Risk Factors for Cervical Human Papillomavirus Infection and High-Grade Intraepithelial Lesion in Women Aged 20 to 31 Years in Germany

2013 ◽  
Vol 23 (3) ◽  
pp. 519-526 ◽  
Author(s):  
Cornelius Remschmidt ◽  
Andreas M. Kaufmann ◽  
Ingke Hagemann ◽  
Elena Vartazarova ◽  
Ole Wichmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Genital Warts ◽  
Hpv Infection ◽  
Older Age ◽  
High Grade ◽  
Negative Group ◽  
Positive Group ◽  
Hpv Test ◽  
Intraepithelial Lesion ◽  
Test Result

BackgroundPersistent infection with high-risk human papillomaviruses (HPVs) can lead to cervical intraepithelial lesion and cervical cancer. Sexual behavior and smoking have been identified as risk factors for HPV infection. However, it is unclear which factors account for the persistence of HPV infection and for high-grade squamous intraepithelial lesions (HSIL). Therefore, we conducted a study to identify epidemiological risk factors for the following: (1) the presence of HPV among women without a recent diagnosis of HSIL and (2) HSIL.Materials and MethodsParticipants aged 20 to 31 years were recruited at 2 study sites. All women received a cervical Papanicolaou test, were tested for HPV, and categorized into 1 of 3 different groups: The women of the first group had negative cytological test results and a negative HPV test result (HPV-negative group), and the women of the second group had negative cytological test result but positive HPV test result (HPV-positive group). The third group consisted of women with a diagnosis of HSIL (HSIL group). We first compared the HPV-negative group with the HPV-positive group, and then the HPV-positive group with the HSIL group.ResultsOne hundred forty-seven women were included: 53 women in the HPV-negative group, 46 women in the HPV-positive group, and 48 women in the HSIL group. Comparing the HPV-negative with the HPV-positive group, we found that more than 5 sexual partners during a lifetime were independently associated with cervical HPV infection, whereas the chance of being infected decreased with older age. Irregular condom use during one-night stands or smoking was associated with HPV infection only in univariable but not multivariable analysis. In contrast, older age and having had genital warts were independently associated with an HSIL diagnosis when comparing the HPV-positive group with the HSIL group.DiscussionAlthough the study was hampered by its relatively small sample size, our data suggest that main risk factors for the acquisition of HPV infection are a higher number of sexual partners and younger age, whereas older age and genital warts may be epidemiological cofactors in the development of HSIL.

scholarly journals HPV-16 E7-Specific Cellular Immune Response in Women With Cervical Intraepithelial Lesion Contributes to Viral Clearance: A Cross-Sectional and Longitudinal Clinical Study

2022 ◽  
Vol 12 ◽  
Author(s):  
Lina Zhang ◽  
Xinyi Shi ◽  
Qing Zhang ◽  
Zhilei Mao ◽  
Xiaoyu Shi ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Response ◽  
Hpv Infection ◽  
T Cell Response ◽  
Viral Clearance ◽  
Low Grade ◽  
High Grade ◽  
Cross Sectional ◽  
Intraepithelial Lesion ◽  
Longitudinal Clinical Study

High-risk human papillomavirus (HPV) infection is the cause of almost all cervical cancers. HPV16 is one of the main risk subtypes. Although screening programs have greatly reduced the prevalence of cervical cancer in developed countries, current diagnostic tests cannot predict if mild lesions may progress into invasive lesions or not. In the current cross-sectional and longitudinal clinical study, we found that the HPV16 E7-specific T cell response in peripheral blood mononuclear cells of HPV16-infected patients is related to HPV16 clearance. It contributes to protecting the squamous interaepithelial lesion (SIL) from further malignant development. Of the HPV16 infected women enrolled (n = 131), 42 had neither intraepithelial lesion nor malignancy (NILM), 33 had low-grade SIL, 39 had high-grade SIL, and 17 had cervical cancer. Only one of 17 (5.9%) cancer patients had a positive HPV16 E7-specific T cell response, dramatically lower than the groups of precancer patients. After one year of follow-up, most women (28/33, 84.8%) with persistent HPV infection did not exhibit a HPV16 E7-specific T cell response. Furthermore, 3 malignantly progressed women, one progressed to high-grade SIL and two progressed to low-grade SIL, were negative to the HPV16 E7-specific T cell response. None of the patients with a positive HPV16 E7-specific T cell response progressed to further deterioration. Our observation suggests that HPV16 E7-specific T cell immunity is significant in viral clearance and contributes in protection against progression to malignancy.

scholarly journals Epidemiology and outcomes of Clostridium difficile infection among hospitalised patients: results of a multicentre retrospective study in South Africa

