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Indications, interprétation du test HPV et des marqueurs moléculaires

  • Chapter
Traité des infections et pathologies génitales à papillomavirus

  • 444 Accesses

Abstrait

L’infection par certains types de papillomavirus à risque (HPV HR) est une condition requise pour le développement des pré-cancers et du cancer du col utérin. Ce fait a été établi par les études épidémiologies sur de larges séries qui ont évalué les facteurs de risque de cancer du col chez les sujets présentant des néoplasies intraépithéliales cervicales (CIN) ou dysplasies. Les mécanismes moléculaires allant de la réplication à l’intégration virale dans l’ADN du noyau jusqu’à la transformation cellulaire sont bien connus.

Les HPV HR, en particulier les 16 et 18, transmis par contact sexuel, sont très prévalents dans la population générale en particulier chez les jeunes femmes de 15 à 25 ans, période privilégiée d’exposition aux virus. La clearance de ces virus est élevée témoignant de la capacité immunitaire naturelle à éradiquer spontanément ces virus dont l’infection sera passée inaperçue pour la majorité des sujets exposés. Seules les femmes qui auront gardé les virus persistants témoins de l’échappement immunitaire sont à risque de développer des CIN actuelles ou futures.

L’histoire naturelle de la maladie est un processus long qui témoigne de l’échappement immunitaire à éradiquer spontanément l’ADN viral chez un nombre limité de sujets exposés.

Cette inégalité immunologique, face aux HPV HR, légitimise le développement de candidats vaccins HPV 16 et 18 prophylactiques.

Le lien entre HPV HR et cancer du col a suscité le développement de méthodes sensibles de détection de l’ADN viral en pratique clinique. Ces méthodes sont actuellement disponibles pour une utilisation clinique.

Le test HPV est considéré aujourd’hui comme l’approche préférentielle de prise en charge des femmes ayant un frottis ambigu (ASC-US) sur le liquide de cytologie ou sur un prélèvement séparé. Des recommandations récentes indiquent la possibilité de proposer ce test dans d’autres utilisations cliniques.

Face à la perspective d’utiliser le test HPV en dépistage primaire en complément du frottis, il est important que les cliniciens, pathologistes et biologistes sachent quand proposer et comment interpréter les résultats de ce test.

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  1. Département de Colposcopie, FMP Paris, Institut Européen du Col., 174 rue de Courcelles, 75017, Paris

    J. Monsonego

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Monsonego, J. (2007). Indications, interprétation du test HPV et des marqueurs moléculaires. In: Traité des infections et pathologies génitales à papillomavirus. Springer, Paris. https://doi.org/10.1007/978-2-287-72066-6_25

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