Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
Sex Transm Dis. 2018 Oct;45(10):666-672. doi: 10.1097/OLQ.0000000000000857.
High-oncogenic-risk human papillomavirus (hrHPV) is necessary, although insufficient, to promote cervical cancer. Like HPV, Epstein-Barr virus (EBV) is a common pathogen with the capacity to promote epithelial neoplasms. We examined the association between cervical EBV, hrHPV, and cytology in female sex workers in Nairobi, Kenya.
Women (n = 332) with known cervical cytology and hrHPV mRNA results were evaluated for cervical EBV DNA by conventional polymerase chain reaction. Prevalence ratios (PRs) were calculated to assess the relationships between EBV, hrHPV, and cervical cytology. Prospective analyses used risk ratios and time-to-event analyses to determine the association of EBV with hrHPV clearance and with abnormal cytology outcomes.
Baseline prevalence of hrHPV and EBV was 29% and 19%, respectively. Higher EBV prevalence was found among women with older age, HIV, hrHPV, abnormal cytology, Mycoplasma genitalium infection, smoking habits, younger age at sexual debut, and less frequent condom use. At baseline, women with EBV had a higher prevalence of hrHPV infection than did EBV-negative women (52% vs. 24%; HIV-adjusted PR [95% confidence interval], 1.8 [1.3-2.6]). Epstein-Barr virus-positive women had a higher prevalence than did EBV-negative women of high-grade precancer (15% vs. 2%) and abnormal cytology (37% vs. 15%), although HIV- and hrHPV-adjusted associations were not significant (high-grade precancer: PR, 2.0 [0.7-5.9]; abnormal cytology: PR, 1.4 [0.9-2.2]). In prospective analyses, a marginal association was observed between baseline EBV detection and delayed hrHPV clearance.
Our data support a possible role for EBV as a high-risk marker or cofactor for HPV-mediated cervical cancer development.
高致癌风险型人乳头瘤病毒（hrHPV）是促进宫颈癌发生的必要条件，尽管还不充分。与 HPV 一样，EB 病毒（EBV）也是一种常见的病原体，具有促进上皮肿瘤发生的能力。我们在肯尼亚内罗毕的女性性工作者中检查了宫颈 EBV、hrHPV 和细胞学之间的关系。
对已知宫颈细胞学和 hrHPV mRNA 结果的女性（n=332）进行常规聚合酶链反应检测宫颈 EBV DNA。计算患病率比（PR）以评估 EBV、hrHPV 和宫颈细胞学之间的关系。前瞻性分析使用风险比和时间事件分析来确定 EBV 与 hrHPV 清除和异常细胞学结果之间的关联。
hrHPV 和 EBV 的基线患病率分别为 29%和 19%。年龄较大、HIV、hrHPV、异常细胞学、支原体感染、吸烟习惯、初次性行为年龄较小和使用避孕套频率较低的女性中，EBV 阳性率较高。在基线时，EBV 阳性的女性比 EBV 阴性的女性更有可能感染 hrHPV（52%比 24%；HIV 调整后的 PR [95%置信区间]，1.8 [1.3-2.6]）。EBV 阳性的女性比 EBV 阴性的女性更有可能出现高级别癌前病变（15%比 2%）和异常细胞学（37%比 15%），尽管 HIV 和 hrHPV 调整后的关联不显著（高级别癌前病变：PR，2.0 [0.7-5.9]；异常细胞学：PR，1.4 [0.9-2.2]）。在前瞻性分析中，基线 EBV 检测与 hrHPV 清除延迟之间存在边缘关联。
我们的数据支持 EBV 作为 HPV 介导的宫颈癌发展的高危标志物或共同因子的可能作用。
