Menon Sonia, Wusiman Aibibula, Boily Marie Claude, Kariisa Mbabazi, Mabeya Hillary, Luchters Stanley, Forland Frode, Rossi Rodolfo, Callens Steven, Vanden Broeck Davy
International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.
CDC Foundation, Atlanta, GA, United States of America.
PLoS One. 2016 Oct 20;11(10):e0163965. doi: 10.1371/journal.pone.0163965. eCollection 2016.
There is a scarcity of data on the distribution of human papillomavirus (HPV) genotypes in the HIV positive population and in invasive cervical cancer (ICC) in Kenya. This may be different from genotypes found in abnormal cytology. Yet, with the advent of preventive HPV vaccines that target HPV 16 and 18, and the nonavalent vaccine targeting 90% of all ICC cases, such HPV genotype distribution data are indispensable for predicting the impact of vaccination and HPV screening on prevention. Even with a successful vaccination program, vaccinated women will still require screening to detect those who will develop ICC from other High risk (HR) HPV genotypes not prevented by current vaccines. The aim of this review is to report on the prevalence of pHR/HR HPV types and multiple pHR/HR HPV genotypes in Kenya among HIV positive women with normal, abnormal cytology and ICC.
PUBMED, EMBASE, SCOPUS, and PROQUEST were searched for articles on HPV infection up to August 2nd 2016. Search terms were HIV, HPV, Cervical Cancer, Incidence or Prevalence, and Kenya.
The 13 studies included yielded a total of 2116 HIV-infected women, of which 89 had ICC. The overall prevalence of pHR/HR HPV genotypes among HIV-infected women was 64% (95%CI: 50%-77%). There was a borderline significant difference in the prevalence of pHR/HR HPV genotypes between Female Sex workers (FSW) compared to non-FSW in women with both normal and abnormal cytology. Multiple pHR/HR HPV genotypes were highly prominent in both normal cytology/HSIL and ICC. The most prevalent HR HPV genotypes in women with abnormal cytology were HPV 16 with 26%, (95%CI: 23.0%-30.0%) followed by HPV 35 and 52, with 21% (95%CI: 18%-25%) and 18% (95%CI: 15%-21%), respectively. In women with ICC, the most prevalent HPV genotypes were HPV 16 (37%; 95%CI: 28%-47%) and HPV 18 (24%; 95%CI: 16%-33%).
HPV 16/18 gains prominence as the severity of cervical disease increases, with HPV 16/18 accounting for 61% (95%CI: 50.0%-70.0%) of all ICC cases. A secondary prevention program will be necessary as this population harbors multiple pHR/HR HPV co-infections, which may not be covered by current vaccines. A triage based on FSW as an indicator may be warranted.
关于肯尼亚艾滋病毒阳性人群以及浸润性宫颈癌（ICC）中人乳头瘤病毒（HPV）基因型分布的数据匮乏。这可能与在异常细胞学检查中发现的基因型有所不同。然而，随着针对HPV 16和18型的预防性HPV疫苗以及针对90%的ICC病例的九价疫苗的出现，此类HPV基因型分布数据对于预测疫苗接种和HPV筛查在预防方面的影响不可或缺。即使有成功的疫苗接种计划，接种疫苗的女性仍需进行筛查，以检测那些会因当前疫苗无法预防的其他高危（HR）HPV基因型而发展为ICC的人。本综述的目的是报告肯尼亚艾滋病毒阳性且细胞学检查正常、异常以及患有ICC的女性中pHR/HR HPV类型和多种pHR/HR HPV基因型的患病率。
检索了PUBMED、EMBASE、SCOPUS和PROQUEST截至2016年8月2日关于HPV感染的文章。检索词为艾滋病毒、HPV、宫颈癌、发病率或患病率以及肯尼亚。
纳入的13项研究共涉及2116名艾滋病毒感染女性，其中89人患有ICC。艾滋病毒感染女性中pHR/HR HPV基因型的总体患病率为64%（95%置信区间：50%-77%）。在细胞学检查正常和异常的女性中，女性性工作者（FSW）与非FSW相比，pHR/HR HPV基因型的患病率存在临界显著差异。多种pHR/HR HPV基因型在细胞学检查正常/HSIL和ICC中都非常突出。细胞学检查异常的女性中最常见的HR HPV基因型是HPV 16，占26%（95%置信区间：23.0%-30.0%），其次是HPV 35和52，分别占21%（95%置信区间：18%-25%）和18%（95%置信区间：15%-21%）。在患有ICC的女性中，最常见的HPV基因型是HPV 16（37%；95%置信区间：28%-47%）和HPV 18（24%；95%置信区间：16%-33%）。
随着宫颈疾病严重程度的增加，HPV 16/18型愈发突出，HPV 16/18型占所有ICC病例的61%（95%置信区间：50.0%-70.0%）。由于该人群存在多种pHR/HR HPV合并感染，而当前疫苗可能无法覆盖，因此有必要开展二级预防计划。基于FSW作为指标进行分类可能是有必要的。
