across the spectrum of cervical lesions, HPV-16 is consistently the most common HPV type contributing to 50-55% of invasive cervical cancer cases strongly suggesting that this viral type has a biological advantage for transmission, persistency and transformation. The same phenomenon is observed albeit at a lower level for HPV-18 and HPV-45. Sexual behavioral patterns across age groups and populations are central to the description of the HPV circulation and of the risk of infection. The concept of group sexual behavior (in addition to individual sexual behavior) is important in exploring HPV transmission and has implications for defining and monitoring HPV and cancer prevention strategies. In natural history studies, the pattern of HPV DNA prevalence by age groups is similar to the patterns of HPV incidence. Rates of exposure in young women are high and often include multiple types. There is a spontaneous and rapid decrease of the HPV DNA detection rates in the middle-age groups followed by a second rise in the post-menopausal years. This article reviews: 1) the evidence in relation to the burden of HPV infections in the world and the contributions of each HPV type to the spectrum of cervical cellular changes spanning from normal cytology to invasive cervical cancer; 2) the critical role of the patterns of sexual behavior in the populations; and 3) selected aspects of the technical and methodological complexity of natural history studies of HPV and cervical neoplasia.
在任何给定时间点，细胞学正常的女性中全球人乳头瘤病毒（HPV）感染率约为10%，这表明HPV是最常见的性传播感染之一。HPV - 16始终是最常见的类型，HPV - 18次之，存在一些细微的地区差异。此外，在整个宫颈病变范围内，HPV - 16始终是最常见的HPV类型，占浸润性宫颈癌病例的50 - 55%，这强烈表明该病毒类型在传播、持续性和转化方面具有生物学优势。HPV - 18和HPV - 45也观察到同样的现象，尽管程度较低。不同年龄组和人群的性行为模式对于描述HPV的传播和感染风险至关重要。群体性行为概念（除个体性行为外）在探索HPV传播方面很重要，对定义和监测HPV及癌症预防策略具有重要意义。在自然史研究中，按年龄组划分的HPV DNA感染率模式与HPV发病率模式相似。年轻女性的暴露率很高，且通常包括多种类型。中年组HPV DNA检测率会自发快速下降，随后在绝经后 years又会再次上升。本文综述了：1）关于全球HPV感染负担的证据以及每种HPV类型对从正常细胞学至浸润性宫颈癌的宫颈细胞变化范围的贡献；2）人群中性行为模式的关键作用；3）HPV和宫颈肿瘤自然史研究在技术和方法复杂性方面的选定方面。
