RESUMO
Determinants of human papillomavirus (HPV)-16 serological conversion and persistence were assessed in a population-based cohort of 10 049 women in Guanacaste, Costa Rica. Serologic responses to HPV-16 were measured in 7986 women by VLP-based enzyme-linked immunosorbent assay at both study enrollment (1993/94) and at 5-7 years of follow-up. Seropositive women were defined as >/=5 standard deviations above the mean optical density obtained for studied virgins at enrollment (n=573). Seroconnversion (n=409), persistence (n=675), and clearance (n=541) were defined based on enrollment and follow-up serology measurements. Age-specific distributions revealed that HPV-16 seroconversion was highest among 18- to 24-year-old women, steadily declining with age; HPV-16 seropersistence was lowest in women 65+ years. In age-adjusted multivariate logistic regression models, a 10-fold risk increase for HPV-16 seroconversion was associated with HPV-16 DNA detection at enrollment and follow-up; two-fold risk of seroconversion to HPV-16 was associated with increased numbers of lifetime and recent sexual partners and smoking status. Determinants of HPV-16 seropersistence included a 1.5-fold risk increase associated with having one sexual partner during follow-up, former oral contraceptive use, and a 3-fold risk increase associated with HPV-16 DNA detection at both enrollment and follow-up. Higher HPV-16 viral load at enrollment was associated with seroconversion, and higher antibody titres at enrollment were associated with seropersistence.
Assuntos
DNA Viral/análise , Modelos Teóricos , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/imunologia , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Idoso , Anticorpos Antivirais/análise , Estudos de Coortes , Anticoncepcionais Orais , Costa Rica , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Testes Sorológicos , Comportamento SexualRESUMO
OBJECTIVES: To determine seroprevalence and determinants of herpes simplex virus 2 (HSV-2) seropositivity, in a random sample of a population based cohort of 10 049 women of Guanacaste, Costa Rica, using a highly sensitive and specific serological assay. METHODS: Seroprevalence was determined by a type specific HSV-2 ELISA assay in an age stratified random sample of 1100 women. Univariate and multivariate logistic regression was used to calculate odds ratios and 95% confidence intervals for risk factors of seropositivity. RESULTS: Overall age adjusted HSV-2 seroprevalence was 38.5% (95% CI, 37.5 to 39.5), and it was strongly associated with increasing age (p(Trend<0.0001)), both among monogamous women and women with multiple sexual partners. A greater number of lifetime sexual partners increased the risk of seropositivity, with a 28.2% (95% CI, 24.4 to 32.2) seroprevalence among monogamous women and 75% (95% CI, 65.6 to 83.0) seroprevalence for those with four or more partners (OR = 7.6 95% CI, 4.7 to 12.4 p(Trend<0.0001)). Barrier contraceptive use was negatively associated with HSV-2 seropositivity (OR 0.54, 95% CI, 0.31 to 0.94). Women with antibodies against HPV 16, 18, or 31 were 1.6 times more likely to be HSV-2 seropositive (OR 1.6, 95% CI, 1.2 to 2.1). CONCLUSIONS: HSV-2 infection is highly endemic in Guanacaste, even among lifetime monogamous women, suggesting a role of male behaviour in the transmission of the infection. Until vaccination against HSV-2 is available, education to prevent high risk sexual behaviour and the use of condoms appear as preventive measures against HSV-2.
