The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS

The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety.

KEY MESSAGES

• The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.
• Collaborations have been established between researchers in North America and East African countries for these studies.
• Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.

     

Anal Pap smears: Should we be doing them?

Purpose: To identify the need to perform anal Papanicolau (Pap) smears for diagnosing histologic changes associated with human papilloma virus (HPV) infection in order to provide early intervention for the prevention of anal cancer. To offer the primary care provider information, based on evidence-based research, about identifying the high-risk patient using risk factors, instructions on performing the anal Pap smear, interpreting the results, and initiating treatment interventions and/or referrals for care. Additionally, the possibility of an HPV vaccine for men will be discussed.
Data Sources: Evidence-based literature, theoretical framework, and peer-reviewed articles.
Conclusions: Performing anal Pap smears is a valuable tool to detect cytologic changes associated with some strains of HPV infection. For persons participating in receptive anal intercourse, this diagnostic procedure provides the opportunity for early detection to guide appropriate follow-up and interventions.
Implications for practice: Appropriate screening can be incorporated easily into a primary care practice. High-risk groups that would benefit from this screening include men who have sex with men, HIV-infected men and women, immunocompromised men and women, women with a history of cervical or vulvar cancer (or high-grade cervical lesions), and women participating in receptive anal intercourse.     

The impact of HIV antiviral therapy on human papillomavirus (HPV) infections and HPV-related diseases

Human papillomavirus (HPV) infections play an important role in the pathogenesis of anogenital cancer and its precursors. HIV-infected individuals exhibit a high prevalence of HPV DNA. Several studies have further shown that HIV-infected individuals have an increased prevalence of squamous intraepithelial lesions (SIL) of the cervix, vulva and anus. The incidence of invasive cervical cancer is also elevated in HIV-positive women as well as that of anal cancer in HIV-positive women and men. Given the relationship between HIV-induced immunosuppression and HPV-associated disease, treatment with highly active antiretroviral therapy (HAART) has the potential, through immune reconstitution of the host, to alter the natural history of HPV infection and SIL. However, data on the impact of HAART on HPV disease are sparse and mixed results have been reported.     

某地区女性泌尿生殖道感染患者人乳头瘤病毒感染现状调查

目的 研究该地区女性泌尿生殖道感染患者人乳头瘤病毒(HPV)感染状况及HPV阳性患者HPV基因型分布状况,确定该地区HPV感染的优势型别.方法 采用基因芯片技术对591例女性泌尿生殖道感染患者进行HPV检测.结果 检出HPV阳性者288例,检出率为48.73%;低危型感染116例,占40.28%,高危型141例,占48.96%,混合型感染31例,占10.76%;低危型感染以HPV6、11型为主,分别占48.28%、42.24%;高危型感染以HPV16型为主,占43.26%.HPV易感年龄阶段为20～＜40岁,占所有感染者的63.54%.结论 该地区女性泌尿生殖道感染患者HPV感染率较高,以高危型感染为主,且存在与低危型混合感染的可能.     

不同年龄段女性人乳头瘤病毒感染状况分析

目的了解不同年龄段女性人乳头瘤病毒(HPV)感染状况,为宫颈癌防治提供理论依据。方法对临床3 426例宫颈分泌物标本采用多通道实时荧光定量聚合酶链反应(PCR)仪检测8种高危型HPV DNA亚型(HPV16、18、45、31、33、52、58、67),分析不同年龄段受检者HPV感染状况。结果 3 426例标本中共检出HPV阳性583例,阳性率为17.02%。HPV感染人群分布以19~40岁组为主,以19~30岁人群中感染率最高,达到20.37%,明显高于其余的年龄组(P0.05)。在检出类型中有单一亚型感染,也有多亚型的多重感染,其中比例最高的亚型是HPV33/52/58/67(59.01%),明显高于其它HPV亚型(P0.05);居第2位和第3位的分别为HPV16(14.92%)、HPV18/45(9.43%)。结论 19~30岁是女性感染HPV的高峰期,HPV感染有年轻化趋势,但中老年女性群体中HPV感染率依然居高不下。常见的HPV感染基因型为33/52/58/67、16和18/45,提示有一定人群特点。     

