Clifford Gary M, Tully Stephen, Franceschi Silvia
International Agency for Research on Cancer, Lyon, France.
Clin Infect Dis. 2017 May 1;64(9):1228-1235. doi: 10.1093/cid/cix135.
Data on the relative carcinogenic potential of human papillomavirus (HPV) types among women infected with human immunodeficiency virus (HIV) (WHIV) are needed to inform prevention programs for this population.
A systematic literature review and meta-analysis of high-risk HPV-type distribution in 19883 HIV-positive women was performed. The women, from 86 studies worldwide, included 11739 with normal cytological findings; 1784 with atypical squamous cells of undetermined significance (ASCUS); 2173 with low-grade and 1282 with high-grade squamous intraepithelial lesions (HSILs) diagnosed cytologically; 1198 with cervical intraepithelial neoplasia grade 1 (CIN1), 456 with CIN2, and 455 with CIN3 diagnosed histologically; and 796 with invasive cervical cancers (ICCs). A large proportion of WHIV, and almost all with ICCs, were from Africa.
In Africa, HPV 16 accounted for 13% of HPV-positive WHIV with normal cytological findings, but this proportion increased through ASCUS, low-grade squamous intraepithelial lesions, CIN1, and CIN2 (18%-25%), up to 41%-47% for CIN3 and ICCs. Only HPV 16, HPV 18, and HPV 45 accounted for a greater proportion of HPV infections in ICCs compared with normal cytological findings (ICC:normal ratios, 3.68, 2.47, and 2.55, respectively). Other high-risk types accounted for important proportions of low- and/or high-grade lesions, but their contribution dropped in ICCs, with ICC:normal ratios in Africa ranging from 0.79 for HPV 33 down to 0.38 for HPV 56. Findings for HPV 16 and HPV 18 in Europe/North America, Asia, and Latin America were compatible with those from Africa.
HPV 16 and HPV 18 in particular, but also HPV 45, at least in Africa, warrant special attention in WHIV. Broad consistency of findings with those in HIV-uninfected population would suggest that the risk stratification offered by partial HPV genotyping tests also have relevance for HIV-positive women.
需要了解感染人类免疫缺陷病毒（HIV）的女性（WHIV）中人类乳头瘤病毒（HPV）各型的相对致癌潜力数据，以为该人群的预防计划提供参考。
对19883名HIV阳性女性的高危HPV型分布进行了系统的文献综述和荟萃分析。这些女性来自全球86项研究，包括11739名细胞学检查结果正常者；1784名意义不明确的非典型鳞状细胞（ASCUS）患者；2173名细胞学诊断为低级别鳞状上皮内病变者和1282名高级别鳞状上皮内病变（HSIL）患者；1198名组织学诊断为宫颈上皮内瘤变1级（CIN1）者、456名CIN2患者和455名CIN3患者；以及796名浸润性宫颈癌（ICC）患者。很大一部分WHIV患者，几乎所有ICC患者都来自非洲。
在非洲，HPV 16在细胞学检查结果正常的HPV阳性WHIV中占13%，但这一比例在ASCUS、低级别鳞状上皮内病变、CIN1和CIN2中逐渐增加（18%-25%），在CIN3和ICC中高达41%-47%。与细胞学检查结果正常相比，只有HPV 16、HPV 18和HPV 45在ICC中的HPV感染比例更高（ICC:正常比例分别为3.68、2.47和2.55）。其他高危型在低级别和/或高级别病变中占重要比例，但在ICC中的贡献下降，在非洲，ICC:正常比例从HPV 33的0.79到HPV 56的0.38不等。欧洲/北美、亚洲和拉丁美洲的HPV 16和HPV 18的研究结果与非洲的结果一致。
尤其是HPV 16和HPV 18，但至少在非洲，HPV 45在WHIV中值得特别关注。研究结果与未感染HIV人群的研究结果广泛一致，这表明部分HPV基因分型检测提供的风险分层对HIV阳性女性也有意义。