Assuntos
Herpes Genital/epidemiologia , Herpesvirus Humano 2 , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Costa Rica/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Reação em Cadeia da Polimerase , Fatores de Risco , Saúde da População Rural , Estudos Soroepidemiológicos , Parceiros SexuaisRESUMO
Human papillomavirus (HPV) seroprevalence and determinants of seropositivity were assessed in a 10049-woman population-based cohort in Guanacaste, Costa Rica. Serologic responses based on VLP-based ELISA were obtained from the plasma collected at study enrollment in 1993/1994 for HPV-16 (n=9949), HPV-18 (n=9928), HPV-31 (n=9932), and HPV-45 (n=3019). Seropositivity was defined as five standard deviations above the mean optical density obtained for studied virgins (n=573). HPV-16, -18, -31, and -45 seroprevalence was 15, 15, 16, and 11%, respectively. Of women DNA-positive for HPV-16, -18, -31, or -45, seropositivity was 45, 34, 51, and 28%, respectively. Peak HPV seroprevalence occurred a decade after DNA prevalence; lifetime number of sexual partners was the key determinant of seropositivity independent of DNA status and age. DNA- and sero-positive women showed the highest risk for concurrent CIN3/cancer, followed by DNA-positive, sero-negative women.
Assuntos
Anticorpos Antivirais/sangue , Papillomaviridae/imunologia , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos Virais/imunologia , Estudos de Coortes , Costa Rica/epidemiologia , DNA Viral/análise , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Estudos Soroepidemiológicos , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/virologiaRESUMO
To examine human leukocyte antigen (HLA) involvement in the development of all grades of cervical neoplasia, a nested case-control study of 10,077 women in Guanacaste, Costa Rica, was conducted. Participants had invasive cervical cancer, high-grade squamous intraepithelial lesions (HSILs; n=166), or low-grade squamous intraepithelial lesions (LSILs); were positive for human papillomavirus (HPV) with no evidence of cervical neoplasia (n=320); or were HPV negative with no evidence of cervical neoplasia but with a history of high-risk sexual behavior (n=173). Compared with women who were HPV negative, women with HLA-DRB1*1301 were associated with decreased risk for cancer/HSILs (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.2-0.7) and for LSILs/HPV (OR, 0.6; 95% CI, 0.3-0.9). Women with both HLA-B*07 and HLA-DQB1*0302 had an 8.2-fold increased risk for cancer/HSILs (95% CI, 1.8-37.2) and a 5.3-fold increased risk for LSILs/HPV (95% CI, 1.2-23.7). These results support the hypothesis that multiple risk alleles are needed in order to increase risk for cervical neoplasia, but a single protective allele may be sufficient for protection.
Assuntos
Antígenos de Histocompatibilidade Classe II/genética , Antígenos de Histocompatibilidade Classe I/genética , Leucócitos/imunologia , Displasia do Colo do Útero/imunologia , Neoplasias do Colo do Útero/imunologia , Alelos , Estudos de Casos e Controles , Costa Rica/epidemiologia , Feminino , Predisposição Genética para Doença , Antígenos HLA-DQ/genética , Cadeias beta de HLA-DQ , Antígenos HLA-DR/genética , Cadeias HLA-DRB1 , Humanos , Fatores de Risco , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/genética , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/genéticaRESUMO
We examined factors associated with high-grade squamous intraepithelial lesions (HSIL) and cervical cancer among human papillomavirus (HPV)-infected women in a prevalent case-control study conducted within a population-based cohort of 10 077 women in Costa Rica. We compared 146 women with HPV-positive HSIL or cancer (HSIL/CA) against 843 HPV-positive women without evidence of HSIL/CA. Subjects completed a risk factor questionnaire. We evaluated the associations between exposures and HSIL/CA among women positive for any HPV and restricted to those positive for high-risk HPV types. Risk of HSIL/CA increased with increasing number of live births (P(trend)= 0.04). Women who smoked 6+ cigarettes/day had a RR for HSIL/CA of 2.7 (95% CI = 1.1-6.7) compared to non-smokers. Current use of barrier contraceptives was associated with a reduction in risk of HSIL/CA (RR = 0.39; 95% CI = 0.16-0.96). Sexual behaviour and a self-reported history of sexually transmitted diseases (STDs) other than HPV were not associated with HSIL/CA. Oral contraceptive use was associated with HSIL/CA among women with <3 pregnancies. Effects were similar in analysis restricted to women positive for high-risk HPV types. Among women positive for high-risk HPV types, 44% of HSIL/CA could be attributed to multiparity (>/=3 pregnancies) and/or smoking. Among HPV-positive women, multiparity and smoking are risk factors for HSIL/CA. Oral contraceptive use may be associated with HSIL/CA in subgroups of women.
