HPV-Infektionen: Diagnostik und Impfung

Humane Papillomaviren (HPV) sind doppelsträngige DNA-Viren, von denen > 200 verschiedene Subtypen bekannt sind. Die HPV-Subtypen lassen sich je nach malignem Potenzial einer Infektion entweder in Niedrigrisikosubtypen (6, 11, 40, 42, 43, 44, etc.) oder Hochrisikosubtypen (6, 18, 31, 33, 35, 39 etc.) einteilen. Die häufigsten Hochrisikosubtypen sind HPV 16 und 18 (verantwortlich für 70 % der Zervixkarzinome) [1]. Die Infektion mit HPV Niedrigrisikosubtypen kann zu gutartigen Feigwarzen oder Larynxpapillomatose führen, während eine Infektion mit Hochrisikosubtypen zu invasiven Karzinomen insbesondere dem Zervixkarzinom aber auch Karzinomen des Mund-Rachenraums, Vagina-, Vulva-, Penis- und Analkarzinomen führen kann [2].

Bei Zervixkarzinomen lässt sich in 99,7 % DNA von Hochrisiko-HPV nachweisen. Bereits 1976 postulierte Harald zur Hausen, dass die Infektion mit HPV einen essenziellen Faktor bei der Pathogenese des Zervixkarzinoms darstellt, wofür er 2008 mit dem Medizin-Nobelpreis ausgezeichnet wurde.

International variiert die Prävalenz von HPV-Infektionen in Abhängigkeit von Kulturkreis, sozialer Schicht und Alter und liegt zwischen 3 % –50 % [3] [4]. In Westeuropa wird die Prävalenz von humanen Papillomaviren bei Frauen auf ca. 9 % geschätzt, wobei es einen Altersgipfel bei 20 – 24 Jahren mit einer Prävalenz von 29 – 45 % gibt [5] [6] [7].

Infektionen mit HPV finden häufig schon bei den ersten Sexualkontakten statt [8]. Kondome stellen keinen absoluten Schutz vor der Übertragung dar, können aber vermutlich die Wahrscheinlichkeit einer Übertragung verringern [9]. Bislang wurde eine Reihe von Risikofaktoren für eine HPV-Infektion identifiziert ([Tab. 1]) [10] [11] [12] [13].

Tab. 1 Risikofaktoren für eine HPV-Infektion.

Promiskuität

niedriger sozioökonomischer Status

Immunsuppression

früher Geschlechtsverkehr

Rauchen

Multiparität

Einnahme oraler Kontrazeptiva > 5 Jahre

Ko-Infektion mit sexuell übertragbaren Erregern

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