title: Factors influencing the biological behaviour of cervical human papillomavirus (HPV) infections in prospectively followed-up women.
abstract: To assess the natural history of Human papillomavirus (HPV) infections in uterine cervix, recently linked with cervical intraepithelial neoplasia (CIN), a long-term prospective follow-up study was started at our clinic in 1981. At this writing, a total of 418 women have been followed-up for a mean of 20 +/- 15 (M SD) months. On each attendance (at six-month intervals), the patient is subjected to colposcopy accompanied either by Papanicolaou (PAP) smears or punch biopsies. The latter are analysed for the cytopathic changes of HPV, for concomitant CIN, as well as for HPV structural proteins with IP-PAP technique. The local immunocompetent cell (ICC) infiltrates are analysed using ANAE technique to define B cells, MPS cells and T cells and monoclonal antibodies (McAb) for T cells subsets, NK (natural killer) cells and Langerhans cells. The relative levels of B- and T lymphocytes and MPS cells did not correlate with the clinical course, i.e. regression (RE), persistence (PE) or progression (PR) of the HPV lesions. The same was true with the expression of HPV antigens, intensity of the ICC infiltrate, as well as with the relative levels of NK (HNK-1+) cells and Langerhans (OKT-6+) cells. The T helper/T suppressor cell ratio was subject to minor fluctuations only as determined in three subsequent biopsies, and did not bear any meaningful relationship to the natural history of the HPV lesions. During the follow-up, 24.0% of the HPV lesions regressed, 54.9% remained persistent, and 21.1% progressed, 26 (6.2%) having been coned due to progression into CIS. The clinical course was most significantly influenced by the grade of HPV-associated CIN, to which RE was inversely and PR directly related. The results clearly confirm that cervical HPV infections are capable of progressing into CIS and thus show a natural history equivalent to that of classical CIN. Therefore, cervical HPV infections should be regarded as truly precancerous lesions, which should be examined, treated and followed-up with the same concern as the classical CIN.
mesh_terms: D000328:Adult; D003127:Colposcopy; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000276:immunology; D011230:Precancerous Conditions / Q000276:immunology / Q000473:pathology*; D011446:Prospective Studies; D014412:Tumor Virus Infections / Q000276:immunology / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000276:immunology / Q000473:pathology*