Asociación entre la infección por el VIH y el Virus del Papiloma Humano: Implicaciones para la prevención del cáncer de cérvix en mujeres VIH positivas
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Casabona, Jordi
Agustí Benito, Cristina
Agustí Benito, Cristina
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327 p.
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Stuardo Ávila, V. Asociación entre la infección por el VIH y el Virus del Papiloma Humano: Implicaciones para la prevención del cáncer de cérvix en mujeres VIH positivas. Universitat Pompeu Fabra; 2010. handle: http://hdl.handle.net/10803/22704
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Programa de doctorat en Biomedicina
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Antecedentes: La infección por el virus del papiloma humano de alto riesgo HPV (HR) es un factor necesario para las lesiones cervicales (SIL) y el cáncer cervical invasivo (ICC). En las mujeres infectadas por el HIV, la infección por HPV es más frecuente y hay un mayor riesgo de ICC. Los objetivos de este estudio son: estimar la prevalencia de HPV (HR) y de lesiones cervicales, describir la distribución de los diferentes genotipos, conocer las características clínico-epidemiológicas y de la historia de cribado de las mujeres coinfectadas por el HIV y el HPV (HR) e identificar los factores asociados a la infección por HPV (HR) y a las alteraciones citológicas en mujeres HIV positivas de Cataluña. Métodos: 479 mujeres HIV positivas provenientes de la cohorte PISCIS participaron en el estudio. Las participantes se sometieron a una exploración ginecológica, citología cervical, captura híbrida (HC2, Digene), genotipado de HPV (Roche lineal-Array PCR) y colposcopia y biopsia, si era necesario. Los datos fueron obtenidos a través de cuestionarios con variables sociodemográficas, conductuales, clínicas y de cribado. Para conocer los factores asociados se utilizó un modelo de regresión logística multivariante. Resultados: La prevalencia de infección por HPV (HR) fue de 33.2%. La prevalencia de ASCUS, LSIL y HSIL fueron 7.9%, 13.8% y 3.8%, respectivamente. Los genotipos más frecuentes fueron HPV16 (23%), HPV53 (20.3%) y HPV52 (16.2%). La frecuencia de cribado anual y la cobertura de cribado dentro de los últimos 2 años en las mujeres HIV positivas coinfectadas por el HPV (HR) fueron de 45.1% y 55.1% respectivamente. Los factores asociados a la infección por HPV (HR) fueron: la edad (OR: 0.9 IC: 0.94- 0 .99), último PAP anormal (OR: 8.2 IC: 4.0-16.9) y 1 versus > 11 PAP a lo largo de la vida (OR: 2.0 IC: 1.1-3.8). Los factores asociados a las alteraciones citológicas fueron: la primera relación sexual ≤18 años (OR: 2.3 IC: 1.1-5.0), último PAP anormal (OR: 10.3 IC: 3.5-30.1), recuento de CD4 <200 cel/mm3 versus >500 cel/mm3 (OR: 5.7 IC: 2.2-14.8) y recuento de CV >10000 copias/mL versus <400 copias/mL (OR: 3.1 IC: 1.4-6.9). Conclusiones: Se confirma en nuestro medio la elevada prevalencia de infección por HPV (HR), de lesiones cervicales y de genotipos con alto potencial oncogénico. Existe un cribado inadecuado consistente con la alta incidencia de ICC entre las mujeres HIV positivas en Cataluña. Es urgente aumentar la sensibilización entre los profesionales de la salud y las mujeres HIV positivas para optimizar la detección y prevención del ICC. Es necesario valorar en esta cohorte de manera longitudinal la asociación entre el HIV y el HPV (HR) para conocer los efectos de la terapia antirretroviral en el desarrollo y progresión de las lesiones cervicales.
