Human Papillomavirus-The Most Significant Risk Determinant of Cervical Intraepithelial Neoplasia

Kjær, Susanne K.; Brule, A J van den; Bock, Johannes E.; Poll, P; Engholm, Gerda; Sherman, Mark E.; Meijer, Chris J.L.M.

doi:10.1097/00128360-199707000-00020

Cited by 36 publications

(49 citation statements)

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“…Recruitment was from May 1991 to January 1993.We included 11 088 women in the study, all of whom gave informed consent. A detailed description of the enrolment procedure is provided elsewhere 7. The study was approved by the local ethics committee.…”

Section: Methodsmentioning

confidence: 99%

Type specific persistence of high risk human papillomavirus (HPV) as indicator of high grade cervical squamous intraepithelial lesions in young women: population based prospective follow up study

Kjær

Brule

Paull

et al. 2002

BMJ

382

273

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Objectives To investigate the role of human papillomavirus (HPV) in the development of cervical neoplasia in women with no previous cervical cytological abnormalities; whether the presence of virus DNA predicts development of squamous intraepithelial lesion; and whether the risk of incident squamous intraepithelial lesions differs with repeated detection of the same HPV type versus repeated detection of different types. Design Population based prospective cohort study. Setting General population in Copenhagen, Denmark. Participants 10 758 women aged 20-29 years followed up for development of cervical cytological abnormalities; 370 incident cases were detected (40 with atypical squamous cells of undetermined significance, 165 with low grade squamous intraepithelial lesions, 165 with high grade squamous intraepithelial lesions). Main outcome measures Results of cervical smear tests and cervical swabs at enrolment and at the second examination about two years later. Results Compared with women who were negative for human papillomavirus at enrolment, those with positive results had a significantly increased risk at follow up of having atypical cells (odds ratio 3.2, 95% confidence interval 1.3 to 7.9), low grade lesions (7.5, 4.8 to 11.7), or high grade lesions (25.8, 15.3 to 43.6). Similarly, women who were positive for HPV at the second examination had a strongly increased risk of low (34.3, 17.6 to 67.0) and high grade lesions (60.7, 25.5 to 144.0). For high grade lesions the risk was strongly increased if the same virus type was present at both examinations (813.0, 168.2 to 3229.2). Conclusions Infection with human papillomavirus precedes the development of low and high grade squamous intraepithelial lesions. For high grade lesions the risk is greatest in women positive for the same type of HPV on repeated testing.

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Section: Methodsmentioning

confidence: 99%

Type specific persistence of high risk human papillomavirus (HPV) as indicator of high grade cervical squamous intraepithelial lesions in young women: population based prospective follow up study

Kjær

Brule

Paull

et al. 2002

BMJ

382

273

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“…[1][2][3] The high risk HPV types 16 and 18 are also frequently found in invasive carcinoma tissue from both these anatomical sites. [4][5][6] Anal intraepithelial lesions (squamous cell dyskaryosis and AIN) are common in homosexual men with increased risk associated with HIV seropositivity, advancing immunosuppression (associated with declining CD4 count), the presence of high risk oncogenic HPV infection, and epidemiological factors such as smoking.…”

Section: Introductionmentioning

confidence: 99%

A study of anal intraepithelial neoplasia in HIV positive homosexual men

Lacey¹,

Wilson²,

Tilston³

et al. 1999

Sexually Transmitted Infections

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Objectives:To determine the prevalence of high grade anal intraepithelial neoplasia (HGAIN), the value of anal cytology in screening for HGAIN, and the characterisation of epidemiological factors and human papillomavirus (HPV) types. Methods: Prospective cohort study of HIV positive homosexual men. Subjects were interviewed, underwent STD, anal cytological, and HPV screening at enrolment and at subsequent follow up visits with anoscopy and biopsy at the final visit. 57 enrolled, average CD4 count 273 ×10 6 /l (10-588); 41 completed the cytological surveillance over the follow up period (181 visits, average follow up 17 months), 38 of these had anoscopy and anal biopsy. Results: Oncogenic HPV types were detected in 84% and high grade dyskaryosis in 10.5% (6/57) at enrolment. There was a 70% incidence of high grade dyskaryosis during follow up in patients with negative/warty or low grade dyskaryosis at enrolment. Anoscopy correlated with histology in high grade AIN lesions (sensitivity 91%, specificity 54%) and cytology was 78% sensitive (18/23) for HGAIN on biopsy. Conclusions: AIN and infection with multiple oncogenic HPV types are very common among immunosuppressed HIV positive homosexual men. Apparent progression from low to high grade cytological changes occurred over a short follow up period, with no cases of carcinoma. All 23 cases of HGAIN were predicted by cytology and/or anoscopy. Future studies focusing on the risk of progression to carcinoma are needed before applying anal cytology as a screening tool for AIN in this population. (Sex Transm Inf 1999;75:172-177)

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“…1 Although more than 30 genital types have been described, HPV-16 is responsible for 50% to 60% of cervical cancers. 2 However, HPV-16 infection in the genital tract does not necessarily lead to malignant disease; most women seem to clear the infection spontaneously within the first 48 months from detection of the virus.…”

mentioning

confidence: 99%

“…3 In contrast, persistent detection of HPV-16 DNA in women with or without abnormal cytology is associated with an increased risk for the development of cervical cancer. 1,4 Strong evidence suggests that HPV-specific cell-mediated immune (CMI) response is pivotal in clearing HPV. 5 However, the target antigen remains to be elucidated.…”

mentioning

confidence: 99%

Cell-Mediated Immune Responses to Human Papillomavirus 16 E6 and E7 Antigens as Measured by Interferon Gamma Enzyme-Linked Immunospot in Women With Cleared or Persistent Human Papillomavirus Infection

Farhat

Nakagawa

Moscicki

2009

International Journal of Gynecological Cancer

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Cell mediated immune responses have been thought to be important in the control of HPV infections. We examined cell-mediated immune responses to HPV 16 E6 and E7 in the peripheral blood using IFN-γ enzyme-linked ImmunoSpot (ELISpot) assay in women with HPV 16 infection who showed clearance and compared these women to women with HPV 16 persistence. Women participating in a longitudinal study of cervical HPV were recruited once cervical HPV 16 infection was detected by PCR. Four groups of women were examined; 1) persistent 2) intermittent 3) transient and 4) cleared. Ninety-six samples from 55 women were compared. Comparing IFN-γ ELISpot to HPV 16 clearance, of 10 women with recent persistence, none had response to either E6 or E7; 14/24 women with recent clearance had E6 and 8/24 had E7 response. Women with intermittent persistence behaved similar to clearance group than recent persistors: 50% were positive to E6 and 20% to E7. In summary, anti E6 responses appeared critical in the immediate control of HPV and in some women an immune tolerance eventually develops if HPV is not eliminated soon after infection.

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Human Papillomavirus-The Most Significant Risk Determinant of Cervical Intraepithelial Neoplasia

Cited by 36 publications

References 0 publications

Type specific persistence of high risk human papillomavirus (HPV) as indicator of high grade cervical squamous intraepithelial lesions in young women: population based prospective follow up study

Type specific persistence of high risk human papillomavirus (HPV) as indicator of high grade cervical squamous intraepithelial lesions in young women: population based prospective follow up study

A study of anal intraepithelial neoplasia in HIV positive homosexual men

Cell-Mediated Immune Responses to Human Papillomavirus 16 E6 and E7 Antigens as Measured by Interferon Gamma Enzyme-Linked Immunospot in Women With Cleared or Persistent Human Papillomavirus Infection

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