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Современные направления в диагностике, лечении и профилактике ВПЧ-ассоциированных заболеваний шейки матки (в помощь клиницисту)
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
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Prilepskaya VN, Iurova MV. Current approaches in the diagnosis, treatment and prevention of HPV-associated cervical diseases: practical recommendations. A review. Gynecology. 2023;25(2):245–250.
DOI: 10.26442/20795696.2023.2.202193
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Ключевые слова: ВПЧ-ассоциированные заболевания, цервикальная интраэпителиальная неоплазия, скрининг, вакцинация от ВПЧ, инозин пранобекс
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Papillomavirus infection is one of the most important infectious diseases of the reproductive system. The genome of human papillomavirus (HPV) transforms the cervical epithelial cells, leading to progressive changes: from cervical epithelial neoplasia to carcinoma in situ and further to invasive cancer. More than 550 000 cases of cervical cancer (CC) are reported yearly. In Russia, the incidence of CC in 2020 decreased for the first time in 20 years, and the average annual rate of increase in incidence was 1.27%. It became possible thanks to the introduction of a new system of diagnosis, treatment, and prevention of cervical cancer, in particular, the introduction of screening and a program of modern methods of diagnosis and treatment. Uniform for all countries, screening cervical diseases aims to diagnose changes in the cervical epithelium that occur due to HPV, which may be silent. Until now, the basis of screening programs was a cytological study (pap-test). Since 2018, most EU countries have switched to primary screening for HPV (HPV test) due to its greater sensitivity compared to the cytological method. No etiopathogenetic methods of HPV therapy have been developed yet. However, numerous studies have described the effective treatment of HPV-associated cervical lesions. It was shown that the most effective is a comprehensive approach involving treatment aimed at abnormal tissues and nonspecific antiviral and immunomodulatory therapy. The basis of the CC prevention strategy, of course, is primary prevention through vaccination. Studies are ongoing on the effectiveness of the new generation of vaccines based on the L2 viral protein and therapeutic vaccines against HPV.
Keywords: HPV-associated diseases, cervical epithelial neoplasia, screening, HPV vaccination, inosine pranobex
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19. Yang J, Pu YG, Zeng ZM, et al. Interferon for the treatment of genital warts: a systematic review. BMC Infect Dis. 2009;9:156. DOI:10.1186/1471-2334-9-156
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N Engl J Med. 2007;356(19):1928-43. DOI:10.1056/NEJMoa061760
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25. Van Damme P, Bouillette-Marussig M, Hens A, et al. GTL001, A Therapeutic Vaccine for Women Infected with Human Papillomavirus 16 or 18 and Normal Cervical Cytology: Results of a Phase I Clinical Trial. Clin Cancer Res. 2016;22(13):3238-48. DOI:10.1158/1078-0432.CCR-16-0085
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1. Braaten KP, Laufer MR. Human Papillomavirus (HPV), HPV-Related Disease, and the HPV Vaccine. Rev Obstet Gynecol. 2008;1(1):2-10.
2. Hoots BE, Palefsky JM, Pimenta JM, Smith JS. Human papillomavirus type distribution in anal cancer and anal intraepithelial lesions. Int J Cancer. 200915;124(10):2375-83. DOI:10.1002/ijc.24215
3. IARC monographs on the evaluation of carcinogenic risks to humans. Vol. 90. Human papillomaviruses. Lyon, France: IARC, 2007.
4. Muñoz N, Castellsagué X, Berrington de González A, Gissmann L. Chapter 1: HPV in the etiology of human cancer. Vaccine. 2006;24(Suppl. 3):S3/1-10. DOI:10.1016/j.vaccine.2006.05.115
5. Modis Y, Trus BL, Harrison SC. Atomic model of the papillomavirus capsid. EMBO J. 2002;21:4754-62. DOI:10.1093/emboj/cdf494
6. The Nobel Prize in Physiology or Medicine 2008. Available at: https://www.nobelprize.org/prizes/medicine/2008/summary/ Accessed: 11.04.2023.
7. IARC European guidelines for quality assurance in cervical cancer screening, Всемирная организация здравоохранения (WHO). Available at: https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en. Accessed: 11.04.2023.
8. Nazarova NM, Burmenskaia OV, Sulamanidze LA, et al. Rasprostranennost' tipov virusa papillomy cheloveka anogenital'noi oblasti u patsientok s VPCh-assotsiirovannymi zabolevaniiami sheiki matki. Akusherstvo i ginekologiia. 2015;12:89-96 (in Russian).
