RESUMEN
OBJECTIVE: To examine the association of knowledge about human papillomavirus (HPV) on the time to completion of the 3-dose quadrivalent vaccine series in an inner-city population of adolescent female subjects at high risk for infection. STUDY DESIGN: We prospectively followed 139 female subjects aged 14-20 years enrolled in a vaccine surveillance study in New York City during a period of at least 24 months. Participants were given a 30-item true or false survey on HPV at enrollment and ranked according to the number of correct responses. Multivariate Cox regression was used to examine the association between level of knowledge about HPV and time to completion (in days) of vaccine dose 1-3, dose 1-2, and dose 2-3. RESULTS: Overall time to completion of the 3-dose vaccine ranged from 158 days to 1114 days. Participants in the high knowledge group (top quartile) were significantly more likely to complete the 3-dose series earlier (hazard ratio 1.69, 95% CI 1.03-2.77; P = .04), in particular doses 2-3 (hazard ratio 1.71, 95% CI 1.02-2.89; P = .04), than those with low-to-moderate knowledge (bottom 3 quartiles). CONCLUSIONS: These findings suggest that knowledge of HPV is associated with shorter time to complete the 3-dose HPV vaccine series. Educational campaigns at time of vaccination may be important to improve vaccine adherence.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Esquemas de Inmunización , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Adolescente , Niño , Femenino , Humanos , Programas de Inmunización , Ciudad de Nueva York , Papillomaviridae , Cooperación del Paciente , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Población Urbana , Poblaciones Vulnerables , Adulto JovenRESUMEN
BACKGROUND: A few recent studies have suggested that other sexually transmitted infections may increase the likelihood of a human papillomavirus (HPV) infection progressing to high-grade cervical neoplasia and cancer. GOAL: The goal was to assess whether exposures to Chlamydia trachomatis, human T-cell lymphotrophic virus type 1 (HTLV-I), and/or human simplex virus type 2 (HSV-2) are greater in colposcopy patients with cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) than in patients with low-grade cervical neoplasia (CIN1). STUDY DESIGN: Sequential patients (n=447) attending a colposcopy clinic in Kingston, Jamaica, a country with high cervical cancer rates and high HTLV-I prevalence, were tested for (1) HPV DNA by L1 consensus primer (MY09/11) polymerase chain reaction assays, (2) C trachomatis DNA by ligase chain reaction, (3) C trachomatis antibodies by both microimmunofluorescence and a peptide (VS4) enzyme linked immunosorbent assay (ELISA), (4) HTLV-I antibodies by ELISA confirmed by western blotting, and (5) HSV-2 antibodies by a recombinant HSV-2-specific ELISA. Odds ratios and 95% confidence intervals were estimated with use of multinomial logistic regression models. RESULTS: HPV DNA detection was associated with grade of cervical neoplasia but other evaluated sexually transmitted infections were not. CONCLUSIONS: HTLV-I, C trachomatis, and/or HSV-2 were not associated with severity of cervical neoplasia in Jamaican women.
