了解人乳头瘤病毒(HPV)是否可能在子宫颈中建立潜伏期很重要。更好地了解HPV自然史有助于对参加筛查的妇女进行临床咨询,并准确地告知筛查和HPV疫苗接种等健康预防策略。我们评估了有异常细胞学史的老年女性潜伏HPV感染的程度。
我们在奥胡斯进行了一项横断面研究,丹麦,2013年3月至2015年4月。如果妇女因良性疾病而接受宫颈截肢或全子宫切除术,则将其纳入研究。手术前,女性完成问卷调查,并收集宫颈涂片进行HPV检测和形态学评估.对于延迟的评估(即,没有活动性HPV感染的证据,但在组织中检测到HPV),我们选择有异常宫颈细胞学或组织学病史的女性,因为这些女性被认为有潜在感染的风险增加。使用SPF10-DEIA-LipA25测定对宫颈组织进行广泛的HPV检测。
在注册的103名女性中,该分析中包括26个。中位年龄为55岁(四分位间距[IQR]52-65),而且大多数妇女都是绝经后和出生的。一生中性伴侣的中位数为六个(IQR3-10),85%的人报告最近没有新的性伴侣。五名女性(19.2%)在手术时出现活动性感染的迹象,19人接受了潜伏期评估。其中,11例(57.9%)检测到潜伏感染,HPV16是最普遍的类型(50%)。18名有低度或高度细胞学病史但未治疗的女性中,近80%(n=14)患有活动性或潜伏性HPV感染。潜伏感染占主导地位。在六名有高级别细胞学和随后的切除治疗史的妇女中,有两名检测到HPV。都是潜伏感染。
可以在宫颈组织标本中检测到HPV,而没有任何活动性HPV感染的证据。表明潜在的,免疫控制感染。建模研究在估计停止筛查的适当年龄以及评估HPV疫苗接种的影响时,应考虑在其模型中包括潜在状态。
Understanding whether human papillomavirus (HPV) may establish latency in the uterine cervix is important. A better understanding of HPV natural history is useful for clinical counseling of women attending screening and to accurately inform health prevention strategies such as screening and HPV vaccination. We evaluated the extent of latent HPV infections in older women with a history of abnormal cytology.
We conducted a cross-sectional study in Aarhus, Denmark, from March 2013 through April 2015. Women were enrolled if they underwent cervical amputation or total hysterectomy because of benign disease. Prior to surgery, women completed a questionnaire and a cervical smear was collected for HPV testing and morphological assessment. For evaluation of latency (i.e., no evidence of active HPV infection, but HPV detected in the tissue), we selected women with a history of abnormal cervical cytology or histology, as these women were considered at increased risk of harboring a latent infection. Cervical tissue underwent extensive HPV testing using the SPF10-DEIA-LipA25 assay.
Of 103 women enrolled, 26 were included in this analysis. Median age was 55 years (interquartile range [IQR] 52-65), and most women were postmenopausal and parous. The median number of sexual partners over the lifetime was six (IQR 3-10), and 85% reported no recent new sexual partner. Five women (19.2%) had evidence of active infection at the time of surgery, and 19 underwent latency evaluation. Of these, a latent infection was detected in 11 (57.9%), with HPV16 being the most prevalent type (50%). Nearly 80% (n = 14) of the 18 women with a history of previous low-grade or high-grade cytology with no treatment had an active or latent HPV infection, with latent infections predominating. HPV was detected in two of the six women with a history of high-grade cytology and subsequent excisional treatment, both as latent infections.
HPV can be detected in cervical tissue specimens without any evidence of an active HPV infection, indicative of a latent, immunologically controlled infection. Modeling studies should consider including a latent state in their model when estimating the appropriate age to stop screening and when evaluating the impact of HPV vaccination.