Scottish HPV Reference Laboratory, Dept of Lab Medicine Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, EH16 4SA, UK.
Public Health Scotland, 5 Cadogan Street, Glasgow, G2 6QE, UK.
Br J Cancer. 2023 Oct;129(7):1134-1141. doi: 10.1038/s41416-023-02386-9. Epub 2023 Aug 10.
Understanding the pattern and dominance of HPV types in high grade cervical disease within increasingly vaccinated populations will help inform the development of appropriate screening and management protocols.
Over 1700 cases of cervical intraepithelial neoplasia (CIN) diagnosed between 2011 and 2017 in women younger than 25 were genotyped for HPV. Logistic regression was used to assess the association between HPV 16/18 positivity with biopsy-collection year, birth year, deprivation and vaccination status. Regression analysis was repeated for cross-protective types (31, 33 and 45). Type specific detail of non-vaccine types by vaccination status was presented descriptively.
Detection of HPV 16/18 or 16/18/31/33 and 45 was lower in CIN2 associated with full vaccination vs no vaccination (OR 0.3; 95% CI 0.2-0.5 & 0.4; 95% CI 0.3-0.6 respectively) Similar observations were made for CIN3. The relative contribution of non-established high-risk types including those considered low risk was greater among vaccinated women with CIN2+ vs unvaccinated women with CIN2+.
The change in HPV distribution in CIN2+ in vaccinated populations is a further marker of vaccine impact. Additionally, the progression rate of CIN2+ in vaccinated populations may be lower given the shift in type distribution. The definition of high grade disease in vaccinated populations may warrant reassessment.
了解 HPV 类型在高等级宫颈疾病中的模式和优势，对于制定适当的筛查和管理方案具有重要意义。
在 2011 年至 2017 年间，对 1700 多例年龄在 25 岁以下的女性的宫颈上皮内瘤变（CIN）病例进行 HPV 基因分型。使用逻辑回归评估 HPV 16/18 阳性与活检采集年份、出生年份、贫困程度和疫苗接种状态之间的相关性。对交叉保护型 HPV（31、33 和 45）进行了回归分析。按疫苗接种状态列出了非疫苗型 HPV 的具体类型。
与未接种疫苗相比，接种疫苗后 CIN2 相关的 HPV 16/18 或 16/18/31/33 和 45 的检出率较低（比值比分别为 0.3，95%可信区间为 0.2-0.5 和 0.4，95%可信区间为 0.3-0.6）。CIN3 也有类似的观察结果。在接种疫苗的 CIN2+女性中，非既定高危型 HPV （包括低危型 HPV）的相对贡献大于未接种疫苗的 CIN2+女性。
HPV 在接种疫苗人群中 CIN2+分布的变化是疫苗影响的又一标志。此外，鉴于 HPV 型别分布的变化，接种疫苗人群中 CIN2+的进展速度可能较低。在接种疫苗的人群中，高级别疾病的定义可能需要重新评估。
