Orlando G, Bianchi S, Fasolo M M, Mazza F, Frati E R, Rizzardini G, Matteelli A, Zanchetta N, Amendola A, Tanzi E
Infectious Diseases Outpatient Unit, Centro Diagnostico Italiano, Milan, Italy.
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
J Prev Med Hyg. 2017 Dec 30;58(4):E259-E265. doi: 10.15167/2421-4248/jpmh2017.58.4.804. eCollection 2017 Dec.
Primary-prevention by prophylactic vaccination against HPV-related cancers and HPV-based screening programs are based on HPV-type distribution in immunocompetent individuals. HIV-infected women are at high risk of invasive HPV-disease sustained by a broader range of HPV-types and have higher multi-type infection rates than immunocompetent hosts.
This is a cross-sectional analysis of High Risk HPV (HR HPV) type distribution in 805 HIV+ women (HIW) compared with a control group of 1402 immunocompetent HIV- women (SPW) enrolled in the VALHIDATE study in order to define HPV type-specific distribution according to cytology.
HIW had a 3.8, 3.6, and 2.7 times higher risk of atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL) and high grade squamous intraepithelial lesion (HSIL) than SPW respectively. HPV-DNA prevalence was 28.4% in HIW and 11.81% in SPW (p<0.0001). The prevalence of infection increased from normal cytology to HSIL both in HIW (from 21.45% to 90.91%) and SPW (from 9.54% to 75%). The OR for women with normal cytology of having a positive HPV-DNA test result of was 2.6 times higher in HIW than in SPW. The cumulative prevalence of HPV-16/18 in HSIL is much lower in HIW (36.4±28.4) than SPW (62.5±33.5).
A higher prevalence of infection and broader HPV type distribution were observed in HIV+ women compared to the general population. More than 60% of HSIL lesions of HIW patients are caused by single or multi-type infections from non-HPV16/18 HPVs. The potential 9v-HPV vaccine coverage could be even higher than that expected for the general population given the wide panel of HPV-types observed in the HSIL of HIV+ women.
通过预防性接种HPV相关癌症疫苗进行一级预防以及基于HPV的筛查项目是基于免疫功能正常个体中的HPV类型分布。HIV感染女性患侵袭性HPV疾病的风险较高，其HPV类型范围更广，且多类型感染率高于免疫功能正常的宿主。
这是一项对805名HIV阳性女性（HIW）中高危HPV（HR HPV）类型分布的横断面分析，与参与VALHIDATE研究的1402名免疫功能正常的HIV阴性女性（SPW）对照组进行比较，以根据细胞学确定HPV类型特异性分布。
HIW出现意义不明确的非典型鳞状细胞（ASCUS）、低级别鳞状上皮内病变（LSIL）和高级别鳞状上皮内病变（HSIL）的风险分别比SPW高3.8倍、3.6倍和2.7倍。HIW中HPV-DNA患病率为28.4%，SPW中为11.81%（p<0.0001）。无论是HIW（从21.45%增至90.91%）还是SPW（从9.54%增至75%），从正常细胞学检查到HSIL，感染患病率均有所增加。HIW中细胞学检查正常但HPV-DNA检测结果呈阳性的女性的比值比是SPW中的2.6倍。HIW的HSIL中HPV-16/18的累积患病率（36.4±28.4）远低于SPW（62.5±33.5）。
与普通人群相比，HIV阳性女性的感染患病率更高，HPV类型分布更广。HIW患者中超过60%的HSIL病变是由非HPV16/18型HPV的单类型或多类型感染引起的。鉴于在HIV阳性女性的HSIL中观察到的HPV类型范围广泛，潜在的9价HPV疫苗覆盖率可能甚至高于普通人群的预期。
