从全球癌症登记处推断 HPV 的自然史:多国校准的见解。
Inferring the natural history of HPV from global cancer registries: insights from a multi-country calibration.
机构信息
Gender Equality Division, Bill & Melinda Gates Foundation, Seattle, WA, USA.
Global Health Division, Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, USA.
出版信息
Sci Rep. 2024 Jul 10;14(1):15875. doi: 10.1038/s41598-024-65842-3.
Human papillomavirus (HPV) is the cause of almost all cases of cervical cancer, a disease that kills some 340,000 women per year. The timeline from initial infection with HPV to the onset of invasive cervical cancer spans decades, and observational studies of this process are limited to settings in which treatment of precancerous lesions was withheld or inadequate. Such studies have been critical for understanding the natural history of HPV. Modeling can shed additional insight on the natural history of HPV, especially across geographical settings with varying prevalence of factors known to affect the host-side immune response to HPV, such as HIV and tobacco use. In this study, we create models for the 30 most populous countries in Sub-Saharan Africa, each with country-specific demographic, and behavioral inputs. We found that it was not possible to fit the data if we assumed that the natural history parameters were exactly identical for all countries, even after accounting for demographic and behavioral differences, but that we could achieve a good fit with the addition of a single immunocompetence parameter for each country. Our results indicate that variation in host immune responses may play a role in explaining the differences in the burden of cervical cancer between countries, which in turn implies a greater need for more geographically diverse data collection to understand the natural history of HPV.
人乳头瘤病毒(HPV)是几乎所有宫颈癌病例的病因,这种疾病每年导致约 34 万名妇女死亡。从 HPV 初次感染到浸润性宫颈癌的发病时间跨越几十年,而对这一过程的观察性研究仅限于对癌前病变不予治疗或治疗不足的环境。这些研究对于了解 HPV 的自然史至关重要。建模可以为 HPV 的自然史提供更多的见解,尤其是在具有不同已知因素(如 HIV 和烟草使用)影响宿主对 HPV 的免疫反应的地理环境中。在这项研究中,我们为撒哈拉以南非洲人口最多的 30 个国家创建了模型,每个国家都有特定的人口统计学和行为学输入。我们发现,如果我们假设所有国家的自然史参数完全相同(即使考虑到人口统计学和行为学差异),则无法拟合数据,但如果为每个国家添加一个单独的免疫能力参数,则可以很好地拟合数据。我们的结果表明,宿主免疫反应的差异可能在解释各国宫颈癌负担的差异方面发挥作用,这意味着需要更多具有地域差异的数据收集来了解 HPV 的自然史。