International Agency for Research on Cancer, Lyon, France.
Int J Cancer. 2013 Sep 15;133(6):1441-6. doi: 10.1002/ijc.28131. Epub 2013 Mar 16.
HIV-positive women are infected with human papillomavirus (HPV) (especially with multiple types), and develop cervical intraepithelial neoplasia (CIN) and cervical cancer more frequently than HIV-negative women. We compared HPV DNA prevalence obtained using a GP5+/6+ PCR assay in cervical exfoliated cells to that in biopsies among 468 HIV-positive women from Nairobi, Kenya. HPV prevalence was higher in cells than biopsies and the difference was greatest in 94 women with a combination normal cytology/normal biopsy (prevalence ratio, PR = 3.7; 95% confidence interval, CI: 2.4-5.7). PR diminished with the increase in lesion severity (PR in 58 women with high-grade squamous intraepithelial lesions (HSIL)/CIN2-3 = 1.1; 95% CI: 1.0-1.2). When HPV-positive, cells contained 2.0- to 4.6-fold more multiple infections than biopsies. Complete or partial agreement between cells and biopsies in the detection of individual HPV types was found in 91% of double HPV-positive pairs. The attribution of CIN2/3 to HPV16 and/or 18 would decrease from 37.6%, when the presence of these types in either cells or biopsies was counted, to 20.2% when it was based on the presence of HPV16 and/or 18 (and no other types) in biopsies. In conclusion, testing HPV on biopsies instead of cells results in decreased detection but not elimination of multiple infections in HIV-positive women. The proportion of CIN2/3 attributable to HPV16 and/or 18 among HIV-positive women, which already appeared to be lower than that in HIV-negative, would then further decrease. The meaning of HPV detection in cells and random biopsy from HIV-positive women with no cervical abnormalities remains unclear.
HIV 阳性妇女感染人乳头瘤病毒（HPV）（尤其是多种类型）的频率高于 HIV 阴性妇女，因此更容易发展为宫颈上皮内瘤变（CIN）和宫颈癌。我们比较了肯尼亚内罗毕 468 名 HIV 阳性妇女宫颈脱落细胞中 GP5+/6+PCR 检测到的 HPV DNA 流行率与活检中的流行率。与活检相比，细胞中的 HPV 流行率更高，在细胞学正常/活检正常的 94 名妇女中差异最大（流行率比，PR=3.7；95%置信区间，CI：2.4-5.7）。随着病变严重程度的增加，PR 降低（58 名高级别鳞状上皮内病变/ CIN2-3 妇女的 PR=1.1；95%CI：1.0-1.2）。当 HPV 阳性时，细胞中包含的多重感染是活检的 2.0-4.6 倍。在双 HPV 阳性样本中，91%的样本中细胞和活检在检测单个 HPV 类型方面完全或部分一致。如果将这些类型在细胞或活检中的存在均计为 HPV16 和/或 18 型的存在，则将 CIN2/3 归因于 HPV16 和/或 18 型的比例将从 37.6%（当细胞或活检中存在这些类型时）降低至 20.2%（当活检中存在 HPV16 和/或 18 型（且不存在其他类型）时）。总之，在 HIV 阳性妇女中，用活检代替细胞检测 HPV 会降低多重感染的检出率，但不会消除多重感染。HIV 阳性妇女中 CIN2/3 归因于 HPV16 和/或 18 的比例已经低于 HIV 阴性妇女，这一比例还会进一步降低。对于无宫颈异常的 HIV 阳性妇女，细胞和随机活检中 HPV 检测的意义仍不清楚。
