Fu Tsung-chieh Jane, Fu Xi Long, Hulbert Ayaka, Hughes James P, Feng Qinghua, Schwartz Stephen M, Hawes Stephen E, Koutsky Laura A, Winer Rachel L
Department of Epidemiology, University of Washington, Seattle, WA.
Department of Pathology, University of Washington, Seattle, WA.
Int J Cancer. 2015 Nov 15;137(10):2432-42. doi: 10.1002/ijc.29602. Epub 2015 May 29.
Characterizing short-term HPV detection patterns and viral load may inform HPV natural history in mid-adult women. From 2011-2012, we recruited women aged 30-50 years. Women submitted monthly self-collected vaginal samples for high-risk HPV DNA testing for 6 months. Positive samples were tested for type-specific HPV DNA load by real-time PCR. HPV type-adjusted linear and Poisson regression assessed factors associated with (i) viral load at initial HPV detection and (ii) repeat type-specific HPV detection. One-hundred thirty-nine women (36% of 387 women with ≥4 samples) contributed 243 type-specific HR HPV infections during the study; 54% of infections were prevalent and 46% were incident. Incident (vs. prevalent) detection and past pregnancy were associated with lower viral load, whereas current smoking was associated with higher viral load. In multivariate analysis, current smoking was associated with a 40% (95% CI: 5-87%) increase in the proportion of samples that were repeatedly positive for the same HPV type, whereas incident (vs. prevalent) detection status and past pregnancy were each associated with a reduction in the proportion of samples repeatedly positive (55%, 95% CI: 38-67% and 26%, 95% CI: 10-39%, respectively). In a separate multivariate model, each log10 increase in viral load was associated with a 10% (95% CI: 4-16%) increase in the proportion of samples repeatedly positive. Factors associated with repeat HPV detection were similar to those observed in longer-term studies, suggesting that short-term repeat detection may relate to long-term persistence. The negative associations between incident HPV detection and both viral load and repeat detection suggest that reactivation or intermittent persistence was more common than new acquisition.
对短期人乳头瘤病毒（HPV）检测模式和病毒载量进行特征分析，可能有助于了解中年女性的HPV自然史。2011年至2012年，我们招募了30至50岁的女性。这些女性每月自行采集阴道样本，进行为期6个月的高危型HPV DNA检测。对阳性样本通过实时聚合酶链反应（PCR）检测特定型别的HPV DNA载量。采用HPV型别校正的线性回归和泊松回归评估与以下因素相关的情况：（i）初次检测到HPV时的病毒载量，以及（ii）特定型别的HPV重复检测情况。139名女性（387名有≥4份样本的女性中的36%）在研究期间出现了243次特定型别的高危型HPV感染；54%的感染为持续性感染，46%为新发感染。新发感染（与持续性感染相比）及既往妊娠与较低的病毒载量相关，而当前吸烟与较高的病毒载量相关。在多变量分析中，当前吸烟与同一HPV型别样本重复阳性比例增加40%（95%置信区间：5%-87%）相关，而新发感染（与持续性感染相比）状态及既往妊娠均与样本重复阳性比例降低相关（分别为55%，95%置信区间：38%-67%；26%，95%置信区间：10%-39%）。在另一个多变量模型中，病毒载量每增加一个log10，样本重复阳性比例增加10%（95%置信区间：4%-16%）。与HPV重复检测相关的因素与长期研究中观察到的因素相似，这表明短期重复检测可能与长期持续性感染有关。新发HPV感染与病毒载量及重复检测之间的负相关表明，再激活或间歇性持续感染比新感染更为常见。
