Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami, Miller School of Medicine, Miami, FL 33129, USA.
Gynecol Oncol. 2010 Mar;116(3):572-7. doi: 10.1016/j.ygyno.2009.10.058. Epub 2009 Nov 10.
To review and summarize evidence from clinical, translational and epidemiologic studies which have examined the clinically relevant aspects of HPV type prevalence and cervical dysplasia in HIV-infected women.
Relevant studies were identified through a MEDLINE search. References of identified reports were also used to identify additional published articles for review.
HIV-infected women in different geographic regions (such as Zambia, Brazil, Rochester NY) appear to be infected with less prevalent types of HR-HPV as compared to the general population who, across all continents, are more commonly infected with types 16 and 18. Secondly, integration of HPV DNA into the host genome is no longer thought to be a necessary cause of malignant transformation of cervical cells. However, rate of integration appears to differ by the type of HPV. In fact, the types of HPV which appear to be more common in cervical dysplasia of HIV-infected women are the same types which are more likely to require integration for malignant transformation. Finally, HPV types found in HIV-infected women are relatively common and likely to persist. The most common among these types belong to the alpha-9 and -7 species which are the most carcinogenic species.
Given that current vaccines target HR-HPV-16/18, the findings from the above mentioned studies may have important implications for the design of HPV vaccines that target the types of HPV associated with disease risk in HIV-infected women. HPV typing and assessment of the physical state (whether it is integrated or episomal) appear to be two valuable parameters for the prognostic evaluation of dysplastic lesions of the uterine cervix. This, however, has not yet been assessed in HIV-infected women. Recent data about the immune response in HPV/HIV co-infection may lead to understanding potential mechanisms for less virulent HPV causing malignant transformation in HIV-infected women.
综述临床、转化和流行病学研究中的证据，这些研究检查了 HIV 感染女性中 HPV 型别流行和宫颈发育不良的临床相关方面。
通过 MEDLINE 搜索确定相关研究。还利用已确定报告的参考文献来确定其他已发表的文章进行综述。
来自不同地理区域（如赞比亚、巴西、纽约罗切斯特）的 HIV 感染女性似乎感染的 HR-HPV 型别较少，而在所有大陆，普通人群中更常见的是 16 和 18 型。其次，HPV DNA 整合到宿主基因组中不再被认为是宫颈细胞恶性转化的必要原因。然而，整合率似乎因 HPV 类型而异。事实上，在 HIV 感染女性的宫颈发育不良中似乎更常见的 HPV 类型与需要整合才能发生恶性转化的类型相同。最后，在 HIV 感染女性中发现的 HPV 类型相对常见且可能持续存在。其中最常见的类型属于 alpha-9 和 -7 种，它们是最具致癌性的种。
鉴于目前的疫苗针对 HR-HPV-16/18，上述研究的结果可能对针对与 HIV 感染女性疾病风险相关的 HPV 类型设计 HPV 疫苗具有重要意义。HPV 分型和评估物理状态（是否整合或游离）似乎是对宫颈发育不良病变进行预后评估的两个有价值的参数。然而，这尚未在 HIV 感染女性中进行评估。最近关于 HPV/HIV 合并感染免疫反应的研究数据可能有助于了解 HIV 感染女性中低毒力 HPV 导致恶性转化的潜在机制。
