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El virus del papiloma humano tipo 18 y la neoplasia intraepitelial cervical de rápido progreso
Ciaran B J Woodman1, Stuart Collins, Terry P Rollason
1Centre for Cancer Epidemiology, University of Manchester, Withington, M20 4QL, Manchester, UK. ciaran.woodman@cce.man.ac.uk
Lancet (London, England)
|January 9, 2003
Resumen
La infección por el virus del papiloma humano tipo 18 (HPV-18) está relacionada con el cáncer de cuello uterino, pero su baja representación en la neoplasia intraepitelial cervical de alto grado (CIN) puede deberse a la subestimación de la gravedad de la enfermedad, lo que podría afectar la efectividad del cribado.
Área de la Ciencia:
- Oncología Ginecológica Oncología Ginecológica.
- Virología Virología.
- Salud Pública La salud pública.
Sus antecedentes:
- El virus del papiloma humano tipo 18 (HPV-18) es una causa significativa de cáncer de cuello uterino, en particular el adenocarcinoma.
- El VPH-18 es paradójicamente poco detectado en la neoplasia intraepitelial cervical (CIN) de alto grado en comparación con el VPH-16.
- Se necesitan estudios longitudinales para comprender el papel del VPH-18 en la progresión de la neoplasia cervical.
Objetivo del estudio:
- Para investigar la aparición de anomalías citológicas después de las infecciones incidentes de HPV-18 y HPV-16.
- Para determinar si la enfermedad cervical asociada con el VPH-18 progresa de manera diferente a través de las etapas preinvasivas en comparación con el VPH-16.
Principales métodos:
- Un estudio longitudinal de 1075 mujeres jóvenes (15-19 años) con citología basal normal y estado de VPH.
- Los seguimientos regulares de 6 meses incluyeron la recolección de muestras citológicas y virológicas.
- El análisis se centró en el riesgo relativo y el tiempo hasta la anomalía citológica después de las infecciones por HPV-18 y HPV-16.
Principales resultados:
- La infección por el VPH-18 mostró un aumento de 2.06 en el riesgo de anomalías nucleares limítrofes y de 3.11 en el de discariosis leve.
- La infección por el VPH-16 mostró un aumento del riesgo de 1,99 para la anomalía límite y 4,76 para la discariosis leve.
- El tiempo hasta la anomalía citológica fue similar tanto para las infecciones por HPV-18 como por HPV-16, y el HPV-18 mostró un menor riesgo de discariosis moderada/severa (0.80) en comparación con el HPV-16 (2.85).
Conclusiones:
- Los hallazgos desafían la hipótesis de que la enfermedad asociada al HPV-18 progresa rápidamente, lo que explica su baja representación en CIN de alto grado.
- Los cambios citológicos después de la infección por el VPH-18 pueden subestimar la gravedad real de la enfermedad cervical subyacente.
- Esta subestimación podría reducir la efectividad de los programas de detección de cáncer cervical en la detección de cánceres relacionados con el VPH-18.
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