[Natural course of HPV infection. Usefulness of HPV analysis in cervix diagnosis]

Cervical carcinomas and their precursors (cervical dysplasia, CIN1-3) are associated with human papillomavirus (HPV) infections. Epidemiological and in vitro-studies have shown that some of the genital HPV types, the high risk-types 16, 18, 31 etc., code for proteins (E6/E7) which strongly influence the cell cycle and genome stability. Progression from weak to severe dysplasia and to invasive cancer is associated with increasing expression of these viral oncogenes. Which additional cofactors contribute to progression of some dysplasias to carcinomas is still a matter of investigation. Recent results point to genetic predisposition (p53 polymorphism), cellular immune reaction, and cytokine expression. For HPV detection in cervical swabs and biopsies two highly sensitive and reliable systems (PCR, Hybrid Capture system) are available. Although classical histological methods are sufficient for the diagnosis of high-grade lesions and invasive cancer, HPV testing might give valuable diagnostic and prognostic clues especially in cases of unclear cytology (ASCUS) or weak dysplasia.