Human papillomaviruses and cervical cancer in Bangkok. I. Risk factors for invasive cervical carcinomas with human papillomavirus types 16 and 18 DNA

Personal interviews, tests for antibodies to herpes simplex virus type 2, Treponema pallidum, and hepatitis B, tests for hepatitis B surface antigen (HBsAg), and polymerase chain reaction-based assays for human papillomavirus (HPV) DNA in cervical scrapings were obtained from 190 women with squamous cell and 42 women with adenomatous cervical carcinoma and from 291 hospitalized controls diagnosed in Bangkok, Thailand, between September 1991 and September 1993. Risk was strongly associated with oncogenic HPV types, with types 16 and 18 predominating in squamous and adenomatous lesions, respectively. The 126 cases with HPV-16 and the 42 cases with HPV-18 were compared with 250 controls with no evidence of any HPV. The risk of both viral tumor types increased with decreasing age at first intercourse in this predominantly monogamous population, which may be explained by more visits to prostitutes by the husbands of cases with early than late age at first intercourse. HPV-16 tumors were weakly associated with HBsAg carrier state and smoking. The risk of tumors of both viral types increased with parity and use of oral contraceptives but not with injectable progestogens. Factors that may predispose to persistent, oncogenic HPV-16 or -18 infection may include estrogens or progestins in the presence of estrogens, immunosuppression, and smoking, but other factors related to low socioeconomic status are also involved.     

Socioeconomic differences in cervical cancer: two case-control studies in Colombia and Spain.

OBJECTIVES: This study examined the causes of socioeconomic differences in invasive cervical cancer in two countries that differ substantially in cervical cancer incidence and economic development. METHODS: Data were derived from two case-control studies carried out in Spain and Colombia; there were 373 case subjects, 387 control subjects, and 425 husbands interviewed with a structured questionnaire. Exfoliated cells were obtained from cervical or penile scrapes and tested for human papillomavirus (HPV) DNA. RESULTS: Relative to better educated women, women with low educational levels in both countries reported fewer Pap smears and had a higher prevalence of HPV DNA. The prevalence ratio of HPV DNA across educational strata was twofold in Spain and fourfold in Colombia. In both countries, husbands of poorly educated women reported higher use of prostitutes than husbands of better educated women. In Colombia, 30% of husbands of poorly educated women harbored HPV DNA, compared with 10% of husbands of better educated women. CONCLUSIONS: Socioeconomic differences in invasive cervical cancer could be partly explained by differences in the prevalence of HPV DNA and by a lower use of preventive care.     

Human papillomavirus infection among human immunodeficiency virus-infected women in Maharashtra,India

Introduction

Frequency and distribution of HPV types in HIV-infected women with and without cervical neoplasia and their determinants have not been widely studied in India. We report and discuss HPV prevalence and type distribution in HIV-infected women.

Methods

HPV genotyping was done using cervical samples from 1109 HIV-infected women in a cross-sectional study.

Results

Any HPV was detected in 44.8% and high-risk ones in 41.0% women. Frequency of single and multiple high-risk infections were 26.7% and 14.3%, respectively. Frequencies of high-risk HPV infections in women with and without cervical neoplasia were 73.5% and 37.6%, respectively. HPV16 was the most common genotype, present in 11.5%, and 58.5% of women with cervical intraepithelial neoplasia (CIN) 2 and 3. Other most common high-risk HPV types in CIN 2–3 lesions were HPV 31 (22.6%); 56 (13.2%); 18 and 68a (11.3%) and 33, 35 and 51 (9.4%); and 70 (7.5%). Women under 30 or over 44 years, no abortions, and women with diagnosis of HIV infection within the last 5 years were at high risk of multiple oncogenic HPV infection.

Conclusion

We observed a very high frequency of high-risk HPV and multiple infections in HIV-infected women.     

