Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Int J Cancer. 2012 Sep 15;131(6):1472-8. doi: 10.1002/ijc.27363. Epub 2012 Jan 3.
Human papillomavirus (HPV) is detected in nearly all cervical cancers and approximately half of vaginal cancers. However, vaginal cancer is an order of magnitude less common than cervical cancer, not only in the general population but also among women with HIV/AIDS. It is interesting therefore that recent studies found that HPV was common in both normal vaginal and cervical tissue, with higher prevalence of nononcogenic HPV types in the vagina. In our investigation, we prospectively examined HPV infection in 86 HIV-positive and 17 HIV-negative women who underwent hysterectomy during follow-up in a longitudinal cohort. Cervicovaginal lavage specimens were obtained semi-annually and tested for HPV DNA by polymerase chain reaction. To address possible selection biases associated with having a hysterectomy, subjects acted as their own comparison group--before versus after hysterectomy. The average HPV prevalence was higher in HIV-positive than HIV-negative women both before (59% vs. 12%; p < 0.001) and after hysterectomy (56% vs. 6%; p < 0.001). Multivariate random effects models (within-individual comparisons) demonstrated significantly lower HPV prevalence [odds ratio (OR) = 0.71; 95% confidence interval (CI) = 0.59-0.85) after hysterectomy. The association of HPV prevalence with hysterectomy was similar among HIV-positive and HIV-negative women. However, hysterectomy had greater effects on oncogenic (OR = 0.48; 95% CI = 0.35-0.66) than nononcogenic HPV types (OR = 0.89; 95% CI = 0.71-1.11; P(interaction) = 0.002). Overall, we observed greater reductions in oncogenic than nononcogenic HPV prevalence after hysterectomy. If correct, these data could suggest that oncogenic HPV have greater tropism for cervical compared to vaginal epithelium, consistent with the lower incidence of vaginal than cervical cancer.
人乳头瘤病毒（HPV）几乎存在于所有宫颈癌和大约一半的阴道癌中。然而，阴道癌的发病率比宫颈癌低一个数量级，不仅在普通人群中，而且在 HIV/AIDS 女性中也是如此。因此，最近的研究发现 HPV 在正常阴道和宫颈组织中很常见，阴道中存在更高比例的非致癌性 HPV 类型。在我们的研究中，我们前瞻性地检查了在纵向队列中接受子宫切除术的 86 名 HIV 阳性和 17 名 HIV 阴性女性的 HPV 感染情况。每半年采集宫颈阴道灌洗液标本，通过聚合酶链反应检测 HPV DNA。为了解决与子宫切除术相关的可能选择偏差，受试者作为自身对照组——在子宫切除术前和术后进行比较。HPV 阳性组的 HPV 流行率高于 HPV 阴性组，无论在子宫切除术前（59%比 12%；p<0.001）还是术后（56%比 6%；p<0.001）。多变量随机效应模型（个体内比较）显示，子宫切除术后 HPV 流行率显著降低[比值比（OR）=0.71；95%置信区间（CI）=0.59-0.85]。HPV 流行率与子宫切除术的相关性在 HIV 阳性和 HIV 阴性女性中相似。然而，子宫切除术对致癌（OR=0.48；95%CI=0.35-0.66）HPV 类型的影响大于非致癌 HPV 类型（OR=0.89；95%CI=0.71-1.11；P（交互）=0.002）。总体而言，我们观察到子宫切除术后致癌 HPV 流行率的降低大于非致癌 HPV 流行率的降低。如果这些数据是正确的，这可能表明致癌 HPV 对宫颈上皮的亲和力大于阴道上皮，这与阴道癌的发病率低于宫颈癌相一致。