Assuntos
Carcinoma in Situ/virologia , Carcinoma de Células Escamosas/virologia , Papillomaviridae , Infecções por Papillomavirus/complicações , Infecções Tumorais por Vírus/complicações , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/etiologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/etiologia , Estudos de Casos e Controles , Costa Rica/epidemiologia , Feminino , Humanos , Incidência , Papillomaviridae/patogenicidade , Paridade , Fatores de Risco , Comportamento Sexual , Infecções Sexualmente Transmissíveis/complicações , Fumar/efeitos adversos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologiaRESUMO
BACKGROUND: Human papillomavirus (HPV) is the main cause of cervical neoplasia. Because few population-based studies have investigated the prevalence of type-specific infection in relation to cervical disease, we studied a high-risk population, estimating the prevalence of HPV infection and the risk associated with various HPV types. METHODS: We screened 9175 women in Guanacaste, Costa Rica, to obtain a referent standard final diagnosis, and tested 3024 women for more than 40 types of HPV with a polymerase chain reaction-based system. RESULTS: Among women with normal cytology, HPV infections peaked first in women younger than 25 years, and they peaked again at age 55 years or older with predominantly non-cancer-associated types of HPV and uncharacterized HPV types. Low-grade squamous intraepithelial lesions (LSILs) (n = 189) decreased consistently with age. The prevalence of high-grade squamous intraepithelial lesions (HSILs) (n = 128) peaked first around age 30 years and again at age 65 years or older. Seventy-three percent of LSILs were HPV positive, with HPV16 being the predominant type (16% of positive subjects). HPV was found in 89% of HSILs and 88% of cancers, with HPV16 being strongly predominant (51% and 53% of positive subjects). Virtually all HSILs and cancers had cancer-associated HPV types, with high odds ratios (ORs) and attributable fractions around 80%. Risk for HPV16 was particularly high (OR for HSILs = 320, 95% confidence interval [CI] = 97-1000; OR for cancer = 710, 95% CI = 110-4500). CONCLUSIONS: We confirm the early decline of HPV infection with age but note increased prevalence after menopause, which could be related to a second peak of HSILs, an observation that warrants further investigation. At least 80% of HPVs involved in cervical carcinogenesis in this population have been characterized. Polyvalent vaccines including the main cancer-associated HPV types may be able to prevent most cases of cervical disease in this region.
Assuntos
Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Vigilância da População , Saúde da População Rural/estatística & dados numéricos , Infecções Tumorais por Vírus/epidemiologia , Infecções Tumorais por Vírus/virologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto , Distribuição por Idade , Idoso , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/virologia , Costa Rica/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Reação em Cadeia da Polimerase , Prevalência , Infecções Tumorais por Vírus/diagnóstico , Neoplasias do Colo do Útero/diagnósticoRESUMO
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)
Assuntos
Adulto , Adolescente , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/virologia , Dependovirus/isolamento & purificação , Infecções por Parvoviridae/virologia , Carcinoma in Situ/virologia , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/epidemiologia , Dependovirus/genética , DNA Viral/análise , Globinas/genética , Papillomavirus Humano/genética , Papillomavirus Humano/isolamento & purificação , Reação em Cadeia da Polimerase , Infecções Tumorais por Vírus/virologiaRESUMO
Progression from infection with human papillomavirus (HPV) to cervical cancer in some women is thought to involve a permissive host environment, one in which immune response is mobilized in an inappropriate manner. In a previous study (A. Hildesheim et al., Cancer Epidemiol. Biomark. Prev., 6: 807-813, 1997), increasing levels of soluble interleukin 2 receptor (sIL-2R), a known proxy for general immune activation, was found to be positively associated with increasing levels of cervical neoplasia. We attempted to confirm this finding by conducting a nested case-control study of 478 women within a 10,000-woman population-based cohort in Costa Rica. We selected for