Folate,vitamin B12, and homocysteine status. findings of no relation between human papillomavirus persistence and cervical dysplasia

OBJECTIVES: Human papillomavirus (HPV) infections are the cause of most, if not all, cervical cancers. Women consistently positive for oncogenic type HPV infections have a greater risk of developing cervical dysplasia compared with women transiently infected. HPV infection alone appears to be insufficient to produce disease, suggesting that other cofactors may be needed. Folate, vitamin B12, and homocysteine, through their role in DNA methylation, may be involved in cervical neoplasia. METHODS: This study examined the associations between HPV persistence and circulating folate, vitamin B12, and homocysteine levels among 91 low-income Hispanic women. Further, the relation of these nutrients to cervical pathology was evaluated. HPV status was determined at two visits approximately 3 mo apart. RESULTS: Adjusted mean circulating concentrations of folate, vitamin B12, and homocysteine were not statistically different between women with two positive HPV tests, one positive test, or two negative HPV tests. No association was observed between tertiles of folate, vitamin B12, or homocysteine and HPV persistence risk. Further, adjusted mean levels of these nutrients were not statistically different between cytologic grades. CONCLUSIONS: Results from this small study did not support a role for folate, vitamin B12, or homocysteine in HPV persistence or cervical dysplasia.     

Design and methods of the Ludwig-McGill longitudinal study of the natural history of human papillomavirus infection and cervical neoplasia in Brazil. Ludwig-McGill Study Group.

This article reports on a large longitudinal study, begun in 1993, of the natural history of human papillomavirus (HPV) infection and cervical neoplasia in a population of low-income women in S?o Paulo, Brazil, a city with one of the highest risks worldwide for cervical cancer. Known as the Ludwig-McGill cohort study, the epidemiological investigation focuses on persistent infection with oncogenic HPV types as the precursor event leading to cervical neoplasia. The objectives of this study are to: 1) study the epidemiology of persistent cervical HPV infection in asymptomatic women, 2) investigate whether persistent HPV infection increases risk of low-grade and high-grade cervical lesions, 3) search for determinants of persistent HPV infection, 4) search for molecular variants of HPV that may be associated with an increased risk of lesions, 5) investigate whether viral burden is correlated with persistent infections and with lesion risk, 6) study the antibody response to HPV as a predictor of persistence and lesion progression, and 7) examine the role of HLA typing and codon 72 p53 gene polymorphism in mediating HPV persistence and lesion severity. The study accrued 2,528 female subjects through March 1997. Subjects were followed up every 4 months in the first year, with twice-yearly return visits to take place in subsequent years. Participants undergo a questionnaire-based interview, have a cervical specimen taken for Pap cytology and HPV testing, and have a blood sample drawn for HPV antibody testing. A cervicography is performed once in the first year and every two years thereafter. In this article we describe the design and methods of the study, provide baseline cohort characteristics, and present a preliminary assessment of the prognostic value of baseline HPV status.     

陇南市武都区妇女人乳头状瘤病毒感染状况调查及危险因素分析

目的:调查甘肃省宫颈癌高发区妇女子宫颈上皮内人乳头状瘤病毒(human papillomavirus,HPV)感染状况及其危险因素。方法:采用横断面研究,于2005年在甘肃省陇南市武都区以整群抽样的方法选择30～49岁、有性生活史的农村女性人群进行HPV感染状况调查、宫颈脱落细胞HPV DNA检测及细胞学和病理学诊断。所有女性按年龄分层入组,进行问卷调查、宫颈脱落细胞采集、第二代杂交捕获试验检测HPV。结果:2 052例受检者中,HPV总感染率为7.89%(168/2 052),其中,宫颈正常人群HPV感染率为5.49%(108/1 968),CINⅠ妇女HPV感染率为47.06%(16/34),CINⅡ及以上病变的妇女HPV感染率为78.13%(25/32)。随着宫颈上皮内瘤样病变程度增加,HPV感染率明显上升(χ2=17.996,P<0.001)。HPV感染与丈夫婚外性行为、宫颈柱状上皮异位、尿路感染、阴道滴虫感染等因素有关。结论:武都区30～49岁妇女中HPV感染率为7.89%;随着宫颈上皮内瘤样病变程度的增加,HPV感染率增加;影响HPV感染率的危险因素有丈夫婚外性行为、妇女宫颈柱状上皮异位、尿路感染、阴道滴虫感染等。     