Asunto(s)
Papillomaviridae/aislamiento & purificación , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/microbiología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/microbiología , Adulto , Anticuerpos Antibacterianos/análisis , Anticuerpos Antivirales/análisis , Western Blotting , Chlamydia trachomatis/aislamiento & purificación , Colposcopía , ADN Bacteriano/análisis , ADN Viral/análisis , Ensayo de Inmunoadsorción Enzimática , Femenino , Herpesvirus Humano 2/aislamiento & purificación , Virus Linfotrópico T Tipo 1 Humano/aislamiento & purificación , Humanos , Jamaica/epidemiología , Persona de Mediana Edad , Oportunidad Relativa , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/virología , Displasia del Cuello del Útero/patología , Displasia del Cuello del Útero/virologíaRESUMEN
Evidence from several sources has suggested that adeno-associated virus (AAV) infection might protect against cervical cancer, in part, by interfering with human papillomavirus (HPV)-induced tumorigenesis. Detection of AAV type 2 (AAV-2) DNA in cervical tissues has been reported. However, there have been few in vivo studies of women with cervical HPV infection or neoplasia, and these have reported inconsistent results. Therefore, we used polymerase chain reaction (PCR) assays targeted to the AAV-2 rep and cap genes to test tissue specimens from women in an epidemiological study of cervical neoplasia in Jamaica. We tested 105 women with low-grade cervical intraepithelial neoplasia (CIN-1), 92 women with CIN-3/carcinoma in situ or invasive cancer (CIN-3/CA), and 94 normal subjects. PCR amplification of human beta-globin DNA was found in almost all cervical specimens, indicating that these materials were adequate for PCR testing. The prevalence of HPV DNA, determined by HPV L1 consensus primer PCR was, as expected, strongly associated with presence and grade of neoplasia. Each of the AAV PCR assays detected as few as 10 copies of the virus genome. However, none of the 291 cervical specimens from Jamaican subjects tested positive for AAV DNA. Negative AAV PCR results were also obtained in tests of cervical samples from 79 university students in the United States. Exposure to AAV was assessed further by serology. Using a whole virus AAV-2 sandwich enzyme-linked immunosorbent assay, we found no relationship between AAV antibodies and presence or grade of neoplasia in either the Jamaican study subjects or women enrolled in a U.S. cervical cancer case (n = 74) - control (n = 77) study. Overall, the data provide no evidence that AAV infection plays a role in cervical tumorigenesis or that AAV commonly infects cervical epithelial cells.(Au)
Asunto(s)
Adulto , Adolescente , Femenino , Humanos , Persona de Mediana Edad , Neoplasias del Cuello Uterino/virología , Dependovirus/aislamiento & purificación , Infecciones por Parvoviridae/virología , Carcinoma in Situ/virología , Displasia del Cuello del Útero/virología , Neoplasias del Cuello Uterino/epidemiología , Dependovirus/genética , ADN Viral/análisis , Globinas/genética , Virus del Papiloma Humano/genética , Virus del Papiloma Humano/aislamiento & purificación , Reacción en Cadena de la Polimerasa , Infecciones Tumorales por Virus/virologíaRESUMEN
Human papillomavirus (HPV) is widely accepted as the primary etiologic agent in the development of cervical cancer. DNA of a particular HPV type, HPV 16, is found in about half of tumors tested. Inconsistent with this causal relationship, however, population-based studies of HPV DNA prevalence have often failed to find high rates of anogenital HPV infection in countries with high cervical cancer rates. To examine this issue, we used serology to compare HPV 16 exposure in healthy volunteer blood donors in the United States (n = 278) and similar subjects from a country with 3-fold higher cervical cancer rates, Jamaica (n = 257). Jamaican sexually transmitted disease (STD) patients (n = 831) were also studied to examine in detail the relation of HPV 16 antibodies with sexual history. Serology was conducted using an ELISA employing HPV 16 virus-like particles (VLPs). Age-adjusted seroprevalence rates were greatest among male (29 percent) and female (42 percent) STD patients, intermediate in male (19 percent) and female (24 percent) Jamaican blood donors and lowest among male (3 percent) and female (12 percent) U.S. blood donors. The higher seroprevalence in women was significant, and prevalence tended to increase with age. In multivariate logistic regression, controlling for age and gender, Jamaican blood donors were 4.2-fold (95 percent CI 2.4 - 7.2) and STD patients 8.1-fold (95 percent CI 5.0 - 13.2) more likely to have HPV 16 VLP antibodies than U.S. blood donors. Among STD patients, HPV 16 antibodies were associated with lifetime number of sex partners and years of sexual activity, as well as other factors. Our data suggest that HPV 16 VLP antibodies are strongly associated with sexual behavior. Moreover, exposure to HPV 16 appears to be much greater in Jamaica than in the United States, consistent with the high rate of cervical cancer in Jamaica (Au)
