| Abstract | Humani papilloma virusi su mali, neobloženi, dvolančani DNK virusi veličine genoma oko 8000 parova baza. Danas je poznato 200 različitih tipova virusa, ali ih samo 40 može zaraziti anogenitalnu regiju koja se može svrstati u tri klase na temelju njihovog potencijala. HPV genotipovi 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 59, 68, 73 i 82 pripadaju skupini visokog rizika koji se povezuju s intraepitelnim lezijama i genitalnim karcinomima.
HPV je najčešća spolno prenosiva bolest u svijetu, a smatra se da 660 milijuna ljudi u svijetu ima tu infekciju. Papilloma virusi uzročnici su brojnih infekcija kože, stopala, anogenitalnih bradavica, laringealnih papiloma te različitih karcinoma. Velika većina HPV infekcija na svim mjestima je subklinička i asimptomatska. Stoga većina HPV pozitivnih pojedinaca ne znaju da su zaraženi. Prijenos HPV infekcije događa se kod žena tijekom spolnog odnosa sa zaraženim partnerom. Od kontakta virusom do pojave prvih kliničkih promjena potrebno je između 3 tjedna do 8 mjeseci, ali za razvoj malignih promjena potrebno je 10 – 15 godina. HPV infekcija najvažniji je predisponirajući faktor za razvoj predzloćudnih i zloćudnih promjena vrata maternice.
U razvijenim zemljama program probira na karcinom vrata maternice, provodi se od sredine 1950-ih godina. Metoda prvog izbora je Papa test koji ima relativno nisku osjetljivost jer zahtjeva educirano i izvježbano osoblje. Nakon patološkog nalaza Papa - testa potrebno je ponoviti nalaz Papa - testa, napraviti HPV testiranje, kolposkopiju i biopsiju.
Uvođenjem molekularnih metoda koje imaju znatno veću osjetljivost u odnosu na Papa test, omogućena je ranija detekcija osoba koje imaju HPV pa su time pod rizikom razvoja lezija. Detekcija nukleinskih kiselina PCR tehnikom neivazivna je metoda detekcije HPV infekcije spolnog sustava. Također, detekcijom pojedinačnih tipova HPV 16 i 18, kao najčešćih uzročnika karcinoma, omogućeno je selektiranje žena pod najvećim rizikom te njihovo daljnje upućivanje na kolposkopiju i biopsiju.
Tijekom 2018. godine u NZJZ SDŽ testirano je ukupno 2717 žena, od kojih su 842 (31 %) bile pozitivne, a najzastupljeniji je bio HPV tip 16. Provođenjem mjera primarne (cijepljenje i edukacija) i sekundarne prevencije (probir na karcinom vrata maternice HPV testiranjem), u budućnosti bi trebale biti eliminirane bolesti koje uzrokuju HPV. |
| Abstract (english) | Human papilloma viruses are small, unbroken, double-stranded DNA genomic viruses, about 8,000 base pairs. Today, 200 different types of virus are known, but only 40 of them can infect anogenital region that can be classified into three classes based on their cancer potential. HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 59, 68, 73 and 82 belong to a high risk group associated with intraepithelial lesions and genital carcinoma.
HPV is the most common sexually transmitted disease in the world, and it is believed that 660 million people have this infection worldwide. Papilloma viruses cause many infections of the skin, feet, anogenital warts, laryngeal papillomas, and various cancers. The majority of HPV infections in all places are subclinical and asymptomatic. Therefore, most HPV positive individuals do not know that they are infected. Transmission of HPV infection occurs in women during sexual intercourse with the infected partner. From the contact of the virus to the appearance of the first clinical changes, it takes between 3 weeks and 8 months, but for the development of malignant changes it takes 10 to 15 years. HPV infection is the most important predisposing factor for the development of premalignant and malignant changes in the cervix.
In developed countries, the cervical cancer screening program exists since the mid-1950s. The first choice method is a Pap test that has relatively low sensitivity because it requires educated and trained staff. After the pathological Pap test, it is necessary to repeat the Papa test, then to perform HPV testing, colposcopy and biopsy.
By introducing molecular methods that have a much greater sensitivity in comparison with Pap test, earlier detection of HPV positive persons is enabled who were at risk of developing lesions. Detection of nucleic acids by PCR technique is an inescapable method of detecting HPV infection in the genital system. Also, detection of individual types of HPV 16 and 18 as the most common causer of cancer, allowed gynecologist to select women at the highest risk and their further referral to colposcopy and biopsy.
In 2018, a total of 2717 women were tested in the Public Health Institute of Split and Dalmatia County, out of which 842 (31 %) were HPV positive and the most common type was HPV 16. By performing primary (vaccination and education) and secondary prevention (HPV cervical cancer screening), HPV-related diseases should be eliminated in the future. |