9. Zlokachestvennye novoobrazovaniia v Rossii v 2020 g. (zabolevaemost' i smertnost'). Pod red. AD Kaprina, VV Starinskogo, AO. Shakhzadovoi. Moscow, 2021 (in Russian).
10. Gusakov KI, Nazarova NM, Prilepskaya VN, et al. Prospects for the prevention of HPV-associated cancer. Obstetrics and Gynegology. 2019;8:33-9 (in Russian). DOI:10.18565/aig.2019.8.33-39
11. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2014;383(9916):524-32.
12. Starodubtseva NL, Brzhozovskiy AG, Bugrova AE, et al. Label-free cervicovaginal fluid proteome profiling reflects the cervix neoplastic transformation. J Mass Spectrom. 2019;54(8):693-703. DOI:10.1002/jms.4374
13. Saslow D, Solomon D, Lawson HW, et al. ACS-ASCCP-ASCP Cervical Cancer Guidelines Committee. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-72.
14. Goodman MT, Shvetsov YB, McDuffie K, et al. Sequential acquisition of human papillomavirus (HPV) infection of the anus and cervix: the Hawaii HPV Cohort Study. J Infect Dis. 2010;201(9):1331-9. DOI:10.1086/651620.
15. Garland SM, Kjaer SK, Muñoz N, et al. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clin Infect Dis. 2016;63(4):519-27. DOI:10.1093/cid/ciw354
16. Santesso N, Mustafa RA, Wiercioch W, et al. Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. Int J Gynaecol Obstet. 2016;132(3):266-71. DOI:10.1016/j.ijgo.2015.07.026
17. Hurtado-Roca Y, Becerra-Chauca N, Malca M. Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review. Rev Saude Publica. 2020;54:27. DOI:10.11606/s1518-8787.2020054001750
18. Yan J, Chen SL, Wang HN, Wu TX. Meta-analysis of 5% imiquimod and 0.5% podophyllotoxin in the treatment of condylomata acuminata. Dermatology. 2006;213(3):218-23. DOI:10.1159/000095039
19. Yang J, Pu YG, Zeng ZM, et al. Interferon for the treatment of genital warts: a systematic review. BMC Infect Dis. 2009;9:156. DOI:10.1186/1471-2334-9-156
20. Adamian LV, Artymuk NV, Ashrafian LA, et al. Dobrokachestvennye i predrakovye zabolevaniia sheiki matki s pozitsii profilaktiki raka. Klinicheskie rekomendatsii (protokoly diagnostiki i vedeniia bol'nykh). 2017. Available at: https://docs.cntd.ru/document/550511771. Accessed: 12.04.2023 (in Russian).
21. McCarthy MT, Lin D, Soga T, et al. Inosine pranobex enhances human NK cell cytotoxicity by inducing metabolic activation and NKG2D ligand expression. Eur J Immunol. 2020;50(1):130-7. DOI:10.1002/eji.201847948
22. Joura EA, Leodolter S, Hernandez-Avila M, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet. 2007;69(9574):1693-702. DOI:10.1016/S0140-6736(07)60777-6
23. Garland SM, Hernandez-Avila M, Wheeler CM, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases.
N Engl J Med. 2007;356(19):1928-43. DOI:10.1056/NEJMoa061760
24. Haghshenas MR, Mousavi T, Kheradmand M, et al. Efficacy of Human Papillomavirus L1 Protein Vaccines (Cervarix and Gardasil) in Reducing the Risk of Cervical Intraepithelial Neoplasia: A Meta-analysis. Int J Prev Med. 2017;8:44. DOI:10.4103/ijpvm.IJPVM_413_16
25. Van Damme P, Bouillette-Marussig M, Hens A, et al. GTL001, A Therapeutic Vaccine for Women Infected with Human Papillomavirus 16 or 18 and Normal Cervical Cytology: Results of a Phase I Clinical Trial. Clin Cancer Res. 2016;22(13):3238-48. DOI:10.1158/1078-0432.CCR-16-0085
26. Smalley Rumfield C, Pellom ST, Morillon Ii YM, et al. Immunomodulation to enhance the efficacy of an HPV therapeutic vaccine. J Immunother Cancer. 2020;8(1):e000612. DOI:10.1136/jitc-2020-000612
27. Sukhikh GT, Prilepskaia VN, Ashrafian LA, et al. Diagnostika, lechenie i profilaktika VPCh-assotsiirovannykh zabolevanii sheiki matki v akushersko-ginekologicheskoi praktike. Uchebnoe posobie. Moscow: Binom, 2019 (in Russian).
1 ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*v_prilepskaya@oparina4.ru
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Vera N. Prilepskaya*1, Mariia V. Iurova1,2
1 Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*v_prilepskaya@oparina4.ru