2018 ◽  
Vol 3 (4) ◽  
pp. e000889 ◽  
Author(s):  
Laurel Legenza ◽  
Susanne Barnett ◽  
Warren Rose ◽  
Monica Bianchini ◽  
Nasia Safdar ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Clostridium Difficile ◽  
Patient Characteristics ◽  
Additional Risk Factor ◽  
Western Cape ◽  
Positive Group ◽  
Hospitalised Patients ◽  
District Hospitals ◽  
Test Result

IntroductionLimited data exist on Clostridium difficile infection (CDI) in low-resource settings and settings with high prevalence of HIV. We aimed to determine baseline CDI patient characteristics and management and their contribution to mortality.MethodsWe reviewed adult patients hospitalised with diarrhoea and a C. difficile test result in 2015 from four public district hospitals in the Western Cape, South Africa. The primary outcome measures were risk factors for mortality. Secondary outcomes were C. difficile risk factors (positive vs negative) and CDI treatment.ResultsCharts of patients with diarrhoea tested for C. difficile (n=250; 112 C. difficile positive, 138 C. difficile negative) were reviewed. The study population included more women (65%). C. difficile-positive patients were older (46.5 vs 40.7 years, p<0.01). All-cause mortality was more common in the C. difficile-positive group (29% vs 8%, p<0.0001; HR 2.0, 95% CI 1.1 to 3.6). Tuberculosis (C. difficile positive 54% vs C. difficile negative 32%, p<0.001), 30-day prior antibiotic exposure (C. difficile positive 83% vs C. difficile negative 46%, p<0.001) and prior hospitalisation (C. difficile positive 55% vs C. difficile negative 22%, p<0.001) were also more common in the C. difficile-positive group. C. difficile positive test result (OR 4.7, 95% CI 2.0 to 11.2; p<0.001), male gender (OR 2.8, 95% CI 1.1 to 7.2; p=0.031) and tuberculosis (OR 2.3, 95% CI 1.0 to 5.0; p=0.038) were independently associated with mortality. Of patients starting treatment, metronidazole was the most common antimicrobial therapy initiated (70%, n=78); 32 C. difficile-positive (29%) patients were not treated.ConclusionPatients testing positive for C. difficile are at high risk of mortality at public district hospitals in South Africa. Tuberculosis should be considered an additional risk factor for CDI in populations with high tuberculosis and HIV comorbidity. Interventions for CDI prevention and management are urgently needed.

scholarly journals Management of Atypical Squamous Cell Cases: A Prospective Study of Women seen at a Private Health Service in Northeastern Brazil

2018 ◽  
Vol 40 (03) ◽  
pp. 121-126 ◽  
Author(s):  
Geilson Oliveira ◽  
Judite Oliveira ◽  
Renata Eleutério ◽  
José Eleutério Júnior
Keyword(s):  
Northeastern Brazil ◽  
National Guideline ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
National Guidelines ◽  
Squamous Cells ◽  
Negative Results ◽  
Hpv Test ◽  
Intraepithelial Lesion

Objective To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women. Methods A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H). Results In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p < 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p < 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p < 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075). Conclusion The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.

scholarly journals Risk Factors of Residual Lesions in Cervical High-Grade Intraepithelial Lesion After LEEP in Perimenopausal and Postmenopausal Women

2021 ◽  
Author(s):  
Zhuyun Ding ◽  
Lijuan Xu ◽  
Luting Chen ◽  
Haili Chai ◽  
Yan Jin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Postmenopausal Women ◽  
Margin Status ◽  
High Grade ◽  
Residual Rate ◽  
Significant Difference ◽  
Intraepithelial Lesion ◽  
Residual Lesions ◽  
P16 Expression

Abstract Purpose To investigate the risk factors of residual lesions in cervical high-grade squamous intraepithelial lesion (HSIL) after loop electrosurgical excision procedure (LEEP). Methods A total of 88 patients, including 38 perimenopausal patients and 50 postmenopausal patients, who were diagnosed with cervical HSIL after LEEP in Shanghai Jiaotong University affiliated Songjiang Hospital from May 2016 to May 2021 and then underwent hysterectomy within 3 months were collected. The patients' age, hrHPV typing, liquid-based thin-layer cytology (TCT), cervical biopsy P16 expression under colposcopy, endocervical curettage(ECC) during LEEP , margin status of LEEP and whole uterine pathology were reviewed and the risk factors of residual lesions after LEEP in HSIL patients were analyzed statistically with t test,χ2 test or logistic regression analysis. Results Among the 88 patients, there was no statistical difference in the residual rate between perimenopausal and postmenopausal women (P > 0.05). There were no statistically significant differences in age, hrHPV typing, TCT, P16 expression, and LEEP margin between with and without residue group (P >0.05), but there was statistically significant difference in ECC (P < 0.01). In perimenopausal group, there were no statistically significant differences in all the factors (P >0.05) except ECC (P < 0.01) between with and without residue group. While in postmenopausal group, all the factors were not statistically different(P >0.05) except margin status (P < 0.01).After multivariate, positive endocervical curettage was a risk factor of the residual lesionsin perimenopausal group after LEEP ( P < 0.01), and positive LEEP margin was one for postmenopausal patients (P < 0.05). Conclusions Positive ECC is a risk factor of residual lesions in perimenopausal women with HSIL after LEEP. Positive LEEP margin was a risk factor for the residual lesions in postmenopausal patients.

