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.

     

宫颈癌筛查“三阶梯”方案的效果观察

目的: 观察宫颈癌筛查“三阶梯”方案在我院妇科阴道镜门诊就诊病人中的应用价值。方法: 选取
2012 － 10 ～ 2014 － 08 就诊于解放军总医院妇科阴道镜门诊的连续病人704 例,以组织病理学为诊断金标准,计
算液基细胞学、高危型人乳头状病毒( Human popilloma virus,HPV) 检测及阴道镜结果的诊断指标。结果: 随年
龄增加,TCT、Hr － HPV、阴道镜及病理阳性率有升高趋势,TCT 和阴道镜统计学检验有显著性差异。TCT 灵敏度
90． 24%,特异度17． 55%,诊断符合率42． 18%,Kappa = 0． 049; HPV 灵敏度95． 11%,特异度21． 28%,诊断符合率
55． 62%,Kappa = 0． 155; 阴道镜灵敏度83． 84%,特异度75． 27%,诊断符合率79． 26%,Kappa = 0． 587。结论: 宫颈
癌筛查“三阶梯”方案可以有效地发现宫颈病变的高危人群,但由于细胞学检查和HPV 检测的特异度较低,使阴
道镜门诊存在过度转诊的现象,阴道镜的诊断价值较高,是三阶梯方案中不可缺少的重要部分。     

海南地区宫颈癌病例的HPV感染状况

 目的　分析本地区宫颈癌患者的HPV感染情况。方法　收集 10 1例治疗前病例的颈管分泌物 ,用PCR荧光定量方法进行HPV6、11、16、18的检测。结果　HPV阳性者 4 4例 ,阳性率 4 3.6 % ,在 <4 0岁、4 0～ 5 0岁、>5 0岁 3个年龄段 ,HPV阳性率分别为 5 9.5 %、35 .9%、2 5 % (P <0 .0 5 )。近 2年与 2年前病例HPV感染率分别是 5 0 %、33.3%。宫颈鳞癌的HPV阳性率明显高于腺癌、腺鳞癌 (P <0 .0 1)。结论　HPV感染是宫颈癌的重要致病因素 ;鳞癌的发生与HPV感染的关系较腺癌更密切 ;在本地区极可能存在除上述 4型以外的已定或未定亚型的感染     

Herd immunity effect of the HPV vaccination program in Australia under different assumptions regarding natural immunity against re-infection

Deterministic dynamic compartmental transmission models (DDCTMs) of human papillomavirus (HPV) transmission have been used in a number of studies to estimate the potential impact of HPV vaccination programs. In most cases, the models were built under the assumption that an individual who cleared HPV infection develops (life-long) natural immunity against re-infection with the same HPV type (this is known as SIR scenario). This assumption was also made by two Australian modelling studies evaluating the impact of the National HPV Vaccination Program to assist in the health-economic assessment of male vaccination. An alternative view denying natural immunity after clearance (SIS scenario) was only presented in one study, although neither scenario has been supported by strong evidence. Some recent findings, however, provide arguments in favour of SIS.     

HPV vaccination with Gardasil®: a breakthrough in women’s health

Human papillomavirus (HPV) represents one of the most common sexually transmitted infections. Although infection is often self-limited, a percentage of women with HPV infection will go on to develop cervical precancerous or cancerous lesions. It is estimated that HPV16 is responsible for approximately half of all cervical cancers worldwide. Several studies have tested vaccines directed against specific HPV types, namely types 6, 11, 16 and 18. This paper reviews these studies, particularly focusing on a quadrivalent (type 6, 11, 16 and 18) HPV L1 virus-like particle vaccine under investigation in Phase III trials at present. Data indicate that this vaccine, referred to as Gardasil^®, can prevent precancerous cervical lesions and early in situ cervical cancers with few adverse effects, and the vaccine has been approved by the FDA for this indication. Another vaccine, HPV16 L1, directed solely against HPV16, has also been demonstrated to be effective (at present, follow-up has been for up to 48 months) in providing protection against persistent infection with this viral strain and preventing HPV16-related cervical intraepithelial neoplasia 2/3, while producing minimal adverse effects in recipients. Given the lack of a pharmacological intervention that can eradicate HPV in infected individuals and the prevalence of cervical cancer secondary to HPV infection across the world, the HPV vaccine represents a significant breakthrough in women’s health.     

