Soil-Transmitted Helminth Infections Are Associated With an Increase in Human Papillomavirus Prevalence and a T-Helper Type 2 Cytokine Signature in Cervical Fluids.
BACKGROUND
An ecological correlation between invasive cervical cancer incidence and burden of soil-transmitted helminths (STH) is hypothesized to explain the excess in detectable human papillomavirus (HPV) infection in Latin America, via a global T-helper type 2 (Th2)-biased mucosal immune response secondary to STH infection.


METHODS
The association between current STH infection and HPV prevalence was compared in regions of Peru where STH is or is not endemic. Adjusted prevalence ratios (PRs) with robust variance were estimated as an effect measure of STH infection on HPV prevalence in each study site. Soluble immune marker profiles in STH-infected and STH-uninfected women were compared using Spearman rank correlation with the Sidak correction.


RESULTS
Among women in the helminth-endemic region of the Peruvian Amazon, those with STH infection women had a 60% higher prevalence of HPV, compared with those without STH infection (PR, 1.6; 95% confidence interval, 1.0-2.7). Non-STH parasitic/protozoal infections in the non-STH-endemic population of Peru were not associated with HPV prevalence. In Iquitos, A Th2 immune profile was observed in cervical fluid from helminth-infected women but not helminth-uninfected women.


CONCLUSIONS
A proportion of the increased HPV prevalence at older ages observed in Latin America may be due to a population-level difference in the efficiency of immunological control of HPV across the lifespan due to endemic STH infection.
Department of Pathology Department of Epidemiology.
Patti E
PE
Gravitt
Department of Epidemiology Department of Pharmacoepidemiology, Merck Research Laboratories, Whitehouse Station.
Morgan
M
Marks
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Biomedical Research Unit, Asociación Benéfica PRISMA.
Margaret
M
Kosek
Departamento de Ginecologia, Hospital Regional de Loreto, Iquitos.
Christine
C
Huang
Biomedical Research Unit, Asociación Benéfica PRISMA.
Lilia
L
Cabrera
Biomedical Research Unit, Asociación Benéfica PRISMA.
Maribel Paredes
MP
Olortegui
Departamento de Ginecologia, Hospital Regional de Loreto, Iquitos.
Alberto Mejia
AM
Medrano
Biomedical Research Unit, Asociación Benéfica PRISMA.
Dixner R
DR
Trigoso
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Sarah
S
Qureshi
Intituto de Enfermedades Neoplasicas.
Gustavo S
GS
Bardales
Intituto de Enfermedades Neoplasicas.
Javier
J
Manrique-Hinojosa
Intituto de Enfermedades Neoplasicas.
Albert Z
AZ
Cardenas
Intituto de Enfermedades Neoplasicas.
Manuel A
MA
Larraondo
Hospital Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru.
Jaime
J
Cok
Department of Internal Medicine, University of New Mexico, Albuquerque.
Fares
F
Qeadan
Department of Medicine, New Jersey Medical School, Rutgers-The State University of New Jersey, Newark.
Mark
M
Siracusa
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Robert H
RH
Gilman
D000328:Adult; D002584:Cervix Uteri / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D005786:Gene Expression Regulation / Q000276:immunology; D006373:Helminthiasis / Q000150:complications* / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000378:metabolism; D010568:Peru / Q000453:epidemiology; D010865:Pilot Projects; D012987:Soil / Q000469:parasitology*; D006377:T-Lymphocytes, Helper-Inducer / Q000378:metabolism*
D016207:Cytokines; D012987:Soil
age; cervical cancer; human papillomavirus; parasite; prevalence; soil-transmitted helminth