Asunto(s)
Adulto , Anciano , Adolescente , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudio Comparativo , Anticuerpos Antivirales/sangre , Donantes de Sangre/estadística & datos numéricos , Neoplasias del Cuello Uterino/virología , Proteínas Oncogénicas Virales/inmunología , Virus del Papiloma Humano/inmunología , Factores de Edad , Análisis de Varianza , Jamaica/epidemiología , /epidemiología , /inmunología , Factores de Riesgo , Conducta Sexual , Factores Sexuales , Parejas Sexuales , Enfermedades de Transmisión Sexual/inmunología , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/inmunología , Estados Unidos/epidemiología , Neoplasias del Cuello Uterino , Proteínas Oncogénicas Virales/sangreRESUMEN
Human papillomavirus (HPV) types differ in their associations with cervical cancer. Therefore, the types of HPV in precancerous lesions are important. In many regions with high cancer incidence, the HPV types in precancerous lesions have not been well studied. In Jamaica, a country that has high cervical cancer incidence, 174 colposcopy patients were tested for HPV DNA using polymerase chain reaction. HPV DNA detection was strongly related to presence and grade of cervical neoplasia (P<.001). Furthermore, severe neoplastic change was most highly associated with HPV DNA types also considered high-risk for severe neoplassia in other populations. HPV-45 DNA, a high-risk type uncommon in most previously tested countries, was detected in 12 percent of patients who had neoplasia. Thus, cervical neoplasia in Jamaica, as elsewhere, is linked to HPV. The high prevalence of HPV-45 DNA was notable, and its relation to high cervical cancer incidence in Jamaica must be assessed. (AU)
Asunto(s)
Humanos , Femenino , Adulto , Virus del Papiloma Humano/aislamiento & purificación , ADN Viral/aislamiento & purificación , Neoplasias del Cuello Uterino/virología , Jamaica/epidemiología , Displasia del Cuello del Útero/virología , Colposcopía , Virus del Papiloma Humano/clasificación , Virus del Papiloma Humano/genética , Lesiones Precancerosas/virología , Factores de RiesgoRESUMEN
Neopterin, a marker of cellular immune activation, was elevated in patients who had cervical cancer in previous studies. To examine neopterin in the presence of precursors to cervical cancer (i.e. cervical intraepithelial) we measured serum levels in 185 colposcopy patients in Jamaica, a country with high cervical cancer incidence, and in 72 age-matched Jamaican women selected from a large population-based sample. We also measured serum levels of B-2 microglobulin, another commonly used marker of immune activation. Neopterin and B-2 microglobulin levels were not elevated in colposcopy patients; neither were they rel ted to severity of cervical neoplasia. In multivariable analysis, neither adjustments for detection of cervical human papillomavirus DNA by PCR nor detection of antibodies to human T-cell lymphotropic virus type 1 (a retrovirus endemic to Jamaica) altered our findings. The absence of serologically detectable increase in cellular immune activation linked to cervical intraepithelial neoplasmia does not involve susbtantial systemic immune activation. (AU)
Asunto(s)
Femenino , Humanos , Neoplasias del Cuello Uterino/inmunología , Biomarcadores de Tumor/sangre , Carcinoma in Situ/sangre , Biopterinas/análisis , Biopterinas/sangre , Carcinoma in Situ/patología , Neoplasias del Cuello Uterino/patología , Colposcopía , Jamaica , Estadificación de Neoplasias , Inmunidad CelularRESUMEN
Human T-cell lymphotropic virus type I (HTLV-I) was associated with carcinoma of the cervix in Japan in a recent study that compared hospital cases with healthy population-based controls. To test this relationship in women more alike for cervical neoplasia risk factors (including sexual behavior and human papilloma virus: HPV), we enrolled consecutive patients from a colposcopy clinic in Kingston, Jamaica (an HTLV-1 endemic area). Patients underwent Pap smear, calopscopy, biopsy and cervical swab for detection of HPV by polymerase chain reaction. Cases were defined as women with CIN-3 or invasive cancer (CIN-3/CA). Controls included all patients with either CIN-1 or koilocytotic atypia, atypical squamous cells of undetermined significane or benign cervical pathology (all but one had at least inflammatory changes). Patients with CIN-2 were excluded to minimize risk of case-control misclassification. Cases were much more likely to be HTLV-1 seropositive than controls. Although mean age differed significantly between cases (mean age = 39 years) and controls (mean age = 33 years), control for age did not explain the relation of CIN-3/CA with HTLV-1. Among HPV DNA positive subjects the age-adjusted association was not diminished but lost statistical significance. HTLV-1 seroprevalence may be independently associated with progression to severe neoplasia of the cervix (AU)