Background: High-risk type Human papillomavirus HPV (HR) infection is a necessary factor for cervical squamous intraepithelial lesions (SIL) and invasive cervical cancer (ICC). In HIV infected women, HPV infection is more prevalent and a higher risk of ICC has been identified. The objectives of this study are: to estimate the prevalence of HPV (HR) and cervical lesions, describe the distribution of genotypes, to determine the clinico-epidemiological and screening history of women coinfected by HIV and HPV (HR) and identify the factors associated with HPV (HR) infection and cytological changes in HIV positive women in Catalonia. Methods: 479 HIV infected women were identified from ongoing prospective HIV infected patients cohort. Participants underwent a gynecologic examination, cervical PAP smear, hybrid-capture (HC2, Digene), HPV genotyping (Roche Linear-Array PCR) and colposcopy and biopsy, if necessary. Questionnaires on sociodemographic, behavioral, clinical and cervical cancer screening information were obtained. Multivariable logistic regression modeling was used. Results: HPV (HR) infection prevalence was 33.2%. The prevalence of ASCUS, LSIL and HSIL were 7.9%, 13.8% and 3.8% respectively. Most frequent genotypes were HPV16 (23%), HPV53 (20.3%) and HPV52 (16.2%). The frequency of annual screening and screening coverage within the last two years in HIV positive women coinfected with HPV (HR) were 45.1% and 55.1% respectively. The factors associated to HPV (HR) infection were: age (OR:0.9 CI:0.94-0.99), last PAP smear abnormal (OR:8.2 CI:4.0-16.9) and 1 versus >11 PAP smear lifetime (OR:2.0 CI:1.1-3.8). The factors associated to abnormal cytology were: first sexual intercourse ≤ 18 years (OR: 2.3 CI: 1.1-5.0), the last PAP abnormal (OR: 10.3 CI: 3.5-30.1), CD4 count <200 cells/mm3 versus > 500 cells/mm3 (OR: 5.7 CI: 2.2-14.8) and CV count > 10000 copies/ mL versus <400 copies / mL (OR: 3.1 CI: 1.4-6.9). Conclusion: It is confirmed in our area the high prevalence of HPV (HR) infection, cervical lesions and genotypes with high oncogenic potential. The history of poor cervical cancer screening found is consistent with the high incidence of ICC among HIV infected women in Spain. It is urgent to increase awareness among both health professionals and HIV infected women to optimize the screening and prevention of ICC. It is necessary a longitudinal assessment in this cohort to know the association between HIV and HPV (HR) to determine the effects of antiretroviral therapy in the development and progression of cervical lesions.
Background: High-risk type Human papillomavirus HPV (HR) infection is a necessary factor for cervical squamous intraepithelial lesions (SIL) and invasive cervical cancer (ICC). In HIV infected women, HPV infection is more prevalent and a higher risk of ICC has been identified. The objectives of this study are: to estimate the prevalence of HPV (HR) and cervical lesions, describe the distribution of genotypes, to determine the clinico-epidemiological and screening history of women coinfected by HIV and HPV (HR) and identify the factors associated with HPV (HR) infection and cytological changes in HIV positive women in Catalonia. Methods: 479 HIV infected women were identified from ongoing prospective HIV infected patients cohort. Participants underwent a gynecologic examination, cervical PAP smear, hybrid-capture (HC2, Digene), HPV genotyping (Roche Linear-Array PCR) and colposcopy and biopsy, if necessary. Questionnaires on sociodemographic, behavioral, clinical and cervical cancer screening information were obtained. Multivariable logistic regression modeling was used. Results: HPV (HR) infection prevalence was 33.2%. The prevalence of ASCUS, LSIL and HSIL were 7.9%, 13.8% and 3.8% respectively. Most frequent genotypes were HPV16 (23%), HPV53 (20.3%) and HPV52 (16.2%). The frequency of annual screening and screening coverage within the last two years in HIV positive women coinfected with HPV (HR) were 45.1% and 55.1% respectively. The factors associated to HPV (HR) infection were: age (OR:0.9 CI:0.94-0.99), last PAP smear abnormal (OR:8.2 CI:4.0-16.9) and 1 versus >11 PAP smear lifetime (OR:2.0 CI:1.1-3.8). The factors associated to abnormal cytology were: first sexual intercourse ≤ 18 years (OR: 2.3 CI: 1.1-5.0), the last PAP abnormal (OR: 10.3 CI: 3.5-30.1), CD4 count <200 cells/mm3 versus > 500 cells/mm3 (OR: 5.7 CI: 2.2-14.8) and CV count > 10000 copies/ mL versus <400 copies / mL (OR: 3.1 CI: 1.4-6.9). Conclusion: It is confirmed in our area the high prevalence of HPV (HR) infection, cervical lesions and genotypes with high oncogenic potential. The history of poor cervical cancer screening found is consistent with the high incidence of ICC among HIV infected women in Spain. It is urgent to increase awareness among both health professionals and HIV infected women to optimize the screening and prevention of ICC. It is necessary a longitudinal assessment in this cohort to know the association between HIV and HPV (HR) to determine the effects of antiretroviral therapy in the development and progression of cervical lesions.
Paraules Clau
Virus de la inmunodeficiencia Humana, Virus del Papiloma Humano, cáncer de cérvix, cribado, Human immunodeficiency Virus, Human Papilloma Virus, cervical cancer, screening
Matèries
578 - Virologia
Publicat per
Universitat Pompeu Fabra
