Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Gynecol Oncol. 2013 Dec;131(3):661-6. doi: 10.1016/j.ygyno.2013.09.002. Epub 2013 Sep 13.
Women with early cervical cancer or intraepithelial neoplasia grades 2 and 3 (CIN2+) are treated by conization; however, they still have a higher risk for subsequent CIN2+ than the general female population. Persistence of high-risk (HR) human papillomavirus (HPV) is a key factor in the development of CIN2+. We investigated persistence and reappearance of type-specific HR HPV infection after conization and evaluated possible co-factors.
During 2002-2006, cervical swabs from 604 women were collected before conization, at 4-6 months and at 8-12 months after conization. HPV was detected by HC2 and genotyped by LiPAv2. Information on co-factors was collected through a questionnaire. Associations were assessed by multivariate logistic regression analysis.
HR HPV persistence rate was 9.5%. The α5/6 species were more likely to persist than α9 species (OR, 2.28; 95% CI, 1.11-4.70). For single infections, a doubling in viral load at enrolment increased the risk for persistence by 36% (95% CI, 1.13-1.63). In addition, margin status was associated with risk of persistence. Smoking, oral contraceptive use and severity of the cervical lesion did not significantly affect persistence. Among the HPV infections that had cleared, 2.2% reappeared.
Our study indicates that viral load is important in predicting HPV persistence. The α5/6 species were most likely to persist. However, most of these HPV types have a lower carcinogenic potential than the α7/α9 species and may be by-standers. Further studies are needed to assess whether pre-conization viral load can also predict subsequent CIN2+.
患有早期宫颈癌或上皮内瘤变 2 级和 3 级（CIN2+）的女性接受锥形切除术治疗；然而，她们发生后续 CIN2+的风险仍高于普通女性人群。高危型（HR）人乳头瘤病毒（HPV）的持续存在是 CIN2+发展的关键因素。我们调查了锥形切除术后 HR HPV 感染的持续性和再现性，并评估了可能的共同因素。
2002-2006 年期间，在锥形切除术前、术后 4-6 个月和 8-12 个月时，从 604 名女性的宫颈拭子中采集 HPV。采用 HC2 检测 HPV，并采用 LiPAv2 进行基因分型。通过问卷调查收集共同因素信息。采用多变量逻辑回归分析评估关联。
HR HPV 持续感染率为 9.5%。α5/6 种比α9 种更易持续存在（OR，2.28；95%CI，1.11-4.70）。对于单一感染，登记时病毒载量增加一倍，持续性风险增加 36%（95%CI，1.13-1.63）。此外，边缘状态与持续性风险相关。吸烟、口服避孕药使用和宫颈病变严重程度对持续性没有显著影响。在已清除的 HPV 感染中，有 2.2%再次出现。
我们的研究表明，病毒载量对预测 HPV 持续性很重要。α5/6 种最有可能持续存在。然而，这些 HPV 类型中的大多数比α7/α9 种具有较低的致癌潜能，可能只是旁观者。需要进一步研究来评估锥形切除术前病毒载量是否也可以预测随后的 CIN2+。