Refocusing HIV / AIDS interventions in Thailand: the case for male sex workers and other homosexually active men

Although studies have shown that male sex workers in Thailand are at increased risk of HIV infection, no sustained strategy have so far been directed towards homosexually active men in the country. This paper brings together data from qualitative research carried out in Pattaya and Bangkok, with data generated during a bar-based intervention in Bangkok, to develop a taxonomy of sites in which the recruitment of male commercial sex can occur. The researchers also examined the sexual networks of Thai male sex workers and their clients in order to show the overlap of commercial and non-commercial male-male sex sites, and the intersection of male commercial sex with heterosexual sex. Previous efforts directed towards Thai male sex workers have been non-continuous; largely restricted to high-profile tourist areas; have not acknowledged the importance of recreational sex; and have not built up a capacity for ongoing intervention. With a change of focus, interventions targeted at sex workers could reduce the risks of HIV infection among organized and freelance sex workers as well as their commercial and male and female casual sex partners. Foremost, however, is the need to commit to well planned and long range interventions directed by and at male sex workers.     

Refocusing HIV/AIDS interventions in Thailand: The case for male sex workers and other homosexually active men

Although seroprevalence studies have shown that Thai male sex workers are at heightened risk of HIV infection, no sustained preventive strategies have so far targeted homosexually active men in Thailand. In this paper, we bring together data from qualitative research carried out in Pattaya (McCamish and Sittitrai 1995, 1997) and Bangkok (Storer 1999a, 1999b), with data generated during a bar-based intervention in Bangkok (Carl, unpublished report), to develop a taxonomy of sites in which the recruitment of male commercial sex can occur. We also examine the sexual networks of Thai male sex workers and their clients in order to demonstrate the overlap of commercial and non-commercial male-male sex sites, and the intersection of male commercial sex with heterosexual sex. Previous interventions directed towards Thai male sex workers been non-continuous; largely restricted to high-profile tourist areas, have not acknowledged the importance of recreational sex; and have not built up a capacity for ongoing intervention. With a change of focus, interventions directed towards sex workers could reduce the risks of HIV infection among both organized and freelance sex workers as well as their commercial and male and female casual sex partners. First, however, there needs to be a commitment to well planned and long range interventions directed by and at male sex workers.     

HIV prevalence among populations of men who have sex with men--Thailand, 2003 and 2005

In 2003 and 2005, the Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration and its partners conducted surveillance of human immunodeficiency virus (HIV) prevalence and risk factors among populations of men who have sex with men (MSM) in Thailand. In 2003, the assessment was conducted in Bangkok among a sample of MSM. In 2005, in addition to Bangkok, the assessment was conducted in Chiang Mai and Phuket provinces, and participants were categorized as MSM, male sex workers (MSW), or transgendered persons (TG). This report compares HIV prevalence among MSM in Bangkok during 2003 and 2005, reports HIV prevalence among the three populations in 2005, and summarizes the results of univariate and multivariate analysis of risk factors for HIV infection in 2005. The results indicated a significant increase in HIV infection among MSM in Bangkok from 2003 to 2005. The findings also indicated that in 2005, HIV infection was widespread among MSM, MSW, and TG in the three study locations. Moreover, the following risk factors were independently associated with HIV infection: being recruited from Bangkok or Chiang Mai (MSM), older age (MSM and TG), being recruited from a park or street location (MSW and TG), drug use (MSM), self-reporting a history of sexually transmitted infections (MSW), and self-reporting a previous HIV-positive test result or refusing to disclose a previous HIV test result (MSM and MSW). Sex with women during the preceding 3 months was inversely associated with HIV prevalence among MSW. More effective behavioral and biomedical interventions for MSM, MSW, and TG are needed to stop the spread of HIV in these populations.     

