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Indications et place du test HPV en pratique clinique

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Traité des infections et pathologies génitales à papillomavirus

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Abstrait

Il est clairement établi que l’infection avec certains types de papillomavirus à risque (HPV HR) est une condition requise pour le développement des précancers et du cancer du col utérin. Ce fait a été établi par les études épidémiologiques sur de larges séries qui ont évalué les facteurs de risque de cancer du col chez les sujets ayant des néoplasies intra-épithéliales cervicales (CIN) ou dysplasies. Les mécanismes moléculaires allant de la réplication virale à l’intégration à l’ADN du noyau jusqu’à la transformation cellulaire sont bien établis.

Les HPV HR, transmis par contact sexuel, sont 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 les éradiquer spontanément. Seules les femmes qui auront gardé les virus persistants sont à risque de développer des CIN actuelles ou futures. L’histoire naturelle de la maladie est un long processus qui témoigne de la tolérance immunitaire aux HPV d’un nombre limité de sujets exposés. Cette inégalité immunologique, face aux HPV HR, rend légitime l’utilisation de vaccins HPV 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, en particulier le dépistage primaire.

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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 et place du test HPV en pratique clinique. In: Traité des infections et pathologies génitales à papillomavirus. Springer, Paris. https://doi.org/10.1007/978-2-287-72066-6_9

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  • DOI: https://doi.org/10.1007/978-2-287-72066-6_9

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-72064-2

  • Online ISBN: 978-2-287-72066-6

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