Introducing human papillomavirus vaccines - questions remain

Genital human papillomavirus (HPV) infection and HPV-associated cervical and other anogenital cancers are significant public health problems. HPV 16 and HPV 18 are responsible for approximately 70% of all invasive cervical cancers worldwide. The first prophylactic HPV virus-like particle (VLP) vaccine against HPV types 6/11/16/18 was licensed in 2006 for girls and women aged 9-26 years. The second prophylactic HPV vaccine against HPV types 16 and 18 has been licensed this year. These vaccines are almost 100% effective in preventing infection and high-grade precancer associated with the HPV types included in the vaccine. The vaccines are well tolerated, safe, and highly immunogenic when given in three doses within 6 months. Efficacy of the vaccine against external vulvar and HPV-related vaginal lesions is also high. Even though the vaccine is highly effective against high-grade cervical, vaginal, or vulvar precancers, this only applies to women unexposed to these HPV types and only to high-grade intraepithelial lesions caused by these HPV types. Therefore, it is important to understand that the population impact of the vaccines will be much lower than vaccinating naive populations. Implementing HPV vaccine is a great opportunity but also a great challenge. However, mandatory HPV vaccination may raise many questions, and more answers are needed.     

Prevalence of cervical human papillomavirus in Taiwanese women

PURPOSE: To define the prevalence rate of cervical human papilloma virus (HPV) using DNA oligonucleotide microarray and its correlation with risk factors in Taiwanese women in metropolitan Taipei. METHODS: Thirteen hundred and twenty healthy women, aged 21 - 65 yr without history of cervical intraepithelial neoplasia (CIN) or carcinoma were included in this prospective study. Pap smear and HPV typing using oligonucleotide microarray were performed for each woman. They were given a standardized questionnaire to obtain information about the risk factors of cervical cancer in Taiwan. RESULTS: The overall HPV positivity was 19.85% and multiple infections were found in 35.84% of the infected group, 7.92% of the whole study population. The younger the subject, the higher was the infection rate and multiple infection rates. The most common HPV types were 16, 18, 58, 52, 51 and 56, which is different from the western world. The sensitivity of the HPV DNA chip in detecting CIN and cervical carcinoma is 97.06%, and 100% in detecting CIN 2 or more lesions. Risk factors for HPV infection include earlier coitarche (P < 0.01), multiple sexual partners (P < 0.05), history of sexually transmitted disease (P < 0.05), two or more vaginal deliveries (P < 0.05) and infrequent use of condoms (P < 0.05). The association between oral contraception or cigarette smoking and HPV infection could not be determined because few women smoke or used oral contraception. There was no relationship between induced abortion and HPV infection. CONCLUSIONS: About one-fifth of adult women in metropolitan Taipei were cervical HPV positive. The popular HPV types and the risk factors of HPV infection in metropolitan Taipei are not the same as those in the western world. The sensitivity of the HPV DNA chip in detecting cervical neoplasia is very high.     

妊娠期妇女感染HPV对产妇和胎儿的影响

目的分析妊娠期妇女感染人乳头瘤病毒(HPV)对产妇和胎儿的影响。方法选取116例感染人乳头瘤病毒的产妇作为实验组,另选取健康孕妇116例为对照组,分别对产妇分娩时羊水、胎盘组织及胎儿脐静脉血、口咽部分泌物与外阴分泌物中的HPV进行检测,分析产妇HPV的感染分型。随访1年,观察HPV感染对产妇和胎儿的影响。结果实验组中单型HPV感染及高危型HPV感染的患者所占比例较大,分别为66.38%和76.72%;患者宫颈肉眼形态异常炎症、细胞学检验呈鳞状上皮病变是感染HPV的危险因素;2组患者在分娩方式、产后出血及胎儿生长受限等方面比较,差异无统计学意义(P0.05);正常阴道分娩与剖宫产分娩的胎儿在羊水、胎盘组织及脐静脉血、口咽部分泌物、外阴分泌物或包皮分泌物中的HPV阳性检出率比较无显著差异(P0.05);胎儿HPV感染率为24.14%。结论单型HPV感染及高危型HPV感染是妊娠期妇女HPV感染的主要分型。     

