HIV感染女性的阴道微生态变化与宫颈癌的相关研究

doi:10.12280/gjfckx.20240859

摘要/Abstract

摘要：

目前，经性传播途径感染人类免疫缺陷病毒（human immunodeficiency virus，HIV）的女性越来越多，且HIV所致的低免疫状态使女性发生感染和进展为肿瘤的风险增大。越来越多的研究表明，HIV感染女性（women living with HIV，WLHIV）阴道内细菌、真菌、滴虫、支原体、人乳头瘤病毒等病原体检出率增加，而乳杆菌检出率降低，使女性更容易患生殖道感染性疾病及宫颈癌。因此，增强自身免疫能力，改善阴道内部环境，积极防治宫颈癌前病变，可相应地减少性传播疾病及癌症的发生。就WLHIV的阴道微生态变化及其与宫颈癌发生发展的关系进行了综述。

关键词: HIV感染, 阴道, 微生态, 乳头状瘤病毒科, 生殖道感染, 宫颈肿瘤, 癌前状态

Abstract:

The number of women acquiring human immunodeficiency virus (HIV) infection through sexual transmission is increasing. The immunocompromisedstate resulting from HIV infection significantly elevates the risk of infections and tumorigenesis in women. Growing evidence indicates that women living with HIV (WLHIV) exhibit increased detection rates of various vaginal pathogens, including bacteria, fungi, Trichomonas, Mycoplasma, and human papillomavirus (HPV), while simultaneously showing decreased Lactobacillus prevalence. This dysbiosis predisposes WLHIV to genital infections and cervical cancer. Therefore, strategies aimed at enhancing immunity, improving the vaginal microenvironment, and actively managing cervical precancerous lesions can contribute to reducing the incidence of sexually transmitted infections and cervical cancer. This review summarizes the alterations in the vaginal microecology of WLHIV and their association with the development of cervical cancer.

Key words: HIV infections, Vagina, Microecology, Papillomaviridae, Reproductive tract infections, Uterine cervical neoplasms, Precancerous conditions

胡明珠, 刘丽文, 黄蕾. HIV感染女性的阴道微生态变化与宫颈癌的相关研究[J]. 国际妇产科学杂志, 2025, 52(1): 13-18.

HU Ming-zhu, LIU Li-wen, HUANG Lei. The Relationship between Vaginal Microecology and Cervical Cancer in HIV-Infected Women[J]. Journal of International Obstetrics and Gynecology, 2025, 52(1): 13-18.