the study all of the women diagnosed (at enrollment into the cohort) with: (a) low-grade squamous intraepithelial lesions (LSIL, n = 191); (b) high-grade squamous intraepithelial lesions (HSIL, n = 130); or (c) cancer (n = 37). Controls were 120 cytologically normal, HPV-negative women selected from a random sample of the entire cohort. A questionnaire was administered to participants to elicit information on cervical cancer risk factors. All of the women received a pelvic examination during which cervical cells were collected and used for HPV DNA testing by PCR. Blood samples were also collected. Plasma obtained from the blood samples was tested for sIL-2R levels by ELISA. Results indicated that sIL-2R levels increased with age. Among controls, we observed that 44.3% of women over the age of 50 had high levels of sIL-2R (defined as >735 units/ml) compared with 15.8% of women <30 years of age (P = 0.008). When women with cervical disease (LSIL+) were compared with controls, women in the upper quartile of the sIL-2R distribution had an age-adjusted odds ratio (OR) of 2.1 [95% confidence interval (CI), 1.1-4.1]. Comparing each advancing state of neoplasia with its precursor, we found that women with LSIL had higher sIL-2R levels than controls (OR for upper quartile of sIL-2R, 2.3; 95% CI, 1.1-5.2; comparing LSIL cases with controls); women diagnosed with HSIL were similar to the LSIL group (OR for upper quartile of sIL-2R, 1.1; 95% CI, 0.5-2.4; comparing HSIL cases with LSIL cases); and those with cancer had higher sIL-2R levels than subjects with an HSIL diagnosis (OR for upper quartile of sIL-2R = 1.8; 95% CI, 0.5-7.1; comparing cancer cases with HSIL cases). These data suggest that among our study subjects, sIL-2R levels most likely rise as a response to the events of infection and cancerous invasion, but that sIL-2R levels are unlikely to be predictive of disease progression among women with LSIL.
Assuntos
Receptores de Interleucina-2/sangue , Neoplasias do Colo do Útero/imunologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Intervalos de Confiança , Costa Rica , DNA Viral/genética , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Previsões , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Razão de Chances , Papillomaviridae/genética , Papillomaviridae/crescimento & desenvolvimento , Infecções por Papillomavirus/imunologia , Vigilância da População , Fatores de Risco , Inquéritos e Questionários , Infecções Tumorais por Vírus/imunologia , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/imunologia , Displasia do Colo do Útero/virologiaRESUMO
BACKGROUND AND OBJECTIVES: Human papillomavirus is the major etiologic agent of cervical cancer. Although the incidence of cancer of the cervix is high in Jamaica, the prevalence of human papillomavirus among Jamaican women has not been defined. GOAL OF THE STUDY: To estimate the prevalence of human papillomavirus infection and associated risk factors in women attending an STD clinic in Kingston, Jamaica. STUDY DESIGN: A cross-sectional survey was done of 202 women attending an STD clinic in Kingston in 1990. Cervical and vaginal cells were collected by lavage, and human papillomavirus genomes were detected in extracted DNA using low-stringency Southern blot hybridization. RESULTS: Fifty-eight (28.7%) women were identified as HPV positive. Prevalence of HPV by age group was 39% in women 15-19 years old, 33% of women 20-24 years old, 31% in women 25-29 years old, and 17% in those 30 years or older. Increasing age was significantly associated with a lower prevalence of human papillomavirus infection (test for trend, P = 0.025). The effect of age was independent of years of sexual activity. Women reporting more than one sexual partner per month on average were found to have a significantly higher HPV prevalence (odds ratio 2.87, 95% confidence Interval 1.29-6.38), as were women who reported more frequent sex (test for trend, P = 0.006). CONCLUSIONS: Sexual behavior is associated with risk of human papillomavirus infection. The decrease of human papillomavirus prevalence in older women agrees with other studies that argue in favor of a biological effect, such as increased immunity to human papillomavirus with age. A better understanding of why immunity to human papillomavirus may develop in older women may provide the basis for developing an effective vaccine to prevent cancer of the cervix.