2007年山东省部分城市女性多性伴者行为监测结果分析

[目的]了解山东省女性多性伴者行为特征及性病艾滋病感染状况,为实施有效的干预措施和防治对策提供信息和依据。[方法]2007年7～9月对娱乐场所的女性多性伴者进行匿名问卷调查和血标本收集。[结果]共调查女性多性伴者1197人,年龄15～45岁,以低年龄组（≤24岁）、未婚、初中及以下文化程度为主,对艾滋病3种传播途径全部回答正确者占76．9％,最近1个月商业性行为每次都使用安全套者639例,占53．6％;与固定性伴最近一个月性行为每次都使用安全套的比例低,仅为17．6％;45．6％的调查对象出现过性病症状,29．8％的人自愿做过艾滋病病毒检测。[结论]山东省女性多性伴人群艾滋病阳性率目前总体仍处于较低水平,但高危行为广泛存在,需要实施综合干预,加大对该类人群的健康教育。     

女性性工作者人乳头状瘤病毒流行概况及型别分布

人乳头状瘤病毒(HPV)与宫颈癌、鳞状上皮内病变及尖锐湿疣等诸多疾病相关,而女性性工作者是HPV感染的核心人群,对HPV在该人群中的流行情况研究意义重大.不同文献报道的该人群的HPV的感染率差别较大,从新加坡报道的14.4%到越南报道的84.8%不等.研究女性性工作者中HPV流行概况及其型别分布,有利于制定最佳的疫苗接种方案,使HPV疫苗发挥最大作用.此文对这一人群的HPV流行概况及型别分布等研究作了综述.     

女性性工作者人乳头状瘤病毒流行概况及型别分布

人乳头状瘤病毒(HPV)与宫颈癌、鳞状上皮内病变及尖锐湿疣等诸多疾病相关,而女性性工作者是HPV感染的核心人群,对HPV在该人群中的流行情况研究意义重大.不同文献报道的该人群的HPV的感染率差别较大,从新加坡报道的14.4%到越南报道的84.8%不等.研究女性性工作者中HPV流行概况及其型别分布,有利于制定最佳的疫苗接种方案,使HPV疫苗发挥最大作用.此文对这一人群的HPV流行概况及型别分布等研究作了综述.     

Human papillomaviruses and cervical cancer in Bangkok. II. Risk factors for in situ and invasive squamous cell cervical carcinomas

To identify risk factors for progression of intraepithelial cervical lesions, 190 women with invasive cervical cancer were compared with 75 women with in situ disease diagnosed in Bangkok, Thailand, between September 1991 and September 1993. Polymerase chain reaction-based assays for type-specific human papillomavirus (HPV) DNA in cervical scrapings revealed oncogenic types in 79% of invasive and 57% of intraepithelial tumors. Types 16 and 18, but not types 31/33/35/39, were more common in invasive than intraepithelial tumors, and untyped HPV DNA was found more commonly in the in situ lesions, suggesting that in situ disease is four times more likely to become invasive if due to type 16 or 18 than to other causes, and that tumors with only untyped HPV are not at increased risk of progression. After controlling for HPV type, the risk of developing invasive diseases, compared with the risk of developing intraepithelial lesions, was not related to any of a large number of sexual and hormonal factors considered or to smoking, suggesting that any cofactors these variables represent act before the development of in situ carcinoma. Two indices of socioeconomic status were associated with a reduced risk of only invasive disease, suggesting the existence of unknown protective factors that operate after intraepithelial lesions develop.     

承德地区HPV感染及危险因素分析

目的 了解河北省承德市女性宫颈人乳头瘤病毒（HPV）感染情况,分析HPV感染的危险因素,为HPV感染及宫颈癌防治提供理论依据。方法 于2013年1月-2016年1月在承德市8县3区选取4 250名女性进行问卷调查、液基薄层细胞学检查（TCT）及宫颈HPV DNA检测,对HPV16/18型和细胞学提示不能明确意义的非典型鳞状上皮细胞（ASCUS）、非典型腺上皮细胞（AGC）及以上患者进行阴道镜检查、组织活检及病理检查,分析不同宫颈病变及年龄组HPV感染情况,采用多因素logistic回归模型分析HPV感染危险因素。结果 承德地区4 250名妇女HPV感染819例,感染率为19.27%,最常见的5种HPV高危型别依次为16、58、52、39、51型。伴随宫颈上皮内瘤变（CIN）级别升高,HPV感染率升高,宫颈癌HPV感染率为100%。<20岁组HPV感染率最高,为21.74%;30~49岁及≥60岁组为HPV感染高峰。吸烟、首次性生活年龄过早、受教育程度低（高中以下）、接触性出血和宫颈柱状上皮异位为HPV感染的危险因素,避孕套避孕和了解宫颈癌及HPV为HPV感染的保护因素。结论 HPV感染与CIN及宫颈癌密切相关,加强对具有HPV感染危险因素人群的筛查及管理可有效预防宫颈癌的发生。     

