Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Int J Cancer. 2011 Jun 15;128(12):2962-70. doi: 10.1002/ijc.25628. Epub 2010 Oct 26.
Women diagnosed with cervical cancer report longer duration and more recent use of combined oral contraceptives (COCs). It is unclear whether COC use is associated with upstream events of human papillomavirus (HPV) infection prior to development of clinical disease. The objective of our study was to assess the association of contraceptive use on the risk for prevalent HPV infection in a cohort of long-term hormonal contraceptive (HC) users. One thousand and seventy (n = 1,070) HIV-negative women aged 20-37 from Thailand enrolled in a prospective study of the natural history of HPV. Baseline HPV genotype information, recency and duration of HC use, sexual behavior, other sexually transmitted infection (STI) information and cervical cytology and histology were assessed. At enrollment, 19.8% and 11.5% of women were infected with any HPV or any high-risk (HR)-HPV, respectively. After adjustment for age, current and past sexual risk behaviors, STI history and cytology, the use of COCs for >6 years was found to be associated with an increased risk of infection with any HPV [prevalence ratio (PR): 1.88 (1.21, 2.90)] and any HR-HPV [PR: 2.68 (1.47, 4.88)] as compared to never users. Recent, long-term COC use was associated with an increased risk for prevalent HPV infection independent of sexual behavior and cervical abnormalities. No similar association was observed for recent or long duration use of progestin-only contraceptives (i.e., depomedroxyprogesterone acetate). These data suggest that COC use may impact early upstream events in the natural history of HPV infection.
被诊断患有宫颈癌的女性报告说，她们使用复方口服避孕药（COC）的时间更长、更频繁。目前尚不清楚 COC 的使用是否与人类乳头瘤病毒（HPV）感染的上游事件有关，而这些事件发生在临床疾病出现之前。我们的研究目的是评估在长期使用激素避孕药（HC）的队列中，避孕方法的使用与现患 HPV 感染风险之间的关系。本研究共纳入了 1070 名年龄在 20-37 岁之间、HIV 阴性的泰国女性，她们参加了一项 HPV 自然史的前瞻性研究。在研究开始时，评估了 HPV 基因型信息、HC 使用的最近和持续时间、性行为、其他性传播感染（STI）信息以及宫颈细胞学和组织学。研究结果显示，在研究开始时，分别有 19.8%和 11.5%的女性感染了任何 HPV 或任何高危型（HR）-HPV。在调整年龄、当前和过去的性行为风险、STI 病史和细胞学后，与从未使用过 COC 的女性相比，COC 使用>6 年与感染任何 HPV（比值比 [PR]：1.88（1.21，2.90））和任何 HR-HPV（PR：2.68（1.47，4.88））的风险增加相关。近期长期使用 COC 与现患 HPV 感染风险增加有关，与性行为和宫颈异常无关。而近期或长期使用孕激素避孕药（即去甲孕二烯酮）与现患 HPV 感染之间则没有观察到类似的相关性。这些数据表明，COC 的使用可能会影响 HPV 感染自然史中的上游早期事件。
