Vielot Nadja, Hudgens Michael G, Mugo Nelly, Chitwa Michael, Kimani Joshua, Smith Jennifer
From the Departments of *Epidemiology and †Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya; and §Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
Sex Transm Dis. 2015 Jun;42(6):305-11. doi: 10.1097/OLQ.0000000000000287.
Little is known about risk factors for persistent high-risk human papillomavirus (hrHPV) infection in low-income settings, and prior research has not quantified the relative duration of hrHPV infections stratified by risk factors. We compared the duration of hrHPV infection among female sex workers (FSWs) by exposure to sexually transmitted infections (STIs), using a highly sensitive biomarker assay.
From 2009 to 2011, 350 FSWs enrolled in this longitudinal study. Every 3 months, sociodemographic and sexual behavior data were collected via questionnaire, and APTIMA assays were used to detect the rRNA of Chlamydia trachomatis (CT), Neisseria gonorrhea, Trichomonas vaginalis, Mycoplasma genitalium, and messenger RNA of the E6/E7 oncoproteins expressed by hrHPV. Among 173 FSW who were infected with hrHPV during the observation period, accelerated failure time models estimated time ratios (TRs) for duration of hrHPV infection, comparing FSW infected with STIs at baseline to STI-uninfected FSWs.
Median follow-up time was 26.2 months (interquartile range, 18.8-27.5 months). The median duration of hrHPV infection among all FSWs was 9.3 months (95% confidence interval [CI], 9.3-11.5). The duration of hrHPV infection among FSW infected with CT at baseline was greater than that among FSWs who were uninfected (adjusted TR, 1.7; 95% CI, 1.2-2.6). Among FSWs who were coinfected with hrHPV and CT at baseline, the adjusted TR was 3.4 (95% CI, 2.5-5.4) compared with FSWs infected with hrHPV only. No other STI was associated with hrHPV duration.
Recent or concurrent CT infection was associated with prolonged hrHPV infection among a cohort of Nairobi FSWs. Management of CT could reduce risk for hrHPV persistence.
在低收入环境中，人们对持续性高危型人乳头瘤病毒（hrHPV）感染的风险因素知之甚少，而且先前的研究尚未对按风险因素分层的hrHPV感染相对持续时间进行量化。我们使用一种高度敏感的生物标志物检测方法，比较了女性性工作者（FSW）中因接触性传播感染（STI）而导致的hrHPV感染持续时间。
2009年至2011年，350名FSW参与了这项纵向研究。每3个月通过问卷调查收集社会人口统计学和性行为数据，并使用APTIMA检测法检测沙眼衣原体（CT）、淋病奈瑟菌、阴道毛滴虫、生殖支原体的rRNA以及hrHPV表达的E6/E7癌蛋白的信使RNA。在173名在观察期内感染hrHPV的FSW中，加速失效时间模型估计了hrHPV感染持续时间的时间比（TR），将基线时感染STI的FSW与未感染STI的FSW进行比较。
中位随访时间为26.2个月（四分位间距，18.8 - 27.5个月）。所有FSW中hrHPV感染的中位持续时间为9.3个月（95%置信区间[CI]，9.3 - 11.5）。基线时感染CT的FSW中hrHPV感染持续时间长于未感染的FSW（调整后的TR，1.7；95%CI，1.2 - 2.6）。基线时hrHPV和CT合并感染的FSW与仅感染hrHPV的FSW相比，调整后的TR为3.4（95%CI，2.5 - 5.4）。没有其他STI与hrHPV持续时间相关。
在内罗毕一组FSW中，近期或同时发生的CT感染与hrHPV感染时间延长有关。CT的管理可降低hrHPV持续存在的风险。
