Pennsylvania State University Hershey Medical Center, Hershey, PA, United States.
Medical University of South Carolina, Charleston, SC, United States.
Adv Clin Chem. 2017;81:135-192. doi: 10.1016/bs.acc.2017.01.004. Epub 2017 Mar 18.
Human papillomavirus (HPV) was found to be the causative agent for cervical cancer in the 1980s with almost 100% of cervical cancer cases testing positive for HPV. Since then, many studies have been conducted to elucidate the molecular basis of HPV, the mechanisms of carcinogenesis of the virus, and the risk factors for HPV infection. Traditionally, the Papanicolaou test was the primary screening method for cervical cancer. Because of the discovery and evolving understanding of the role of HPV in cervical dysplasia, HPV testing has been recommended as a new method for cervical cancer screening by major professional organizations including the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology. In order to detect HPV infections, many sensitive and specific HPV assays have been developed and used clinically. Different HPV assays with various principles have shown their unique advantages and limitations. In response to a clear causative relationship between high-risk HPV and cervical cancer, HPV vaccines have been developed which utilize virus-like particles to create an antibody response for the prevention of HPV infection. The vaccines have been shown in long-term follow-up studies to be effective for up to 8 years; however, how this may impact screening for vaccinated women remains uncertain. In this chapter, we will review the molecular basis of HPV, its pathogenesis, and the epidemiology of HPV infection and associated cervical cancer, discuss the methods of currently available HPV testing assays as well as recent guidelines for HPV screening, and introduce HPV vaccines as well as their impact on cervical cancer screening and treatments.
人乳头瘤病毒（HPV）在 20 世纪 80 年代被发现是宫颈癌的致病因素，几乎所有宫颈癌病例的 HPV 检测结果均呈阳性。自那时以来，已经进行了许多研究来阐明 HPV 的分子基础、病毒致癌机制以及 HPV 感染的危险因素。传统上，巴氏涂片检查是宫颈癌的主要筛查方法。由于发现并不断了解 HPV 在宫颈发育不良中的作用，美国癌症协会、美国阴道镜和宫颈病理学会以及美国临床病理学会等主要专业组织建议将 HPV 检测作为宫颈癌筛查的新方法。为了检测 HPV 感染，已经开发并在临床上使用了许多敏感和特异的 HPV 检测方法。不同的 HPV 检测方法具有不同的原理，各有其独特的优势和局限性。针对高危型 HPV 与宫颈癌之间明确的因果关系，已经开发出 HPV 疫苗，利用病毒样颗粒产生抗体反应，预防 HPV 感染。长期随访研究表明，疫苗在长达 8 年内有效；然而，这将如何影响接种疫苗女性的筛查仍不确定。在本章中，我们将回顾 HPV 的分子基础、发病机制以及 HPV 感染和相关宫颈癌的流行病学，讨论目前可用的 HPV 检测方法以及最近的 HPV 筛查指南，并介绍 HPV 疫苗及其对宫颈癌筛查和治疗的影响。
