A LONGITUDINAL ANALYSIS OF HUMAN PAPILLOMAVIRUS-16 INFECTION, NUTRITIONAL-STATUS, AND CERVICAL DYSPLASIA PROGRESSION

To evaluate the effect of potential risk factors, especially human pap illomavirus type 16 (HPV-16) infection and nutritional status on the c ourse of cervical dysplasia, we analyzed data from an intervention tri al conducted from 1985 to 1990, in Birmingham, Alabama, With the use o f data of four repeated evaluations of dysplasia at an interval of 2 m onths, specific relationships between HPV-16 infection, plasma retinol and zinc levels, and dysplasia progression were evaluated through lon gitudinal data analysis of generalized estimating equations, Repeated assessments of nutritional status from blood samples, HPV-16 infection , and dysplasia diagnosis were available from 206 women, Dysplasia dia gnosis was confirmed by both Papanicolaou smear and colposcopy examina tions and was classified as normal, low, or high grade squamous intrae pithelial lesions according to the Bethesda system and assigned a scor e of 0, 1, or 2, respectively, Generalized estimating equation analyse s were performed with assumptions of variance of Poisson and link of l ogarithm, Separate analyses were also conducted for HPV-16-positive an d HPV-16-negative women, By multivariate modeling with adjustment for age, race, smoking, oral contraceptive use, and plasma levels of nutri ents, HPV-16 infection was found to be related to the progression of c ervical dysplasia, with a relative risk of 1.19 and a 95% confidence i nterval of 1.03-1.38, High plasma levels of retinol were related to th e regression of cervical dysplasia, especially in HPV-16-positive wome n, A protective effect was also observed for high levels of zinc, Rest ricting analysis to data from visit two to four showed similar protect ive effects of retinol and zinc, affirming the results were not likely to be confounded by potential selection bias, In conclusion, HPV-16 i nfection was related to the progression of cervical dysplasia, Higher levels of plasma retinol and zinc were related to the regression of dy splasia, especially in HPV-16-positive women, Interactive effects of n utritional factors and viral agents in cervical dysplasia progression and intervention warrant further studies.