Pahwa Vandita, Pimple Sharmila A, Mishra Gauravi A, Majmudar Parishi, Biswas Sanjay K, Deodhar Kedar
Department of Preventive Oncology, Homi Bhabha Cancer Hospital & Research Center, New Chandigarh, Punjab, India.
https://orcid.org/0000-0002-3492-4418.
Ecancermedicalscience. 2024 Sep 19;18:1772. doi: 10.3332/ecancer.2024.1772. eCollection 2024.
Cervical cancer, mostly caused by human papilloma virus (HPV), has disproportionately high incidence in developing countries. HPV infection being essentially a sexually transmitted infection, high-risk behaviour women with multiple sexual contacts like female sex workers (FSWs) are at higher risk of co-infection with HPV and of developing cervical precancer and cancer.
This study aimed to determine the prevalence and determinants of HPV infection and cervical intraepithelial neoplasia (CIN) among FSWs in Mumbai, India.
A cross-sectional study was conducted among 448 FSWs, between the ages of 18-50 years, by collaborating with local non-government organizations working for the health and welfare of FSW communities at sexually transmitted diseases clinics. All FSWs were screened for HPV DNA by hybrid capture II followed by reference diagnosis of colposcopy and/or cervical biopsy.
The prevalence of HPV DNA positivity was 35.5% and CIN was 2.2%. Factors significantly associated with HPV DNA positivity were age group younger than 30 years odds ratio (OR = 2.098, 95% confidence interval (CI) 1.408-3.127), Illiteracy (OR = 2.015, 95% CI 1.305-3.112), being single (OR = 2.409, 95% CI 1.558-3.724), less than 18 years of age at time of initiating work as FSW (OR = 3.718, 95% CI 3.718-2.392), having more than five clients per day (OR = 2.078, 95% CI 1.301-3.318), been working as a FSW for more than 5 years (OR = 2.321, 95% CI 1.455-3.701), not using barrier contraception methods (OR = 5.155, 95% CI 3.395-7.827) and having no exposure to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) education program (OR = 29.153, 95% CI 15.385-55.240). FSWs with a positive HPV DNA test are substantially more likely to have CIN compared to those with a negative test (OR = 7.6, 95% CI 1.59-36.25).
The prevalence of HPV infection and CIN was high among FSWs. FSWs with a positive HPV DNA test had a seven times higher risk of developing CIN. The persistence of HPV infection is expected to significantly raise the risk of cervical cancer in the future. It is suggested to have an integrated approach towards cervical cancer screening and HIV/AIDS control activities.
宫颈癌主要由人乳头瘤病毒（HPV）引起，在发展中国家的发病率极高。HPV感染本质上是一种性传播感染，像女性性工作者（FSW）这类有多个性接触对象的高危行为女性感染HPV以及发生宫颈上皮内瘤变和癌症的风险更高。
本研究旨在确定印度孟买女性性工作者中HPV感染及宫颈上皮内瘤变（CIN）的患病率和决定因素。
通过与为性传播疾病诊所的女性性工作者群体的健康和福利工作的当地非政府组织合作，对448名年龄在18至50岁之间的女性性工作者进行了一项横断面研究。所有女性性工作者均通过杂交捕获II法进行HPV DNA筛查，随后进行阴道镜检查和/或宫颈活检的参考诊断。
HPV DNA阳性率为35.5%，CIN为2.2%。与HPV DNA阳性显著相关的因素包括年龄小于30岁（比值比（OR）=2.098，95%置信区间（CI）1.408 - 3.127）、文盲（OR = 2.015，95% CI 1.305 - 3.112）、单身（OR = 2.409，95% CI 1.558 - 3.724）、开始从事女性性工作者工作时年龄小于18岁（OR = 3.718，95% CI 3.718 - 2.392）、每天有超过五个客户（OR = 2.078，95% CI 1.301 - 3.318）、从事女性性工作者工作超过5年（OR = 2.321，95% CI 1.455 - 3.701）、不使用屏障避孕方法（OR = 5.155，95% CI 3.395 - 7.827）以及未接受过人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）教育项目（OR = 29.153，95% CI 15.385 - 55.240）。HPV DNA检测呈阳性的女性性工作者相比检测呈阴性的女性性工作者发生CIN的可能性要高得多（OR = 7.6，95% CI 1.59 - 36.25）。
女性性工作者中HPV感染和CIN的患病率较高。HPV DNA检测呈阳性的女性性工作者发生CIN的风险高出七倍。预计HPV感染的持续存在将在未来显著增加患宫颈癌的风险。建议对宫颈癌筛查和HIV/AIDS控制活动采取综合方法。
