HPV 型别、HIV 与乌干达坎帕拉浸润性宫颈癌风险：病例对照研究。
HPV types, HIV and invasive cervical carcinoma risk in Kampala, Uganda: a case-control study.
机构信息
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden.
出版信息
Infect Agent Cancer. 2011 Jun 25;6(1):8. doi: 10.1186/1750-9378-6-8.
BACKGROUND
While the association of human papillomavirus (HPV) with cervical cancer is well established, the influence of HIV on the risk of this disease in sub-Saharan Africa remains unclear. To assess the risk of invasive cervical carcinoma (ICC) associated with HIV and HPV types, a hospital-based case-control study was performed between September 2004 and December 2006 in Kampala, Uganda. Incident cases of histologically-confirmed ICC (N=316) and control women (N=314), who were visitors or care-takers of ICC cases in the hospital, were recruited. Blood samples were obtained for HIV serology and CD4 count, as well as cervical samples for HPV testing. HPV DNA detection and genotyping was performed using the SPF10/DEIA/LiPA25 technique which detects all mucosal HPV types by DEIA and identifies 25 HPV genotypes by LiPA version 1. Samples that tested positive but could not be genotyped were designated HPVX. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by logistic regression, adjusting for possible confounding factors.
RESULTS
For both squamous cell carcinoma (SCC) and adenocarcinoma of the cervix, statistically significantly increased ORs were found among women infected with HPV, in particular single HPV infections, infections with HPV16-related types and high-risk HPV types, in particular HPV16, 18 and 45. For other HPV types the ORs for both SCC and adenocarcinoma were not statistically significantly elevated. HIV infection and CD4 count were not associated with SCC or adenocarcinoma risk in our study population. Among women infected with high-risk HPV types, no association between HIV and SCC emerged. However, an inverse association with adenocarcinoma was observed, while decrease in CD4 count was not associated with ICC risk.
CONCLUSIONS
The ORs for SCC and adenocarcinoma were increased in women infected with HPV, in particular single HPV infections, infections with HPV16- and 18-related types, and high-risk HPV types, specifically HPV16, 18 and 45. HIV infection and CD4 count were not associated with SCC or adenocarcinoma risk, but among women infected with high-risk HPV types there was an inverse association between HIV infection and adenocarcinoma risk. These results suggest that HIV and CD4 count may have no role in the progression of cervical cancer.
背景
人乳头瘤病毒（HPV）与宫颈癌的关联已得到充分证实，然而在撒哈拉以南非洲，人类免疫缺陷病毒（HIV）对这种疾病风险的影响尚不清楚。为了评估与 HIV 和 HPV 类型相关的浸润性宫颈癌（ICC）风险，在 2004 年 9 月至 2006 年 12 月期间，在乌干达坎帕拉的一家医院进行了一项基于病例的病例对照研究。招募了 316 例经组织学证实的 ICC 病例（病例组）和 314 名医院 ICC 病例的访客或护理人员作为对照妇女。采集血样进行 HIV 血清学和 CD4 计数检测，以及宫颈样本进行 HPV 检测。使用 SPF10/DEIA/LiPA25 技术检测 HPV DNA，该技术通过 DEIA 检测所有黏膜 HPV 类型，并通过 LiPA 版本 1 鉴定 25 种 HPV 基因型。检测呈阳性但无法进行基因分型的样本被指定为 HPVX。采用逻辑回归计算比值比（OR）和 95%置信区间（CI），并对可能的混杂因素进行调整。
结果
对于宫颈鳞癌（SCC）和腺癌，在 HPV 感染的女性中，发现 HPV 单一感染、HPV16 相关类型感染和高危 HPV 类型（尤其是 HPV16、18 和 45）感染与统计学显著增加的 OR 相关。对于其他 HPV 类型，SCC 和腺癌的 OR 均无统计学显著升高。在我们的研究人群中，HIV 感染和 CD4 计数与 SCC 或腺癌风险无关。在感染高危 HPV 类型的女性中，未发现 HIV 与 SCC 之间存在关联。然而，观察到与腺癌呈负相关，而 CD4 计数下降与 ICC 风险无关。
结论
在 HPV 感染的女性中，SCC 和腺癌的 OR 增加，尤其是 HPV 单一感染、HPV16 和 18 相关类型感染以及高危 HPV 类型，尤其是 HPV16、18 和 45。HIV 感染和 CD4 计数与 SCC 或腺癌风险无关，但在感染高危 HPV 类型的女性中，HIV 感染与腺癌风险呈负相关。这些结果表明，HIV 和 CD4 计数可能在宫颈癌的进展中不起作用。
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