美国、博茨瓦纳和肯尼亚的浸润性宫颈癌：人乳头瘤病毒（HPV）型别分布及其对卫生政策的影响
Invasive cervical cancers in the United States, Botswana and Kenya: HPV type distribution and health policy implications.
作者信息
Ermel Aaron, Qadadri Brahim, Tong Yan, Orang'o Omenge, Macharia Benson, Ramogola-Masire Doreen, Zetola Nicola M, Brown Darron R
机构信息
Indiana University School of Medicine, Indianapolis, IN USA.
Moi University and Moi Teaching and Referral Hospital, Eldoret, Kenya.
出版信息
Infect Agent Cancer. 2016 Nov 11;11:56. doi: 10.1186/s13027-016-0102-9. eCollection 2016.
BACKGROUND
More deaths occur in African women from invasive cervical cancer (ICC) than from any other malignancy. ICC is caused by infection with oncogenic types of human papillomavirus (HPV). Co-infection with the human immunodeficiency virus (HIV) accelerates the natural history of ICC, and may influence the HPV type distribution. Because HPV vaccines are available, this malignancy is theoretically preventable, but the vaccines are largely type-specific in protection against infection. Data on specific HPV types causing ICC in African women is limited, and many studies utilized swab samples rather than actual cancer tissue. A previous study using archived, ICC tissue from women in Botswana identified an unusual HPV type distribution. A similar study was therefore performed in a second sub-Saharan country to provide additional information on the HPV type distribution in ICC.
METHODS
Archived, formalin-fixed, paraffin-embedded ICCs were acquired from women in the United States, Kenya, or Botswana. DNA was extracted and HPV genotyping performed by Roche Linear Array. HIV sequences were identified in ICCs by PCR.
RESULTS
HPV types 16 or 18 (HPV 16/18) were identified in 93.5 % of HPV-positive ICCs from the U.S., 93.8 % from Kenya, and 61.8 % from Botswana ( < 0.0001). Non-HPV 16/18 types were detected in 10.9 % of HPV-positive cancers from the U.S., 17.2 % from Kenya, and 47.8 % from Botswana ( < 0.0001). HIV was detected in 2.2, 31.5, and 32.4 % from ICCs from the U.S., Kenya, or Botswana, respectively ( = 0.0002). The distribution of HPV types was not significantly different between HIVinfected or HIV-uninfected women. The percentages of ICCs theoretically covered by the bivalent/quadrivalent HPV vaccines were 93.5, 93.9, and 61.8 % from the U.S., Kenya and Botswana, respectively, and increased to 100, 98, and 77.8 % for the nanovalent vaccine.
CONCLUSIONS
HPV 16/18 caused most ICCs from the U.S. and western Kenya. Fewer ICCs contained HPV 16/18 in Botswana. HIV co-infection did not influence the HPV type distribution in ICCs from African women from the two countries. Available HPV vaccines should provide protection against most ICCs in the U.S. and Kenya. The recently developed nanovalent vaccine may be more suitable for countries where non-HPV 16/18 types are frequently detected in ICC.
背景
在非洲女性中，因浸润性宫颈癌（ICC）导致的死亡人数超过其他任何恶性肿瘤。ICC 由致癌型人乳头瘤病毒（HPV）感染引起。人类免疫缺陷病毒（HIV）合并感染会加速 ICC 的自然病程，并可能影响 HPV 类型分布。由于有 HPV 疫苗，理论上这种恶性肿瘤是可预防的，但这些疫苗在预防感染方面大多具有型特异性。关于导致非洲女性 ICC 的特定 HPV 类型的数据有限，并且许多研究使用的是拭子样本而非实际癌组织。之前一项利用博茨瓦纳女性存档的 ICC 组织进行的研究发现了不寻常的 HPV 类型分布。因此，在撒哈拉以南的另一个国家进行了类似研究，以提供关于 ICC 中 HPV 类型分布的更多信息。
方法
从美国、肯尼亚或博茨瓦纳的女性中获取存档的、经福尔马林固定、石蜡包埋的 ICC 样本。提取 DNA 并通过罗氏线性阵列进行 HPV 基因分型。通过 PCR 在 ICC 样本中鉴定 HIV 序列。
结果
在美国 93.5%的 HPV 阳性 ICC 中、肯尼亚 93.8%的 HPV 阳性 ICC 中以及博茨瓦纳 61.8%的 HPV 阳性 ICC 中鉴定出 16 型或 18 型 HPV（HPV 16/18）（<0.0001）。在美国 10.9%的 HPV 阳性癌症、肯尼亚 17.2%的 HPV 阳性癌症以及博茨瓦纳 47.8%的 HPV 阳性癌症中检测到非 HPV 16/18 型（<0.0001）。分别在美国、肯尼亚和博茨瓦纳的 ICC 样本中检测到 2.2%、31.5%和 32.4%的 HIV（=0.0002）。HIV 感染女性和未感染女性之间 HPV 类型分布无显著差异。二价/四价 HPV 疫苗理论上覆盖的 ICC 百分比在美国、肯尼亚和博茨瓦纳分别为 93.5%、93.9%和 61.8%，九价疫苗则分别增至 100%、98%和 77.8%。
结论
HPV 16/18 导致了美国和肯尼亚西部的大多数 ICC。在博茨瓦纳，含有 HPV 16/18 的 ICC 较少。HIV 合并感染并未影响来自这两个国家的非洲女性 ICC 中的 HPV 类型分布。现有的 HPV 疫苗应为美国和肯尼亚的大多数 ICC 提供保护。最近研发的九价疫苗可能更适用于在 ICC 中频繁检测到非 HPV 16/18 型的国家。
Zotero 插件