Cervical papillomavirus infection and cervical dysplasia in Hispanic, Native American, and non-Hispanic white women in New Mexico.

BACKGROUND: Human papillomavirus infections of the cervix are found with varying frequencies in different populations worldwide, and have been associated with cervical cytologic abnormalities. METHODS: We studied 1,603 randomly selected Hispanic, Native American, and non-Hispanic White women in New Mexico to determine the prevalence of cervical HPV infection in these ethnic groups, and its association with Pap smear abnormalities, using a new commercial dot-blot hybridization assay. RESULTS: Nine percent of all women screened had evidence of cervical HPV infection (13.7% of non-Hispanic White women, 9.7% of Hispanics, and 6.6% of Native American women). Prevalence was higher in younger women ages 14-19 years than in older age groups. Over half of women with cervical HPV infection (n = 145) had normal Pap smears. The proportion of infected women increased among those with more advanced cytopathologic abnormalities; 5.6 percent with normal Pap smears had cervical HPV vs 66.7 percent with moderate-severe dysplasia. CONCLUSIONS: Cervical HPV infection is common among New Mexico clinic attendees, varies in prevalence among the three major ethnic groups, and is strongly associated with cervical cytopathologic abnormalities.     

2009年高密市部分暗娼人群艾滋病相关知识、行为和HIV感染状况调查

[目的]了解高密市暗娼人群(CSW)艾滋病相关知识知晓情况、行为特征及艾滋病、梅毒感染状况,为制定有效的干预措施和防治对策提供信息和依据。[方法]2009年7～9月对高密市部分娱乐场所的CSW 236人进行问卷调查,并检测HIV、梅毒抗体。[结果]合计调查CSW 236人,艾滋病相关知识知晓率为54.80%;获取艾滋病相关知识的途径是免费宣传材料的占67.37%,是电视的占54.24%,是报刊书籍的占41.95%;最近1个月商业性行为每次都使用安全套者占55.93%;与固定性伴最近一个月性行为时每次都使用安全套者占13.51%;22.46%的人出现过性病症状;出现性病症状时,28.30%的人选择到综合医院处理,35.85%的人选择到私人诊所就诊;16.10%的人自愿做过艾滋病病毒抗体检测。236人均未检出HIV抗体阳性,检出梅毒抗体阳性者13例。[结论]高密市CSW艾滋病阳性率目前仍处于较低水平,但高危行为广泛存在。     

HPV分型及高危八型定量检测在宫颈病变中的意义

目的分析宫颈病变中的人乳头瘤病毒的亚型分布及病毒载量的情况,以及其与宫颈疾病进展的关系。方法潮州中心医院就诊的220例液基细胞学检查异常的患者行阴道镜检查及组织病理学检查。收集宫颈脱落细胞标本,运用HybriMax导流杂交技术检测HPV的21个亚型,运用实时荧光PCR定量检测八个高危亚型的病毒载量。结果 220例样本中,HPV感染率为87.3%,其中HPV16是最主要的基因型(50.91%),随着宫颈病变程度的增高,总HPV感染率和HPV16感染率逐渐升高。HPV58,HPV33,HPV52,HPV31和HPV18是仅次于HPV16的五种基因亚型,其检出率分别为22.73%,11.82%,11.36%,5.9%和4.54%。高危HPV亚型的病毒载量与宫颈病变的严重程度呈正相关(r=0.373,P<0.001)。结论尽管HPV52和HPV58是该地区HPV感染的主导亚型,但在宫颈病变患者中HPV感染以HPV16为主,而与宫颈癌最相关的是HPV16和HPV18。病毒载量是一个潜在的确定子宫颈癌及癌前病变的辅助指标。     

