Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College, London W2 1PG, UK.
Epidemics. 2010 Mar;2(1):21-8. doi: 10.1016/j.epidem.2010.02.002. Epub 2010 Feb 10.
The patterns of transmission, clearance, and progression of HPV infection and the related precancerous lesions are key to accurately model cervical cancer epidemiology and prevention. We have developed an age-structured dynamic model of the transmission of HPV-16 infection. This mathematical model accounts, for the first time, for the effect of infection and precancerous lesions duration on the natural history of HPV-16 infection and precancerous lesions. The model's output has been fitted to contemporaneous sets of data from Turin, Italy, to estimate parameters that have had been indirectly tested by comparing them with other estimates reported in the literature. The average probability of HPV-16 infection transmission per sexual partnership was about 40%. The HPV-16 clearance and progression rates decreased as the length of time with infection increased, clearance ranging between 1.6 per woman-year (in the first 6 months of infection) and 0.036 (after more than 6 years of infection), and progression between 0.072 and 0.018 per woman-year. The rate of clearance of precancerous lesions (CIN2+) was inversely dependent on age, while the progression of CIN2+ toward invasive cervical cancer increased as the precancerous lesions persisted. The present study also suggests that an exclusive role of women's age in shaping the rate of progression to cancer is unlikely. These results should inform future analyses. Including more accurately the role of the duration of infection and precancerous lesions as determinants of the cervical cancer occurrence in models of cervical cancer control may influence predictors of the effectiveness of intervention strategies.
HPV 感染及其相关癌前病变的传播、清除和进展模式是准确模拟宫颈癌流行病学和预防的关键。我们开发了一种 HPV-16 感染传播的年龄结构动态模型。该数学模型首次考虑了感染和癌前病变持续时间对 HPV-16 感染和癌前病变自然史的影响。该模型的输出结果已与意大利都灵的同期数据集相拟合，以估计参数，这些参数是通过与文献中报告的其他估计值进行比较间接测试的。每个性伴侣 HPV-16 感染的平均传播概率约为 40%。HPV-16 的清除率和进展率随着感染时间的延长而降低，清除率在女性-年 1.6（感染的前 6 个月）至 0.036（感染 6 年以上）之间，进展率在女性-年 0.072 至 0.018 之间。癌前病变（CIN2+）的清除率与年龄呈负相关，而 CIN2+向浸润性宫颈癌的进展则随着癌前病变的持续而增加。本研究还表明，癌症进展率仅由女性年龄决定的可能性不大。这些结果应该为未来的分析提供信息。在宫颈癌控制模型中，更准确地纳入感染和癌前病变持续时间作为宫颈癌发生的决定因素的作用，可能会影响干预策略有效性的预测因素。