高危型人乳头状瘤病毒的感染状态及分型与宫颈病变发生的相关性研究

目的检测高危型人乳头状瘤病毒(HR-HPV)的感染状态与宫颈病变的发生及发展的相关性。方法对我院门诊2 876例妇女采用液基薄层细胞检测(TCT)、第二代杂交捕获法技术(HC2)-HPV-DNA检测及HPV分型检测,以TCT细胞学正常及高危型HPV阳性的妇女295人为目标人群,随访重复TCT细胞学和HPV基因分型,并对TCT细胞学异常的妇女进行阴道镜下宫颈组织活检。分析不同HPV感染型别、感染状态(持续性感染、间断性感染及感染清除)的TCT异常和宫颈病理异常的发生情况。结果目标群体随访1年,持续性HPV感染的女性与HPV感染清除或间断性感染的妇女相比宫颈病变的发生率无显著差异(P0.05);目标群体随访2年,持续性HPV感染女性比HPV感染清除或间断性感染妇女有更高的宫颈病变发生率(P0.01)。多重HPV感染并不比单一型别感染有更高的宫颈病变发生率(P0.05)。高危型HPV16和HPV18持续感染发生率高,且宫颈病变的发生率增加(P0.05)。结论持续性HPV感染2年以上,尤其HPV16及HPV18的持续性感染,发生宫颈病变的风险明显增加。高危HPV型别及感染状态的甄别更有临床指导意义。     

高危HPV感染者心理状况及个性化护理干预效果分析

目的对HPV感染妇女心理状况进行调查分析并探讨个性化护理干预效果。方法选择2017年1～7月在医院确诊为高危HPV感染者180例为HPV阳性组,另选择同期在医院行妇科健康体检者150例为对照组。比较两组综合心理评定结果、SAS评分与SDS评分。对HPV感染者实施个性化护理干预,比较干预前后综合心理评定结果、SAS评分与SDS评分。结果 HPV阳性组综合心理评定量表总均分为(0.97±0.20)分,显著高于对照组(P0.05);阳性项目数显著多于对照组,差异有统计学意义(P0.05)。HPV阳性组焦虑因子评分[(1.10±0.20)分]、抑郁因子[(1.10±0.31)分]、躯体化因子[(1.20±0.30)分]、敌对因子[(1.30±0.32)]评分均显著高于对照组,差异有统计学意义(P0.05)。HPV阳性组SAS评分[(58.8±11.6)分],SDS评分[(57.9±10.3)分]显著高于对照组,差异有统计学意义(P0.05)。干预后,HPV阳性组综合心理评定量表总均分(0.86±0.17)分,阳性项目数(56.1±10.3)个,显著低于干预前,差异有统计学意义(P0.05)。干预后,HPV阳性组综合心理评定量表各因子得分较干预前显著下降,差异有统计学意义(P0.05)。干预后,HPV阳性组SAS[(41.3±7.5)分]、SDS[(40.3±8.1)分]评分均显著低于干预前,差异有统计学意义(P0.05)。结论 HPV感染妇女存在明显的焦虑、抑郁、躯体化等不良情绪,实施个性化护理干预,能够显著改善感染者的不良情绪,有利于病毒的清除。     

某地区6590例妇科门诊患者宫颈人乳头瘤病毒感染情况及基因亚型分析

目的:探讨某地区6590例妇科就诊人群人乳头瘤病毒(HPV)的感染状况及基因亚型的分布特征。方法:选取辽宁省人民医院妇科门诊患者6590例为研究对象,采用HPV-DNA核酸分子快速杂交法检测所有患者的HPV总体感染情况及基因分型。结果:6590例患者中,HPV阳性率为19.36%,其中高危型HPV占91.22%,低危型HPV占8.78%,患者发生多重感染276例,其中双重感染占76.45%;16~29岁患者阳性率(25.18%)最高,50~59岁患者阳性率(20.40%)次之,≥70岁患者阳性率(13.97%)最低。16~29岁患者多重感染率(6.72%)最高,其次为70~83岁患者(6.14%)。高危型感染率前5位依次为HPV16、52、58、53、39,低危型感染前3位为HPV81、11、6。结论:妇科门诊患者中HPV的感染率较高,并以高危型感染为主。定期进行HPV筛查,有利于预防及早期发现宫颈病变。