Natural course of human papillomavirus (HPV) infection. Effectiveness of HPV analysis in cervical swabs

Cervical carcinomas and their precursors (cervical dysplasia, CIN1-3) are a ssociated with human papillomavirus (HPV) infections. Epidemiological and i n vitro-studies have shown that some of the genital HPV types, the high ris k-types 16, 18, 31 etc., code for proteins (E6/E7) which strongly influence the cell cycle and genome stability. Progression from weak to severe dyspl asia and to invasive cancer is associated with increasing expression of the se viral oncogenes. Which additional cofactors contribute to progression of some dysplasias to carcinomas is still a matter of investigation. Recent r esults point to genetic predisposition (p53 polymorphism), cellular immune reaction, and cytokine expression. For HPV detection in cervical swabs and biopsies two highly sensitive and reliable systems (PCR, Hybrid Capture sys tem) are available. Although classical histological methods are sufficient for the diagnosis of high-grade lesions and invasive cancer, HPV testing mi ght give valuable diagnostic and prognostic clues especially in cases of un clear cytology (ASCUS) or weak dysplasia.