Hpv cervix
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Human Papillomavirus (HPV) and Cervical Cancer: Insights and Implications
HPV and Cervical Cancer Types
Neuroendocrine Carcinomas of the Cervix
Human papillomavirus (HPV) plays a significant role in the development of neuroendocrine carcinomas of the cervix, including small-cell neuroendocrine carcinoma (SCNC) and large-cell neuroendocrine carcinoma (LCNC). A systematic review and meta-analysis revealed that 85% of SCNC and 88% of LCNC cases were HPV positive, with HPV16 and HPV18 being the most prevalent types. This suggests that prophylactic HPV vaccines targeting these strains could potentially prevent most cases of these rare but aggressive cancers.
Cervical Adenocarcinoma
Cervical adenocarcinoma, unlike the more common squamous cell carcinoma, has seen a rise in incidence. HPV infection is a key risk factor, with HPV16 and HPV18 being the most commonly detected types in patients. Cofactors such as poor hygiene, sexual behavior, long-term hormonal contraception use, and HSV-2 seropositivity also contribute to the risk. The use of intrauterine devices (IUDs) has been inversely associated with the risk of adenocarcinoma, suggesting a protective effect.
Immune Response and HPV
Natural Killer Cells and HPV16
HPV16 has been shown to disable the increased natural killer (NK) cells in early cervical lesions, leading to a hyporesponsive local immune system. This immune evasion may explain the higher severity of lesions and the increased risk of malignant transformation associated with HPV16 compared to HPV18.
Oncoproteins and Carcinogenesis
HPV's role in cervical carcinogenesis is well-documented, particularly through the expression of viral oncogenes E6 and E7. These oncoproteins interact with host-cell proteins, disrupting cell cycle regulation and promoting malignant transformation. This mechanism is consistent across various HPV-related cancers, including anal, vulvar, and oropharyngeal cancers.
HPV Prevalence and Transmission
HPV in Pregnant Women
Studies have shown a 29% prevalence of HPV in the cervix and a 2.4% prevalence in the oral cavity of pregnant women. There was no concordance between cervical and oral HPV types, suggesting that self-inoculation is uncommon and that other modes of transmission or differences in susceptibility may exist.
HPV in HIV-Positive Women
HIV-positive women exhibit a high prevalence of HPV infections in both the cervix (96.6%) and oral cavity (92.5%). Concurrent infections in both anatomical regions were common, with high-risk HPV types being more prevalent. European variants of HPV16 were exclusively found in these women, indicating a strong link to persistent infections and cancer development.
Screening and Monitoring
HPV DNA Testing
HPV DNA testing has proven superior to cytology in terms of sensitivity and positive predictive value for cervical cancer screening. This method is particularly effective in detecting high-risk HPV types, which are responsible for the majority of cervical intraepithelial neoplasms and invasive cervical cancers.
Circulating HPV DNA (cHPV-DNA)
A novel blood test measuring circulating HPV DNA (cHPV-DNA) has shown promise in predicting response to chemoradiotherapy and monitoring for relapse in locally advanced cervical cancer. This test demonstrated high sensitivity and specificity, indicating its potential utility in clinical practice.
Conclusion
HPV is a critical factor in the development of various cervical cancers, with HPV16 and HPV18 being the most significant types. Understanding the role of HPV in immune evasion, transmission, and carcinogenesis is essential for improving screening, prevention, and treatment strategies. Prophylactic vaccines and advanced diagnostic tools like HPV DNA testing and cHPV-DNA monitoring hold promise for reducing the burden of cervical cancer worldwide.
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