常州地区妇女感染宫颈人乳头瘤病毒基因型分析

目的 通过对宫颈癌组织的人乳头瘤病毒(HPV)分型检测,了解常州地区妇女宫颈感染 HPV 基因型的分布情况.方法 取妇女宫颈的脱落细胞,利用凯普导流杂交基因芯片技术(HybriMax)进行21种HPV亚型的检测.结果 2 061例样本中,HPV感染535例,感染率25.95%;HPV感染率排在前5位的依次是HPV16、58、52、33、31.双重感染119例,占感染例数的22.24%,三重感染27例,占感染例数的5.05%.四重感染8例,占感染例数的1.50%.五重感染1例,占感染例数的0.19%.结论 该地区妇女宫颈HPV感染率为25.95%,主要是HPV16、58,其次是HPV52、33、31;混合感染以高危型感染为主.     

湖州市门诊妇女HPV感染亚型的基因芯片检测及分析

目的了解湖州市门诊妇女人乳头瘤病毒（HPV）感染状况和感染型别,为宫颈癌的防治提供理论依据。方法对414例湖州市门诊妇女宫颈分泌物应用基因芯片技术进行18种高危型和5种低危型HPV亚型检测。结果414例妇女中共检出HPV阳性97例,占23.43%,其中单一感染76例,占18.35%;双重感染17例,占4.11%;三重及以上感染4例,占0.97%。97例阳性患者中有高危型HPV感染的为80例,占HPV总阳性人数的82.47%。阳性患者中高危型以16、18、33为主,检出率分别为4.35%、2.17%、2.17%;低危型以6、11型为主,检出率分别为1.69%和1.45%。结论湖州市门诊妇女HPV感染有相当比例,且高危型HPV感染率在总阳性患者中所占比例较高。因此,对门诊妇女有必要进行HPV感染筛查,及早发现高危人群,并进行随访和相应治疗,以降低宫颈癌的发病风险。     

人乳头瘤病毒疫苗临床应用中国专家共识

人乳头瘤病毒(human papilloma virus,HPV)疫苗接种是预防HPV感染及相关疾病的有效方法,是防控HPV感染相关疾病的一级预防措施。低龄人群接种效果优于高龄人群,性暴露前接种免疫效果最佳。HPV疫苗不仅适用于普通人群,同样推荐用于高危、特殊人群。对于具有遗传易感、高危生活方式和HIV感染的适龄女性优先推荐接种HPV疫苗。适龄女性无论是否存在HPV感染、细胞学是否异常均可接种HPV疫苗。近期有妊娠计划、妊娠期或哺乳期女性不宜接种HPV疫苗。接种HPV疫苗后仍应进行子宫颈癌筛查。     

新疆喀什地区维吾尔族女性人乳头状瘤病毒感染分析研究

目的调查喀什地区女性人群宫颈脱落细胞HPV感染情况、亚型分布及其特点。方法收集1 548例女性的宫颈脱落细胞标本,采用PCR-反向点杂交法检测23种HPV基因型,对HPV感染情况及其型别进行分析。结果 HPV感染阳性率为33.3%(485/1 548),其中HPV-16感染率19.4%;HPV42感染率10.3%;HPV52感染率9.9%;HPV58感染率7.6%;HPV53感染率7.2%;单一亚型感染率66.8%,多重感染率33.2%;41~50岁的女性人群中HPV感染率最高(43.3%),高于其他年龄组,且差异具有统计学意义(P0.05)。结论喀什地区女性人群HPV感染以HPV16型为主,而且41~50岁的女性人群中HPV感染率最高,为喀什地区相关部门HPV的预防控制工作提供理论依据。     

浙江省绍兴地区宫颈人乳头瘤病毒感染流行病学调查

目的 了解浙江省绍兴地区女性宫颈人乳头瘤病毒(human papilloma virus, HPV)感染及亚型分布状况,为针对我国女性生殖器疣、宫颈癌防治,HPV疫苗的研制与推广提供参考。 方法 采用回顾性观察分析法,收集2008年1月至2012年10月在绍兴市妇幼保健院对健康体检女性进行宫颈HPV感染筛检者,统计分析其HPV感染及亚型分布情况。 结果 5521名健康体检女性,HPV总感染754例,总感染率为13.7%(754/5521)。其中高危型感染占83.7%(631/754),低危型感染占14.3%(108/754);单一感染占85.1%(642/754),多重感染占14.9%(112/754);21个亚型中HPV-16感染位居首位,占22.5%(170/754),其次依次为HPV-52,HPV-58, HPV-cp8304和HPV-33;各年龄段总HPV感染率差异无统计学意义(P结论 绍兴地区普通女性HPV总感染率为13.7%,以高危型、单一感染为主,排名前10位亚型依次为16、52、58、cp8304、33、11、18、53、6、68。HPV亚型分布存在地区差异。     

