I. Proper understanding and treatment of HPV infection
The relationship between HPV infection and cervical lesions and cervical cancer has been clearly established, and it can even be said that cervical cancer is caused by HPV infection, and the equation that no HPV infection can prevent cervical cancer is valid. However, it cannot be said that HPV infection must lead to cervical cancer and that HPV infection equals cervical cancer, which is not true. The problem is that.
(1) HPV infection is relatively common, especially during the sexually active period before age 30;
(2) Most HPV can be cleared, so these infections are “transient” and do not cause cervical lesions;
(iii) Only a few persistent infections cause cervical lesions;
(4) It takes a long time, usually 8 to 10 years, from HPV-induced CINI, CINII, CINIII to invasive cancer;
⑤ High-risk HPV is the cause of cervical cancer, while low-risk HPV infection rarely causes cervical cancer;
(6) HPV(+) is only an infection, not a disease, and it does not mean that cervical cancer will definitely occur, as the risk is only 2%;
(7) Since the absence of HPV infection, especially high-risk HPV infection, can prevent cervical cancer, avoiding HPV infection can prevent the occurrence of cervical cancer;
The current policy is that “treatment of cervical lesions caused by HPV infection is treatment of HPV infection”, which is also an important measure for cancer prevention.
The current policy is that “treatment of cervical lesions caused by HPV infection is treatment of HPV infection”, which is also an important measure for cancer prevention. In view of the above understanding, we should establish appropriate countermeasures.
II. Management of HPV infection
HPV infection of cervical epithelial cells can exist outside the chromosome in a free state, not causing lesions, or only causing benign lesions and low-grade intraepithelial neoplasia; or it can integrate into the fragile region of the chromosome, especially E6 and E7 have the ability to promote and maintain the integration state, and by binding to p53 and pRB, inactivate the oncogene p53 and pRB, immortalize the cells and malignant proliferation. In these processes, the clinical management principle is to combine HPV testing and cytology to make a choice.
First, if only HPV(+) and cytology (Cyt-) are present, indicating that no lesions have been caused, they can be left untreated but should be followed up. (+), Cyt(+), and HPV(+) should be examined by colposcopy and biopsy. Secondly, for HPV-positive patients, none of the current medications work directly or can eliminate HPV. Some medications may modify the vaginal environment, improve cervical epithelial repair, or treat cervical inflammation, but whether they are beneficial for HPV clearance is difficult to determine, or at least limited. Furthermore, the current policy for managing HPV infection is to “treat the disease” (CIN) or “treat the virus” (HPV) by treating the lesions caused by HPV infection and clearing HPV within a certain period of time (about 12 months). The specific treatment protocol is based on the “three standardized recommendations” (diagnosis of cervical lesions, treatment of cervical lesions, and treatment of HPV testing and cytology). For CIN I, physical therapy (freezing, laser, electrocoagulation, etc.); for CIN II, physical therapy or LEEP; for CIN III, LEEP, CKC or total hysterectomy, etc. It has been proven that various treatments for all levels of CIN can help to clear HPV, and most of them can be negative from 3 months to 12 months after treatment. A clear trend of gradual decrease in viral load can even be observed. If HPV remains positive 1 year after surgery, there is a high risk of residual lesions or recurrence. Finally, there is the issue of psychosocial, counseling, and public education for HPV-infected patients. As people learn more about HPV-induced cervical lesions, it is natural to ask questions about why HPV infection occurs, whether it can lead to cervical cancer, what to do about it, and how sexual partners should be treated.
The American Social Health Association has a counseling hotline for this purpose, and the 1999 Centers for Disease Control Support and External Counseling Conference has several important educational messages specifically for this purpose.
1. Emphasize that a positive HPV test only indicates that it is an infection, not a disease. Infection is common; development of cancer is rare.
2. If HPV(+) alone without cervical lesions, no treatment is needed; if combined with cervical lesions, they should be treated.
Most women (about 90%) will clear HPV infection on their own.
4. HPV infection is mainly transmitted sexually, but other routes are not excluded. The significance of treatment of sexual partners is undetermined and there is a lack of good prescriptions. Pay attention to sexual hygiene and cleanliness is basic.
5, HPV is not an absolute sign of sexual behavior or “fidelity” between sexual partners.
6. Take HPV infection seriously and prevent, avoid and manage HPV infection. The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends that normal cells and HPV(-) be left untreated and followed up routinely after 3 years; normal cells and HPV(+) be reviewed at 12 months and HPV testing repeated. HPV testing should be performed for cytologic findings of unclear significance; HPV testing should be used for predictive assessment of regression, persistence and progression of CIN I and CIN II; and post-treatment follow-up of CIN and cervical cancer. The above can be used as a reference for gynecologists and advice for the patient or patient.
In conclusion, we can say the following about the relationship between HPV infection and cervical cancer: cervical cancer should be considered as a very common complication caused by a very common virus.
HPV Vaccine
HPV vaccine research has received widespread attention from scholars all over the world, and among immunotherapy for tumors, HPV vaccine for cervical cancer is indeed the most promising research with the fastest progress, which has the potential to bring the prevention of cervical cancer to the advanced level of primary prevention.
HPV vaccine is divided into preventive vaccine and therapeutic vaccine.
1. Prophylactic vaccines are nucleic acid-free polyvalent viral particles (VLPs) produced by DNA repetition technology, which are self-assembled VLPs without viral DNA and have good antigenicity and immunogenicity, and can induce a certain concentration of neutralizing antibodies, resulting in longer-lasting immunity. The National Cancer Institute (NCI) vaccine against HPV16VLP induced antibodies up to 40 times higher than those naturally expressed, and Cain et al. reported a good safety profile and up to 75% protective effect. Several recent reports, such as Merch, state that they expect to apply for a provisional license for vaccine application by the end of 2005 and launch their quadrivalent vaccine (HPV16, 18, 6, 11) in 2006. The French trivalent VLPs vaccine (HPV11, 16, 18) has also shown good trial results.
2.Therapeutic vaccine The E6 and E7 oncoproteins of HPV are used as the original targets to stimulate cell-modulated immunity (CMI) and lymphotoxic cells (CILS) to eliminate the existing HPV infection and HPV-related precancerous lesions and cancer progression through cellular immunity, with a view to the combined treatment of LSIL, HSIL and cancer in a sustained manner.
3, HPV vaccine Especially the research and trial application of preventive vaccine is encouraging, but there are still questions that follow: such as the application of the vaccine may have a negative impact on the screening program of cervical smear, which should be reduced in public education; the scope of the population for preventive vaccination, is it the general population rather than the high-risk group, whether it starts from the age of 18 years or with sexual intercourse; should HPV testing be done first? How will the HPV vaccine, which must be more expensive or in short supply to begin with, address immunization of a large number of people in developing countries; and should it even be administered to men? The research and application of therapeutic vaccines may be more problematic or time-consuming. So, as some have already cautioned, despite the dawn of the HPV vaccine, there is no room for blind optimism, lest an illusory shadow be cast.