PIP: During November 1990-January 1991, DNA was extracted from cervicovaginal cells from 202 women attending the Comprehensive Health Centre, a sexually transmitted disease (STD) clinic, in Kingston, Jamaica, to determine the prevalence of human papilloma virus (HPV). Health workers interviewed these women so researchers could identify risk factors for HPV. 58 women (28.7%) tested positive for HPV. 62% had uncharacterized HPV DNA types. 16% had more than one type of HPV. HPV prevalence fell with age (39% for 15-19 year olds, 33% for 20-24 year olds, 31% for 25-29 year olds and 17% for 30+ year olds; odds ratio [OR] for oldest group = 0.34; p = 0.025), suggesting that older women have developed an immunity to HPV infection. The higher the number of years of sexual activity, the lower the HPV prevalence (40% for 1-4 years, 32% for 5-9 years, and 23% for 10+ years; OR for 10+ years was 0.44; p = 0.03). Women with at least two sexual partners over the last 12 months had a higher HPV prevalence than those with fewer sexual partners (OR = 2.87; p = 0.01). The greater the average number of times women claimed to have had vaginal intercourse per month in the last year, the greater the HPV prevalence (OR for 3-4 times = 2.07, OR for 5+ times = 3.22; p = 0.006). A multiple logistic regression analysis revealed that age confounded the inverse association between HPV prevalence and years of sexual activity. 3% of Pap smears exhibited cervical dysplasia. Further studies are needed to obtain a better understanding of why immunity to HPV may occur in older women. This information could form the basis for developing an effective vaccine against cervical cancer.
Assuntos
Infecções por Papillomavirus/epidemiologia , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Adolescente , Adulto , Fatores Etários , Colo do Útero/virologia , Estudos Transversais , DNA Viral/análise , Feminino , Humanos , Jamaica/epidemiologia , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Prevalência , Fatores de Risco , Comportamento Sexual , Doenças Virais Sexualmente Transmissíveis/virologia , Vagina/virologiaRESUMO
The prevalence of human papilloma virus (HPV) was investigated in 202 Jamaican women attending a health clinic for sexually transmitted diseases in 1990. Cervicovaginal cells were collected by lavage, and HPV genomes were detected in extracted DNA using low-stringency Southern Blot hybridization. Fifty-eight (28.7 percent) women were identified as HPV-positive. Prevalence of HPV by age group was 39 percent in women aged 15-19 years, 33 percent in women 20-24 years, 31 percent in women 25-29 years and 17 percent in those aged 30 years or over. Increasing age was significantly associated with a lower prevalence of HPV infection (test for trend p = 0.025). The effect of age was independent of years of sexual activity. Women reporting more than one sexual partner per month on average were found to have a significantly higher HPV prevalence (Odds Ratio 2.75, 95 percent Confidence interval 1.24 - 6.12) as were women who reported more frequent sex (test for trend p=0.006). Sexual behaviour is clearly associated with risk of HPV infection. Moreover, the decrease of HPV prevalence in older women is in agreement with other studies that argue in favour of a biological effect such as increased immunity with age. This study is important in identifying high-risk women in Jamaica, where the incidence of cervical cancer is high (AU)
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Papillomavirus Humano/isolamento & purificação , Neoplasias do Colo do Útero/epidemiologia , Fatores de RiscoRESUMO
We performed a second examination for human papillomavirus (HPV) DNA on 51 sexually experienced 13- to 21-year-old (mean = 17.8 years) female patients seen at an urban teaching hospital. Cervicovaginal lavages were performed 6 to 36 months apart (median = 13.3 months) to collect cells for HPV DNA detection and typing by Southern blot hybridization. At the first and second visits, 39.2% (20/51) and 25.5% (13/51) of patients, respectively, were infected with HPV. Collectively, 56.9% (29/51) of patients had at least one positive HPV test result. Although 7.8% (4/51) were infected with HPV at both visits, only one patient had infection with the same HPV type. These findings suggest that although HPV infection is a common sexually transmitted disease, genotype-specific HPV infection detected by Southern blot at two visits was rare.