无锡地区妇女宫颈HPV感染及基因型别分析

目的对疑似人乳头瘤病毒（HPV）感染的970例妇女进行HPV基因分型检测,以探讨其临床意义。方法用专用宫颈刷采取妇女宫颈的脱落细胞,采用基因芯片法检测970例HPV临床样本,并进行基因分型。结果970例样本中,HPV感染390例,阳性率40．2％。共检出12种HPV亚型,检出感染单一HPV亚型260例（26．8％）,感染两种亚型以上130例（13．4％）。低危型主要为HPV6、11,高危型主要为HPV16、33、52、58、18等。结论无锡地区妇女宫颈HPV感染率较高,感染亚型主要是6、11型。HPV基因分型检测对于生殖道感染以及子宫颈癌的早期发现以及预防和治疗具有重要意义。     

西安地区健康体检女性HPV 感染状况及基因型别分析

目的 分析西安地区女性人乳头瘤病毒（human papilloma virus,HPV）感染状况及基因型的分布情况,为其防治提供依据。方法 选择2019 年4 月～ 2021 年12 月在西安交通大学第二附属医院健康体检的10 772 例女性人群为研究对象,应用PCR-反向杂交法对受检者宫颈脱落细胞样本进行28 种HPV 亚型检测,并将该研究结果与省内及国内其他地区报道结果进行比较分析。结果 检测的10 772 例样本中,有952 例HPV 阳性,感染率为8.84%;共检出27 种HPV 亚型,感染例次前四位的基因型别依次为HPV52,HPV53,HPV16 和HPV42;在HPV 感染类型中,单一型感染最多,共769 例,占比80.78%;各年龄段中,<25 岁和54 ～ <64 岁年龄段女性 HPV 感染率较高,各年龄组HPV 基因型别以高危型别为主,除<25 岁组（χ2=5.17,P=0.075）外,其他5 个年龄组高危型别感染例次与中危型、低危型别感染例次的差异均有统计学意义（χ2=88.60, 98.41,77.01,37.71,8.76,均P<0.05）;该研究结果与省内及国内其他地区报道的结果比较发现,国内女性HPV 感染均以单一型感染、高危基因型别为主,而在HPV 感染率、主要基因型别及高发年龄段上,结果有所不同。结论 西安地区女性人群以高危型HPV 感染为主,其中单一感染最多,青年和中老年女性群体HPV 感染率相对较高。及时了解该地区HPV 感染流行状况,做好HPV 筛查工作,对于女性宫颈癌的预防和治疗具有重要意义。     

粤东地区妇女下生殖道HPV亚型的基因芯片检测与分析

目的了解粤东地区妇女生殖道人乳头瘤病毒(HPV)感染率及型别分布情况。方法采用基因芯片技术对569例粤东地区妇女生殖道分泌物或脱落细胞进行18种高危型HPV和5种低危型HPV检测。结果569例患者中HPV感染275例,占48.3%。单一感染183例,占32.2%;双重感染67例,占11.8%;三重以上感染25例,占4.4%。275例阳性标本主要为高危型HPV16、18型,低危型HPV6、11型。结论粤东地区妇女生殖道病变患者HPV感染率较高,且以高危型HPV16感染率最高,因此,建立建全粤东地区妇女HPV监测体系,及早发现高危人群,最大限度地降低子宫颈癌对妇女生命和健康的威胁度。     

无锡地区妇女宫颈HPV感染及基因型别分析

目的 对疑似人乳头瘤病毒(HPV)感染的970例妇女进行HPV基因分型检测,以探讨其临床意义.方法 用专用官颈刷采取妇女宫颈的脱落细胞,采用基因芯片法检测970例HPV临床样本,并进行基因分型.结果 970例样本中,HPV感染390例,阳性率40.2%.共检出12种HPV亚型,检出感染单一HPV亚型260例(26.8%),感染两种亚型以上130例(13.4%).低危型主要为HPV6、11,高危型主要为HPVl6、33、52、58、18等.结论 无锡地区妇女宫颈HPV感染率较高,感染亚型主要是6、11型.HPV基因分型检测对于生殖道感染以及子宫颈癌的早期发现以及预防和治疗具有重要意义.     

