Indiana University School of Medicine, Indianapolis, IN, USA.
Maseno University, Kisumu, Kenya.
BMC Infect Dis. 2019 Apr 27;19(1):352. doi: 10.1186/s12879-019-3982-7.
Cervical cancer is caused by oncogenic human papillomaviruses (HPV) and is one of the most common malignancies in women living in sub-Saharan Africa. Women infected with the human immunodeficiency virus (HIV) have a higher incidence of cervical cancer, but the full impact on HPV detection is not well understood, and associations of biological and behavioral factors with oncogenic HPV detection have not been fully examined. Therefore, a study was initiated to investigate factors that are associated with oncogenic HPV detection in Kenyan women.
Women without cervical dysplasia were enrolled in a longitudinal study. Data from enrollment are presented as a cross-sectional analysis. Demographic and behavioral data was collected, and HPV typing was performed on cervical swabs. HIV-uninfected women (n = 105) and HIV-infected women (n = 115) were compared for demographic and behavioral characteristics using t-tests, Chi-square tests, Wilcoxon sum rank tests or Fisher's exact tests, and for HPV detection using logistic regression or negative binomial models adjusted for demographic and behavioral characteristics using SAS 9.4 software.
Compared to HIV-uninfected women, HIV-infected women were older, had more lifetime sexual partners, were less likely to be married, were more likely to regularly use condoms, and were more likely to have detection of HPV 16, other oncogenic HPV types, and multiple oncogenic types. In addition to HIV, more lifetime sexual partners was associated with a higher number of oncogenic HPV types (aIRR 1.007, 95% CI 1.007-1.012). Greater travel distance to the clinic was associated with increased HPV detection (aOR for detection of ≥ 2 HPV types: 3.212, 95% CI 1.206-8.552). Older age (aOR for HPV 16 detection: 0.871, 95% CI 0.764-0.993) and more lifetime pregnancies (aOR for detection of oncogenic HPV types: 0.706, 95% CI, 0.565-0.883) were associated with reduced detection.
HIV infection, more lifetime sexual partners, and greater distance to health-care were associated with a higher risk of oncogenic HPV detection, in spite of ART use in those who were HIV-infected. Counseling of women about sexual practices, improved access to health-care facilities, and vaccination against HPV are all potentially important in reducing oncogenic HPV infections.
宫颈癌是由致癌型人乳头瘤病毒（HPV）引起的，是撒哈拉以南非洲地区妇女中最常见的恶性肿瘤之一。感染人类免疫缺陷病毒（HIV）的妇女宫颈癌发病率较高，但对 HPV 检测的全面影响尚不清楚，生物和行为因素与致癌型 HPV 检测的关联也尚未完全研究。因此，开展了一项研究，以调查与肯尼亚妇女致癌型 HPV 检测相关的因素。
未发生宫颈上皮内瘤变的妇女被纳入一项纵向研究。本报告介绍了一项横断面分析的数据。收集人口统计学和行为学数据，并对宫颈拭子进行 HPV 分型。采用 t 检验、卡方检验、Wilcoxon 总和秩检验或 Fisher 确切检验比较 HIV 阴性（n=105）和 HIV 阳性（n=115）妇女的人口统计学和行为学特征，采用 logistic 回归或负二项回归模型调整人口统计学和行为学特征后比较 HPV 检测情况，使用 SAS 9.4 软件进行分析。
与 HIV 阴性妇女相比，HIV 阳性妇女年龄较大，性伴侣较多，已婚比例较低，更常使用避孕套，HPV16 及其他致癌型 HPV 类型和多种致癌型 HPV 类型的检出率更高。除 HIV 感染外，性伴侣数量较多与致癌型 HPV 类型数量增加相关（调整后比值比[aIRR]1.007，95%置信区间[CI]1.007-1.012）。就诊距离较远与 HPV 检出率增加相关（调整后检出≥2 种 HPV 类型的比值比[aOR]3.212，95%CI 1.206-8.552）。年龄较大（HPV16 检出的比值比[aOR]0.871，95%CI 0.764-0.993）和妊娠次数较多（检出致癌型 HPV 类型的比值比[aOR]0.706，95%CI 0.565-0.883）与 HPV 检出率降低相关。
尽管 HIV 阳性妇女接受了抗逆转录病毒治疗，但 HIV 感染、性伴侣数量较多和就诊距离较远与致癌型 HPV 检测风险增加相关。对妇女进行性行为相关咨询、改善对卫生保健设施的获取、以及 HPV 疫苗接种均可能有助于降低致癌型 HPV 感染。
