Muñoz N, Kato I, Bosch F X, Eluf-Neto J, De Sanjosé S, Ascunce N, Gili M, Izarzugaza I, Viladiu P, Tormo M J, Moreo P, Gonzalez L C, Tafur L, Walboomers J M, Shah K V
Unit of Field and Intervention Studies, International Agency for Research on Cancer, Lyon, France.
Sex Transm Dis. 1996 Nov-Dec;23(6):504-10. doi: 10.1097/00007435-199611000-00012.
Strong epidemiologic evidence indicates that human papillomavirus (HPV) is the main etiologic factor of cervical cancer. A few cohort studies suggest that most HPV infections are transient in young women and that persistent HPV infections are more common in older women. Little is known about the determinants of persistent HPV infections. The present study was aimed at increasing our knowledge about these determinants.
To identify risk factors for genital HPV DNA detection among cytologically normal middle-aged women.
Eight hundred ten women who participated as control subjects in three case-control studies on cervical cancer in Spain, Colombia, and Brazil were included in this study. After an interview, women underwent a gynecologic examination with collection of exfoliated cells for a Papanicolaou smear and HPV DNA detection. Human papilloma virus DNA was detected by polymerase chain reaction (PCR)-based hybridization techniques.
The HPV positivity rate was 10.5% in the whole population, but was higher in the areas with high incidence of cervical cancer (17% in Brazil and 13% in Colombia) than in Spain (4.9%), which is a low-risk area for cervical cancer. Age was related to the prevalence of HPV DNA in Brazil, but not in Spain and Colombia. In univariate analyses in all three countries, the prevalence of HPV DNA was positively associated with the number of lifetime sexual partners and inversely associated with the levels of family income and with age at first sexual intercourse. There was four times increase in the odds ratio (OR) of HPV infection in women who had six or more lifetime sexual partners compared with those with one or less. The use of any kind of contraceptive tended to decrease the OR for HPV detection. Their ORs ranged from 0.44 (barrier methods) to 0.48 (oral contraceptives). In Spain and Colombia, antibodies against Chlamydia trachomatis were positively associated with the prevalence of HPV DNA. In a final multivariate model, the positive associations with lifetime number of sexual partners, socioeconomic status, and C. trachomatis persisted.
These results support the sexual transmission of HPV and suggest that socioeconomic status and antibodies to C. trachomatis are independent predictors of HPV detection in middle-aged cytologically normal women.
强有力的流行病学证据表明，人乳头瘤病毒（HPV）是宫颈癌的主要病因。一些队列研究表明，大多数HPV感染在年轻女性中是短暂的，而持续性HPV感染在老年女性中更为常见。关于持续性HPV感染的决定因素知之甚少。本研究旨在增加我们对这些决定因素的了解。
确定细胞学正常的中年女性中生殖器HPV DNA检测的危险因素。
本研究纳入了810名在西班牙、哥伦比亚和巴西三项宫颈癌病例对照研究中作为对照受试者参与的女性。经过访谈后，这些女性接受了妇科检查，并采集了脱落细胞用于巴氏涂片和HPV DNA检测。通过基于聚合酶链反应（PCR）的杂交技术检测人乳头瘤病毒DNA。
整个人群的HPV阳性率为10.5%，但在宫颈癌高发地区（巴西为17%，哥伦比亚为13%）高于西班牙（4.9%），西班牙是宫颈癌低风险地区。年龄与巴西的HPV DNA流行率有关，但在西班牙和哥伦比亚并非如此。在所有三个国家的单因素分析中，HPV DNA的流行率与终身性伴侣数量呈正相关，与家庭收入水平和首次性交年龄呈负相关。与有1个或更少性伴侣的女性相比，有6个或更多终身性伴侣的女性HPV感染的比值比（OR）增加了四倍。使用任何一种避孕方法都倾向于降低HPV检测的OR。其OR范围从0.44（屏障法）到0.48（口服避孕药）。在西班牙和哥伦比亚，抗沙眼衣原体抗体与HPV DNA的流行率呈正相关。在最终的多变量模型中，与终身性伴侣数量、社会经济地位和沙眼衣原体的正相关关系依然存在。
这些结果支持HPV的性传播，并表明社会经济地位和抗沙眼衣原体抗体是细胞学正常的中年女性中HPV检测的独立预测因素。
