坦桑尼亚 HIV 阴性和阳性妇女中高危型人乳头瘤病毒检测的危险因素。

Risk factors for high-risk human papillomavirus detection among HIV-negative and HIV-positive women from Tanzania.

机构信息

Department of International Health, Public Health Institute, University of Copenhagen, Copenhagen, Denmark.

出版信息

Sex Transm Dis. 2013 Sep;40(9):737-43. doi: 10.1097/OLQ.0000000000000005.

DOI:10.1097/OLQ.0000000000000005

PMID:23949589

Abstract

BACKGROUND

Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. The prevalence is dependent on several known factors notably sexual behavior and age, and factors still under scrutiny.

OBJECTIVE

This study aimed to examine risk factors for high-risk (HR) HPV infection among HIV-positive and HIV-negative women from the general population of Tanzania and to assess whether specific risk factors could contribute to the high prevalence of HR HPV infection in older age found in some populations including Tanzanian women.

METHODS

A cross-sectional study of 3699 women from Tanzania was conducted. We obtained information on sociodemographic and lifestyle factors through personal interview. Cervical swabs were collected for detection of HR HPV (Hybrid Capture 2; Qiagen, Hildesheim, Germany) and genotyping (LiPaExtra; Innogenetics, Gent, Belgium). Finally, we obtained a blood sample for HIV testing.

RESULTS

HIV positivity was the strongest risk factor for HR HPV (odds ratio, 4.1; 95% confidence interval, 3.3-5.3). Young age, shorter duration of present relationship, and increasing number of sex partners were also associated with higher risk for HR HPV. Among women 20 to 29 years old, especially number of partners (P = 0.005) and HIV positivity (P < 0.0001) determined the risk. In underweight women 50 years or older (P = 0.004) and HIV positivity (P = 0.0009) increased the risk, whereas increasing number of partners was not related to the risk of HR HPV (P = 0.46).

CONCLUSIONS

Human papillomavirus risk factors among HIV-positive and HIV-negative women were similar, but the strength of association was greater among HIV-positive women, notably for lifetime number of sex partners, time in present relationship, genital warts, and body mass index. We were not able to identify a clear explanation for the high HPV prevalence among older women. However, in the age-stratified analysis, potential indicators of decreased immunity increased the risk for HPV infection among older women, whereas in younger women, risk was particularly associated with sexual activity.

摘要

背景

人乳头瘤病毒（HPV）是全球最常见的性传播感染之一。其流行率取决于一些已知因素，特别是性行为和年龄，以及一些仍在研究中的因素。

目的

本研究旨在检查坦桑尼亚普通人群中 HIV 阳性和 HIV 阴性妇女感染高危型（HR）HPV 的危险因素，并评估特定危险因素是否会导致包括坦桑尼亚妇女在内的一些人群中发现的老年 HR HPV 感染的高流行率。

方法

对来自坦桑尼亚的 3699 名妇女进行了横断面研究。我们通过个人访谈获得了社会人口统计学和生活方式因素的信息。采集宫颈拭子用于检测 HR HPV（杂交捕获 2；Qiagen，德国黑尔德斯海姆）和基因分型（LiPaExtra；Innogenetics，比利时根特）。最后，我们采集了一份血样进行 HIV 检测。

结果

HIV 阳性是 HR HPV 的最强危险因素（比值比，4.1；95%置信区间，3.3-5.3）。年龄较小、现有伴侣关系持续时间较短以及性伴侣数量增加也与 HR HPV 的高风险相关。在 20 至 29 岁的妇女中，特别是伴侣数量（P = 0.005）和 HIV 阳性（P < 0.0001）决定了风险。在 50 岁或以上的体重不足妇女中（P = 0.004）和 HIV 阳性（P = 0.0009）增加了风险，而性伴侣数量的增加与 HR HPV 的风险无关（P = 0.46）。

结论

HIV 阳性和 HIV 阴性妇女的 HPV 危险因素相似，但 HIV 阳性妇女的关联强度更大，特别是与终身性伴侣数量、现有伴侣关系时间、生殖器疣和体重指数有关。我们无法为老年妇女 HPV 高流行率找到明确的解释。然而，在年龄分层分析中，免疫功能下降的潜在指标增加了老年妇女 HPV 感染的风险，而在年轻妇女中，风险与性行为特别相关。