青海地区藏汉回族妇女宫颈人乳头病毒基因亚型分布及与宫颈病变的关系

目的:了解青海地区藏汉回族妇女宫颈人乳头瘤病毒(HPV)感染率和基因亚型分布,分析其与宫颈病变的关系。方法:采用医用核酸分子快速导流杂交基因芯片技术,于2012年1月~2013年12月对青海玉树、西宁及海南地区藏族745例、汉族2594例、回族426例共计3765例妇女进行HPV基因分型检测,同时行薄层液基细胞学检查(TCT),两项阳性者进一步做病理组织学活检。结果:3765例妇女中HPV感染488例,阳性率为12.96%(488/3765),其中高危、低危、单一及复合型HPV阳性率分别为94.67%、5.33%、92.01%、7.99%;藏汉回族阳性率分别为15.84%、12.10%、13.15%,各族中均以HPV l6、58感染比例最高。单一感染率和复合感染率3民族间差异具有统计学意义;而高危型感染率和低危型感染率3民族间差异无统计学意义。藏汉回族宫颈癌及宫颈上皮内瘤变(CIN)中趋于集中的HPV亚型为HPVl6、58、52、53、18、39、31和45。结论:HPV阳性率藏族略高,藏汉回族以高危和单一HPV感染阳性为主;藏汉回族HPV阳性谱及宫颈癌、CIN均以HPVl6、58感染为主;单一感染更易导致宫颈癌的发生。     

Chapter 5: Updating the natural history of HPV and anogenital cancer

The major steps in cervical carcinogenesis include infection of the metaplastic epithelium of the cervical transformation zone with one or more of the 12-18 carcinogenic types of human papillomavirus (HPV) infection, viral persistence, clonal progression of the persistently-infected epithelium to cervical precancer, and invasion. Although these fundamental steps are established, several new epidemiologic studies have shed light on the factors that influence each of these transitions. The importance of the transformation zone in cervical cancer has been extended to other HPV-induced cancers such as anal or tonsillar cancers. Natural history studies show that HPV with normal cervical cytology and cervical intraepithelial neoplasia (CIN) grade 1 behave similarly, with the majority of both showing regression. Although these studies have demonstrated the importance of HPV persistence in the development of precancer CIN-3, the timing from infection to evidence of CIN-3 varies from 1 to 10 years. Whether equivalent lesions diagnosed later differ in their natural history remains unknown. Several factors have been implicated in enhancing persistence and/or progression. However, none are consistently associated with both except age: young women are less likely to show persistence and older women with persistence are more likely to be at risk of invasive cancer. Recent studies have also underscored the importance of the host immune response in clearance of established infections. Finally, data on non-cervical HPV infections, such as penile infections are limited to date compared to cervical infections. Several ongoing cohort studies should give us further insight into male infections in the near future.     

The male street prostitute: a vector for transmission of HIV infection into the heterosexual world

Two hundred and eleven New Orleans male street prostitutes were interviewed and tested for antibodies to the human immunodeficiency virus (HIV). The subjects' lifestyle characteristics and their sex and drug use practices were evaluated to determine the prostitutes' potential to function as a vector for transmission of HIV into populations with currently low infection rates. Information about the customers of the male prostitutes was also obtained from the sample. The period prevalence of HIV in the sample was 175/1000. Many of the male prostitutes reported having wives or girlfriends, some of whom were prostitutes themselves. The prostitutes perceived a majority of their male customers to be heterosexual or bisexual (indicating sexual contact with women as well as men), many (39%) were thought to be married. Results from the study support the argument that male prostitutes serve as a bridge of HIV infection into populations with currently low infection rates through contact with both non-customer sexual partners and customers and thus indirectly to spouses and sexual partners of these individuals.