scholarly journals Risk of cervical cancer associated with HPV infection among the gynae outdoor patients

2014 ◽  
Vol 46 (1-2) ◽  
pp. 3-6
Author(s):  
Tanjila Rahman ◽  
Shahina Tabassum ◽  
Munira Jahan
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
High Risk ◽  
Sexual Activity ◽  
Hpv Infection ◽  
Early Marriage ◽  
Care Hospital ◽  
Socioeconomic Condition ◽  
Hpv Dna ◽  
Hpv Test

Human papilloma virus is an oncogenic DNA virus, which is identified in 99.7% case of invasive cancer. It is the most prevalent virus involved in sexually transmitted diseases worldwide and an important public health challenge for the prevention of cervical carcinoma. Cervical cancer is the second cause of malignant neoplasia and death in women. The present study was thus designed to detect the risk factors for HPV infection in normal and unhealthy cervix of women attending tertiary care hospital (BSMMU). HPV DNA was detected among the study population using the Hybrid Capture 2 assay, which determined HPV high risk types. A total of 68 women between 25-70 years of age were included in this cross sectional study. Among them 13 (19.1%) cases were tested positive for HPV DNA. The risk factors for HPV infection identified from this result are early sexual activity, lower level of education, early marriage, multi-parity, total duration of sexual activity in years and long term use of oral contraceptive pill and poor socioeconomic condition. Increased awareness and understanding regarding HPV infection would improve the risk of infection and control in sexually active women. HPV diagnosis at early stages of infection is of fundamental importance. The use of HPV test in routine cervical mass screening may not be possible in developing countries like Bangladesh due to its high cost. Nevertheless, it has been shown to be a useful tool when combined with cytology to diagnose high-risk infection in apparently normal tissues, and may help to reduce the risk of cervical cancers. The results obtained from this study ultimately contribute to cervical cancer prevention among Bangladeshi women. DOI: http://dx.doi.org/10.3329/bmjk.v46i1-2.18231 Bang Med J (Khulna) 2013; 46 : 3-6

FLT3 Internal Tandem Duplication Is Associated with High Relapse Rate and Central Nervous System Involvement in Acute Promyelocytic Leukemia

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4849-4849
Author(s):  
Haruko Tashiro ◽  
Yoko Oka ◽  
Toshihiko Sugao ◽  
Ryosuke Shirasaki ◽  
Mitsuho Noguchi-Mizutani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relapse Rate ◽  
Tandem Duplication ◽  
Leukocyte Count ◽  
Promyelocytic Leukemia ◽  
Negative Group ◽  
Cns Involvement ◽  
Internal Tandem Duplication ◽  
Positive Group ◽  
High Relapse Rate

Abstract The internal tandem duplication of FMS-like tyrosine kinase 3 (FLT3/ITD) is now accounted as one of important risk factors for the prognosis in acute myelogenous leukemia (AML) patients with normal karyotype. In all-trans retinoic acid era, acute promyelocytic leukemia (APL) has become the most curative subtype of adult AML, and usually hematopoietic stem cell transplantation is not selected for APL patients in 1st complete remission (CR) or 2nd CR without minimal residual disease (MRD) at the polymerase chain-reaction level; however, relapses are still reported to occur in 15–25% of cases after achieving 1st CR without MRD, and some risk factors are proposed including the difference of breakpoint region of the translocation, and leukocyte count at the onset. The incidence of FLT3/ITD in APL has been reported 17–35%; however, it is still a matter of debate that the presence of FLT3/ITD is associated with poor prognosis in APL patients. Thus, we focused on the incidence, clinical features, and prognostic implications of FLT3/ITD in adult newly diagnosed 17 APL patients (median age of 45 years, range 22–67 years, 11 males and 6 females, and median total leukocyte count (TLC) of 2.0 × 109/L, range 0.4– 156.1 × 109/L). All patients achieved CR. The incidence of the presence of FLT3/ITD was 29.4%. The median TLC was significantly higher in FLT3/ITD positive group (median TLC of 9.4 × 109/L) as compared in the negative group (median TLC of 1.2 × 109/L). Higher LDH level in blood was also observed in FLT3/ITD positive group. The rate of central nerves system (CNS) involvement was significantly higher in FLT3/ITD positive group than that in the negative group (60 % vs. 0%). Relapse rate was also significantly higher in FLT3/ITD group (100 % vs. 0%). These data indicate that the presence of FLT3/ITD is associated with the high relapse rate and CNS involvement in APL patients, and implies one of poor prognostic factors.

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