卢旺达感染艾滋病毒的筛查呈阳性女性中高危型人乳头瘤病毒（HPV）的型别特异性持续性、清除率和发病率
Type-specific persistence, clearance and incidence of high-risk HPV among screen-positive Rwandan women living with HIV.
作者信息
Murenzi Gad, Tuyisenge Patrick, Kanyabwisha Faustin, Munyaneza Athanase, Muhoza Benjamin, Kubwimana Gallican, Murangwa Anthere, Mutesa Leon, Anastos Kathryn, Castle Philip E
机构信息
Rwanda Military Hospital, Kigali, Rwanda.
Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
出版信息
Infect Agent Cancer. 2021 Feb 19;16(1):16. doi: 10.1186/s13027-021-00355-6.
BACKGROUND
Persistent infection with high-risk human papillomavirus (hrHPV) is a critical step in cervical carcinogenesis. We report on type-specific hrHPV persistence, clearance and incidence among screen-positive Rwandan women living with HIV (WLWH).
METHODS
This was a nested analysis from a large cervical cancer screening study of ~ 5000 Rwandan WLWH. Women who tested positive for hrHPV and/or visual inspection with acetic acid were referred to colposcopy. For a subset of women (n = 298) who were ≥ 6 months delayed in receiving colposcopy, we tested their screening and colposcopy visit specimens using the AmpFire HPV genotyping assay that tests 14 hrHPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) individually.
RESULTS
The mean, median (interquartile range [IQR]) and range of time between the screening and colposcopy visits were 644, 650 (490-820.5) and 197-1161 days, respectively. Mean, median (IQR) and range of age at the screening visit were 38, 37 (34-43) and 30-54 years, respectively. Two-hundred eighty-three (95.0%) had CD4 count (cells per mm) data available at baseline with mean, median (IQR) and range of 592, 513 (346-717) and 0-7290, respectively. Two-hundred thirty-five WLWH were positive for at least one hrHPV type at the screening visit, of whom 50.2% had at least one HPV type-specific infection persist; 37.2% of all HPV infections detected at the screening visit persisted. Compared to all other HPV types in aggregate, HPV16 (vs. non-HPV16 types) (47.7%, p = 0.03) and HPV33 (vs. non-HPV33 types) (56.7%, p = 0.03) were significantly more likely, and HPV39 (vs. non-HPV39 types) (6.7%, p = 0.01), HPV51 (vs. non-HPV51 types) (15.6%, p < 0.01), and HPV66 (vs. non-HPV66 types (17.9%, p = 0.04) were significantly less likely, to persist. Lower CD4 counts were associated with having any persistent hrHPV infection (p = 0.04) and multiple persistent hrHPV infections (p = 0.04).
CONCLUSION
There is a significant proportion of WLWH with persistent hrHPV infection, emphasizing the need to vaccinate them against HPV prior to becoming sexually active.
背景
高危型人乳头瘤病毒（hrHPV）持续感染是宫颈癌发生的关键步骤。我们报告了卢旺达感染艾滋病毒的女性（WLWH）筛查呈阳性者中hrHPV的型特异性持续感染、清除情况及发病率。
方法
这是一项对约5000名卢旺达WLWH进行的大型宫颈癌筛查研究的巢式分析。hrHPV检测呈阳性和/或醋酸肉眼检查呈阳性的女性被转诊至阴道镜检查。对于一部分接受阴道镜检查延迟≥6个月的女性（n = 298），我们使用AmpFire HPV基因分型检测法对她们的筛查和阴道镜检查标本进行检测，该检测法可单独检测14种hrHPV型别（16、18、31、33、35、39、45、51、52、56、58、59、66和68）。
结果
筛查与阴道镜检查之间的平均时间、中位数（四分位间距[IQR]）和时间范围分别为644天、650天（490 - 820.5天）和197 - 1161天。筛查时的平均年龄、中位数（IQR）和年龄范围分别为38岁、37岁（34 - 43岁）和30 - 54岁。283名（95.0%）女性在基线时有CD4细胞计数（每立方毫米细胞数）数据，其平均、中位数（IQR）和范围分别为592、513（346 - 717）和0 - 7290。235名WLWH在筛查时至少有一种hrHPV型别呈阳性，其中50.2%的人至少有一种HPV型特异性感染持续存在；筛查时检测到的所有HPV感染中，37.2%持续存在。与所有其他HPV型别合计相比，HPV16（与非HPV16型别相比）（47.7%，p = 0.03）和HPV33（与非HPV33型别相比）（56.7%，p = 0.03）持续存在的可能性显著更高，而HPV39（与非HPV39型别相比）（6.7%，p = 0.01）、HPV51（与非HPV51型别相比）（15.6%，p < 0.01）和HPV66（与非HPV66型别相比）（17.9%，p = 0.04）持续存在的可能性显著更低。较低的CD4细胞计数与任何持续性hrHPV感染（p = 0.04）和多种持续性hrHPV感染（p = 0.04）相关。
结论
有相当比例的WLWH存在持续性hrHPV感染，这凸显了在她们开始性活动之前接种HPV疫苗的必要性。
Zotero 插件