在南非豪登省一家三级医院就诊的女性中，人乳头瘤病毒感染的流行率较高，且与多种因素相关。
High prevalence of and factors associated with human papillomavirus infection among women attending a tertiary hospital in Gauteng Province, South Africa.
机构信息
Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
出版信息
BMC Cancer. 2022 Aug 5;22(1):854. doi: 10.1186/s12885-022-09964-9.
BACKGROUND
Persistent high-risk (hr) human papillomavirus (HPV) infection is a necessary cause of cervical cancer. Cervical cancer is a major public health problem in Sub-Saharan Africa including South Africa. This study investigated the prevalence of and factors associated with hr-HPV infection among women attending a tertiary hospital in Gauteng Province, South Africa.
METHODS
Cervical samples were collected from 526 participants aged ≥ 18 years using a Cervex Brush® Combi and tested for hr-HPV types on the Abbott m2000 analyzer using the Abbott RealTime HR HPV assay. Samples that tested hr-HPV deoxyribonucleic acid (DNA)-positive were further tested for hr-HPV E6/E7 messenger ribonucleic acid (mRNA) using the APTIMA® HPV assay on the Panther system (Hologic, Inc.). Sociodemographic data were collected using a self-administered questionnaire. Binomial regression analysis was used to assess factors associated with hr-HPV infection.
RESULTS
Overall hr-HPV DNA prevalence was 48.1% (95%CI: 43.8-52.4%). Of the hr-HPV DNA-positives, 24.5% (95%CI: 19.3-30.1) had HPV-16; 12.3% (95%CI: 8.5-16.9) had HPV-18 and 87.4% (95%CI: 82.6-91.2) had other 12 h-HPVs. Of the samples positive for hr-HPV DNA, 84.2% (95%CI: 79.1-88.5) (213/253) were positive for hr-HPV E6/E7 mRNA. Advanced age was an important factor linked to hr-HPV E6/E7 mRNA positivity. Based on multivariate binomial regression analysis, unemployment (PR: 1.50; 95%CI: 1.23-1.83) and being married (PR: 0.61; 95%CI: 0.47-0.81) were identified as statistically significant (p < 0.0001) predictive and protective factors, respectively, for hr-HPV infection.
CONCLUSIONS
The prevalence of hr-HPV infection was high. Furthermore, hr-HPV DNA-positive samples had a high hr-HPV E6/E7 mRNA prevalence. The presence of hr-HPV E6/E7mRNA indicates active infection and thus a greater risk of developing the cervical disease. Therefore, HPV mRNA testing could be a better test to monitor women who are positive with Pap smear before colposcopy is performed to reduce the burden of referrals.
背景
持续性高危（hr）人乳头瘤病毒（HPV）感染是宫颈癌的必要病因。宫颈癌是撒哈拉以南非洲地区（包括南非）的一个主要公共卫生问题。本研究调查了南非豪登省一家三级医院就诊的女性中 hr-HPV 感染的流行情况和相关因素。
方法
使用 Cervix Brush® Combi 从 526 名年龄≥18 岁的参与者中采集宫颈样本，并使用 Abbott m2000 分析仪上的 Abbott RealTime HR HPV 检测对 hr-HPV 类型进行检测，使用 Panther 系统（Hologic，Inc.）上的 APTIMA® HPV 检测对 hr-HPV DNA 阳性的样本进一步检测 hr-HPV E6/E7 信使核糖核酸（mRNA）。使用自我管理问卷收集社会人口统计学数据。使用二项式回归分析评估与 hr-HPV 感染相关的因素。
结果
总体而言，hr-HPV DNA 的流行率为 48.1%（95%CI：43.8-52.4%）。在 hr-HPV DNA 阳性者中，24.5%（95%CI：19.3-30.1）为 HPV-16；12.3%（95%CI：8.5-16.9）为 HPV-18，87.4%（95%CI：82.6-91.2）为其他 12 种高危型 HPV。在 hr-HPV DNA 阳性的样本中，84.2%（95%CI：79.1-88.5）（213/253）hr-HPV E6/E7 mRNA 阳性。高龄是与 hr-HPV E6/E7 mRNA 阳性相关的重要因素。基于多变量二项式回归分析，失业（PR：1.50；95%CI：1.23-1.83）和已婚（PR：0.61；95%CI：0.47-0.81）被确定为与 hr-HPV 感染具有统计学意义的预测和保护因素（p<0.0001）。
结论
hr-HPV 感染的流行率很高。此外，hr-HPV DNA 阳性样本的 hr-HPV E6/E7 mRNA 阳性率也很高。hr-HPV E6/E7mRNA 的存在表明存在活跃感染，因此发生宫颈癌的风险更大。因此，HPV mRNA 检测可能是一种更好的检测方法，可在进行阴道镜检查之前监测巴氏涂片阳性的女性，以减少转诊负担。
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