Vriend Henrike J, Bogaards Johannes A, van Bergen Jan E A M, Brink Antoinette A T P, van den Broek Ingrid V F, Hoebe Christian J P A, King Audrey J, van der Sande Marianne A B, Wolffs Petra F G, de Melker Hester E
National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
Cancer Med. 2015 Oct;4(10):1589-98. doi: 10.1002/cam4.496. Epub 2015 Jul 21.
We assessed whether infection with chlamydia increases the incidence of carcinogenic human papillomavirus (HPV) infections and if HPV persistence is affected by chlamydia co-infection. For 1982 women (16-29 years-old) participating in two consecutive rounds of a chlamydia screening implementation trial, swabs were polymerase chain reaction tested to detect chlamydia and 14 carcinogenic HPV genotypes. HPV type-specific incidence and persistence rates were stratified for chlamydia positivity at follow-up. Associations were assessed by multilevel logistic regression analyses with correction for sexual risk factors. HPV type-specific incidence ranged from 1.4% to 8.9% and persistence from 22.7% to 59.4% after a median follow-up of 11 months (interquartile range: 11-12). Differences in 1-year HPV persistence rates between chlamydia -infected and noninfected women were less distinct than differences in HPV incidence rates (pooled adjusted odds ratios of 1.17 [95% CI: 0.69-1.96] and 1.84 [95% CI: 1.36-2.47], respectively). The effect of chlamydia co-infection on HPV-infection risk did not significantly differ by HPV genotype. In conclusion, infection with chlamydia increases the risk of infection by carcinogenic HPV types and may enhance persistence of some HPV types. Although these findings could reflect residual confounding through unobserved risk factors, our results do give reason to explore more fully the association between chlamydia and HPV type-specific acquisition and persistence.
我们评估了衣原体感染是否会增加致癌性人乳头瘤病毒(HPV)感染的发生率,以及衣原体合并感染是否会影响HPV的持续感染情况。对于参与两轮连续衣原体筛查实施试验的1982名16至29岁女性,采用聚合酶链反应检测拭子以检测衣原体和14种致癌性HPV基因型。根据随访时衣原体阳性情况对HPV型特异性发病率和持续感染率进行分层。通过多水平逻辑回归分析评估相关性,并校正性风险因素。在中位随访11个月(四分位间距:11 - 12个月)后,HPV型特异性发病率为1.4%至8.9%,持续感染率为22.7%至59.4%。衣原体感染女性与未感染女性之间1年HPV持续感染率的差异不如HPV发病率差异明显(合并调整比值比分别为1.17 [95%置信区间:0.69 - 1.96]和1.84 [95%置信区间:1.36 - 2.47])。衣原体合并感染对HPV感染风险的影响在不同HPV基因型之间无显著差异。总之,衣原体感染会增加致癌性HPV类型感染的风险,并可能增强某些HPV类型的持续感染。尽管这些发现可能反映了未观察到的风险因素导致的残余混杂,但我们的结果确实有理由更全面地探索衣原体与HPV型特异性感染及持续感染之间的关联。