参考文献 35

[1]	UNAIDS. The path that ends AIDS: UNAIDS Global AIDS Update 2023[EB/OL]. (2023-07-13)[2023-12-03]. https://idpc.net/publications/2023/07/the-path-that-ends-aids-2023-unads-global-aids-update.
[2]	Souza TF, Sym YV, Chehter EZ. HIV and neoplasms: What do we know so far?[J]. Einstein(Sao Paulo), 2023,21:eRW0231. doi: 10.31744/einstein_journal/2023RW0231.
[3]	Mlynarczyk-Bonikowska B, Rudnicka L. HPV Infections-Classification, Pathogenesis, and Potential New Therapies[J]. Int J Mol Sci, 2024, 25(14):7616. doi: 10.3390/ijms25147616.
[4]	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3):229-263. doi: 10.3322/caac.21834.
[5]	罗琳琳, 姜琦, 胡新宁, 等. 艾滋病合并恶性肿瘤研究进展[J]. 中华医院感染学杂志, 2024, 34(17):2715-2720. doi: 10.11816/cn.ni.2024-240130.
[6]	Pérez-González A, Cachay E, Ocampo A, et al. Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection[J]. Microorganisms, 2022, 10(5):1047. doi: 10.3390/microorganisms10051047.
[7]	Wang Y, Noël-Romas L, Perner M, et al. Non-Lactobacillus-Dominant and Polymicrobial Vaginal Microbiomes Are More Common in Younger South African Women and Predictive of Increased Risk of Human Immunodeficiency Virus Acquisition[J]. Clin Infect Dis, 2023, 76(8):1372-1381. doi: 10.1093/cid/ciac938.
[8]	Nava-Memije K, Hernández-Cortez C, Ruiz-González V, et al. Bacterial Vaginosis and Sexually Transmitted Infections in an HIV-Positive Cohort[J]. Front Reprod Health, 2021,3:660672. doi: 10.3389/frph.2021.660672.
[9]	Eastment MC, McClelland RS. Vaginal microbiota and susceptibility to HIV[J]. AIDS, 2018, 32(6):687-698. doi: 10.1097/QAD.0000000000001768. pmid: 29424773
[10]	Velloza J, Heffron R. The Vaginal Microbiome and its Potential to Impact Efficacy of HIV Pre-exposure Prophylaxis for Women[J]. Curr HIV/AIDS Rep, 2017, 14(5):153-160. doi: 10.1007/s11904-017-0362-z.
[11]	Mazibuko-Motau N, Sobia P, Xu J, et al. Vaginal microbial shifts are unaffected by oral pre-exposure prophylaxis in South African women[J]. Sci Rep, 2022, 12(1):16187. doi: 10.1038/s41598-022-20486-z. pmid: 36171447
[12]	Mitjà O, Suñer C, Giacani L, et al. Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis[J]. Lancet Reg Health Eur, 2023,34:100737. doi: 10.1016/j.lanepe.2023.100737.
[13]	Waites KB, Crabb DM, Ratliff AE, et al. Latest Advances in Laboratory Detection of Mycoplasma genitalium[J]. J Clin Microbiol, 2023, 61(3):e0079021. doi: 10.1128/jcm.00790-21.
[14]	Kissinger PJ, Gaydos CA, Seña AC, et al. Diagnosis and Management of Trichomonas vaginalis: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines[J]. Clin Infect Dis, 2022, 74(Suppl 2):S152-S161. doi: 10.1093/cid/ciac030.
[15]	Sorvillo F, Kerndt P. Trichomonas vaginalis and amplification of HIV-1 transmission[J]. Lancet, 1998, 351(9097):213-214. doi: 10.1016/S0140-6736(05)78181-2. pmid: 9449891
[16]	Nyirjesy P, Brookhart C, Lazenby G, et al. Vulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines[J]. Clin Infect Dis, 2022, 74(Suppl 2):S162-S168. doi: 10.1093/cid/ciab1057.
[17]	Hufstetler K, Llata E, Miele K, et al. Clinical Updates in Sexually Transmitted Infections, 2024[J]. J Womens Health(Larchmt), 2024, 33(6):827-837. doi: 10.1089/jwh.2024.0367.
[18]	Bi D, Wei S, Luo X, et al. Management for persistent HPV infection and cervical lesions among women infected with HIV: a retrospective observational cohort study[J]. Virol J, 2024, 21(1):133. doi: 10.1186/s12985-024-02405-y. pmid: 38844960
[19]	Mcharo R, Lennemann T, France J, et al. HPV Type Distribution in HIV Positive and Negative Women With or Without Cervical Dysplasia or Cancer in East Africa[J]. Front Oncol, 2021,11:763717. doi: 10.3389/fonc.2021.763717.
[20]	Cambrea SC, Aschie M, Resul G, et al. HPV and HIV Coinfection in Women from a Southeast Region of Romania-PICOPIV Study[J]. Medicina(Kaunas), 2022, 58(6):760. doi: 10.3390/medicina58060760.
[21]	Ermel A, Tong Y, Tonui P, et al. Longer duration of anti-retroviral therapy is associated with decreased risk of human papillomaviruses detection in Kenyan women living with HIV[J]. Int J STD AIDS, 2021, 32(13):1212-1220. doi: 10.1177/09564624211030766.
[22]	Liu G, Sharma M, Tan N, et al. HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer[J]. AIDS, 2018, 32(6):795-808. doi: 10.1097/QAD.0000000000001765. pmid: 29369827
[23]	李雯, 段远琼, 尹如铁. 2023年NCCN人类免疫缺陷病毒感染者癌症临床实践指南(第1版)之子宫颈癌解读[J]. 实用妇产科杂志, 2023, 39(7):506-508.
[24]	Greene SA, De Vuyst H, John-Stewart GC, et al. Effect of Cryotherapy vs Loop Electrosurgical Excision Procedure on Cervical Disease Recurrence Among Women With HIV and High-Grade Cervical Lesions in Kenya: A Randomized Clinical Trial[J]. JAMA, 2019, 322(16):1570-1579. doi: 10.1001/jama.2019.14969. pmid: 31638680
[25]	Wiik J, Sengpiel V, Kyrgiou M, et al. Cervical microbiota in women with cervical intra-epithelial neoplasia, prior to and after local excisional treatment, a Norwegian cohort study[J]. BMC Womens Health, 2019, 19(1):30. doi: 10.1186/s12905-019-0727-0. pmid: 30728029
[26]	Kaizilege GK, Ndaboine E, Chuma C, et al. Unraveling cervical cancer screening dilemmas: histopathological insights from VIA and LEEP at bugando medical centre, Mwanza[J]. BMC Cancer, 2024, 24(1):66. doi: 10.1186/s12885-023-11779-1. pmid: 38216912
[27]	Kang WD, Choi HS, Kim SM. Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)?[J]. Gynecol Oncol, 2013, 130(2):264-268. doi: 10.1016/j.ygyno.2013.04.050. pmid: 23623831
[28]	Stelzle D, Tanaka LF, Lee KK, et al. Estimates of the global burden of cervical cancer associated with HIV[J]. Lancet Glob Health, 2021, 9(2):e161-e169. doi: 10.1016/S2214-109X(20)30459-9. pmid: 33212031
[29]	Musa J, Kocherginsky M, Magaji FA, et al. Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria[J]. Infect Agent Cancer, 2023, 18(1):68. doi: 10.1186/s13027-023-00550-7.
[30]	Chu D, Liu T, Yao Y. Implications of viral infections and oncogenesis in uterine cervical carcinoma etiology and pathogenesis[J]. Front Microbiol, 2023,14:1194431. doi: 10.3389/fmicb.2023.1194431.
[31]	Jallah JK, Anjankar A, Nankong FA. Public Health Approach in the Elimination and Control of Cervical Cancer: A Review[J]. Cureus, 2023, 15(9):e44543. doi: 10.7759/cureus.44543.
[32]	Zuñiga Vinueza AM. Probiotics for the Prevention of Vaginal Infections: A Systematic Review[J]. Cureus, 2024, 16(7):e64473. doi: 10.7759/cureus.64473.
[33]	中华医学会妇产科学分会感染性疾病协作组. 阴道用乳杆菌活菌胶囊临床应用中国专家共识(2023年版)[J]. 中国实用妇科与产科杂志, 2023, 39(5):537-546. doi: 10.19538/j.fk2023050113.
[34]	Sharifian K, Shoja Z, Jalilvand S. The interplay between human papillomavirus and vaginal microbiota in cervical cancer development[J]. Virol J, 2023, 20(1):73. doi: 10.1186/s12985-023-02037-8. pmid: 37076931
[35]	路易玲, 杨海霞, 段丽. 改良阴道冲洗结合益生菌对阴道微生态环境转归的机制和可行性分析[J]. 辽宁医学杂志, 2022, 36(6):56-58.