浙江省温州地区部分体检女性人乳头状瘤病毒基因型的分布

目的 了解浙江省温州地区健康体检女性人乳头状瘤病毒（HPV）感染情况、基因分型及其年龄分布状况，为宫颈癌防治提供参考依据。方法 选择2014年6月至2016年5月在温州医科大学附属第二医院体检中心进行体检的4 089名妇女作为研究对象，根据年龄分为5组，采用流式荧光杂交技术对宫颈脱落细胞标本进行HPV基因分型检测，并对HPV感染率、基因亚型和年龄分布等进行统计分析。结果 4 089名妇女中共检出HPV阳性763例，总感染率为18.66%（763/4 089）。共检出27种亚型，单一亚型感染596例（14.58%，596/4 089），多重感染167例（4.08%，167/1 089），多重感染中以二重感染最常见（78.44%，131/167）。共检出高危型感染575例（14.06%，575/4 089），低危型感染257例（6.29%，257/4 089），高低危型混合感染69例（1.69%，69/4 089）。高危型中52型感染率最高，达18.87%（144/575），其次为53型（9.96%，76/575）、16型（8.91%，68/575）和58型（8.13%，62/575）；低危型感染率前3名分别为81型（7.73%，59/257）、61型（6.16%，47/257）和55型（5.77%，44/257）。不同年龄组HPV总感染率、多重感染率、高危型感染率差异均有统计学意义（2=18.882、19.517、21.113，均P0.01），随着年龄增长，HPV感染率有逐渐增加的趋势，其中59岁及以上年龄组总感染率、多重感染率和高危型感染率均高于其他年龄组。结论 浙江省温州地区HPV感染具有明显的亚型和年龄分布特异性。     

Low prevalence of human papillomavirus (HPV) in Chinese patients with breast cancer

This retrospective study investigated the presence of human papillomavirus (HPV) in Chinese women with breast cancer, and the correlation between HPV infection and carcinogenesis. Tumour and non-cancerous breast tissue samples were obtained from 62 female patients with breast cancer; normal breast tissue samples were obtained from 46 women without breast cancer. HPV DNA was detected by nested polymerase chain reaction using consensus primers; HPV subtypes were determined by reverse dot blot and pyrosequencing analyses. HPV was found in tumour tissue samples from four of the 62 patients (6.5%), while no HPV DNA was detected in either the non-cancerous samples from patients with breast cancer or from the normal breast tissue controls. Of the four HPV-positive cases, three were HPV 16 positive (75%) and one was HPV 18 positive (25%). The low frequency of HPV detected in this study suggests that this infection is not a major risk factor in breast cancer development.     

妊娠及非妊娠妇女宫颈感染人乳头瘤病毒的基因亚型检测及分析

目的:探讨妊娠及非妊娠妇女宫颈感染人乳头瘤病毒(human papilloma virus,HPV)的基因分型情况。方法:收集2012年2月—2013年5月在复旦大学附属金山医院妇产科门诊就诊的684例育龄期女性(非妊娠妇女)和857例妊娠妇女的宫颈上皮细胞标本,采用基因扩增及基因芯片技术对宫颈上皮细胞进行HPV基因亚型检测。结果:非妊娠妇女检出HPV感染195例(感染率28.5%),主要的感染类型为HPV43、16、58等。妊娠妇女检出HPV感染102例(感染率11.9%),主要的感染类型为HPV43、16、58等。妊娠妇女中30岁、30~40岁、40岁的HPV感染率分别为10.9%、15.1%、30%,非妊娠妇女中30岁、30~40岁、40岁的患者HPV感染率分别为25.3%、25.2%、32.2%。结论:妊娠妇女HPV感染率低于非妊娠妇女,两组HPV感染型别基本相同,HPV43、16、58型感染是该院妇产科门诊患者的主要感染型别,非妊娠妇女随年龄增长感染率明显升高。