Assuntos
Colo do Útero/microbiologia , Papillomaviridae/isolamento & purificação , Infecções Tumorais por Vírus/microbiologia , Vagina/microbiologia , Adolescente , Adulto , Southern Blotting , Feminino , Seguimentos , Humanos , Incidência , New York/epidemiologia , Papillomaviridae/classificação , Comportamento Sexual , Infecções Tumorais por Vírus/epidemiologiaRESUMO
To investigate the prevalence rates of and risk factors for genital human papillomavirus (HPV) infection in white, middle-class adolescents, we obtained specimens for HPV from 107 patients undergoing pelvic examination at a suburban adolescent health service. Specimens were obtained by means of cervicovaginal lavage and were analyzed for HPV DNA by Southern blot analysis. The subjects' mean age was 18.5 (+/- 2.0 SD) years; 47% of the subjects were seen for contraception, 36% for possible pregnancy, 12% for a gynecologic complaint, and 5% for a general examination. We detected HPV in 32% of patients; HPV types included 6/11 (6%), 16 (3%), 18 (15%), 31 (3%), 42 (6%), 45 (18%), and 56 (6%). The DNA type was classified as uncharacterized in 47%, and 3% had more than one type. Univariate analysis revealed that patients found to have HPV were more likely to have more than two sexual partners, to have been sexually active for more than 2 years, to have had menarche before 12 years of age, and to have a history of sexually transmitted disease; logistic regression multivariate analysis demonstrated that number of partners and age at menarche were independent risk factors for HPV. These data indicate that HPV is common among sexually active teenagers regardless of ethnicity or socioeconomic status. The association of cervicovaginal HPV infection with sexual activity further supports the notion of the sexual transmission of this agent.
Assuntos
Papillomaviridae , Infecções Tumorais por Vírus/epidemiologia , Doenças do Colo do Útero/microbiologia , Doenças Vaginais/microbiologia , Adolescente , Comportamento do Adolescente , Adulto , Fatores Etários , Southern Blotting , Sondas de DNA de HPV , DNA Viral/análise , Feminino , Humanos , Modelos Logísticos , Menarca , Análise Multivariada , New York/epidemiologia , Papillomaviridae/classificação , Papillomaviridae/isolamento & purificação , Prevalência , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Classe Social , Fatores de Tempo , População Urbana , Doenças do Colo do Útero/epidemiologia , Doenças Vaginais/epidemiologiaRESUMO
We describe two boys, presenting by 1 year of age, with developmental delay from birth, mildly coarse facial features, and hepatomegaly. These clinical features were most suggestive of a mucopolysaccharidosis, particularly MPS II. Biochemical studies, including sulfate incorporation in fibroblasts and lysosomal enzyme analyses in fibroblasts, leukocytes, and serum, showed abnormalities in both sulfatide and mucopolysaccharide metabolism and led to the diagnosis of multiple sulfatase deficiency. With time, both patients developed an ichthyotic rash and profound intellectual deterioration. We conclude that findings in the first year of life in some patients with MSD may closely resemble those in patients with a MPS disorder rather than the late infantile form of metachromatic leukodystrophy, as is classically described. Thus, MSD should be considered in the young patient suspected of having a MPS disorder.