Associations of cervicovaginal lactobacilli with high-risk HPV infection, cervical intraepithelial neoplasia, and cancer: a systematic review and meta-analysis.
- 2019-06-27
- The Journal of Infectious Diseases 220(8)
- Huiyan Wang
- Yan Ma
- Ruonan Li
- Xixi Chen
- Lijuan Wan
- Weidong Zhao
- PubMed: 31242505
- DOI: 10.1093/infdis/jiz325
Abstract
Background: Vaginal dysbiosis characterized by depleted lactobacilli is usually correlated with human papillomavirus (HPV) infection and cervical carcinogenesis, but the effect of the Lactobacillus genus and represented species on this process remains unclear.
Methods: PubMed, EMBASE, and CENTRAL databases were searched up to February 15, 2019. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a fixed-effect model and Review Manager (version 5.3) for Mac.
Results: Eleven studies comprising 1230 cases were included. Lactobacillus spp. was associated with the decreased detection of high-risk subtype (hr)HPV infection (OR = 0.64, 95% CI = 0.48-0.87, I2 = 6%), cervical intraepithelial neoplasia (CIN) (OR = 0.53, 95% CI = 0.34-0.83, I2 = 0%), and cervical cancer (CC) (OR = 0.12, 95% CI = 0.04-0.36, I2 = 0%). At the level of Lactobacillus species, Lactobacillus crispatus, but not Lactobacillus iners, was correlated with the decreased detection of hrHPV infection (OR = 0.49, 95% CI = 0.31-0.79, I2 = 10%) and CIN (OR = 0.50, 95% CI = 0.29-0.88, I2 = 0%).
Conclusions: Cervicovaginal Lactobacillus spp. is associated with the decreased detection of hrHPV infection, CIN, and CC; L. crispatus may be the critical protective factor.
Keywords: cervical cancer; cervical intraepithelial neoplasia; high-risk human papillomavirus; lactobacilli.
Research Insights
| Supplement | Health Outcome | Effect Type | Effect Size |
|---|---|---|---|
| Lactobacillus crispatus | Reduced Detection of Cervical Intraepithelial Neoplasia | Beneficial | Moderate |
| Lactobacillus crispatus | Reduced Detection of High-Risk HPV Infection | Beneficial | Moderate |
| Lactobacillus crispatus LBV 88 | Reduced Detection of Cervical Intraepithelial Neoplasia | Beneficial | Moderate |
| Lactobacillus crispatus LBV 88 | Reduced Detection of High-Risk HPV Infection | Beneficial | Moderate |
| Lactobacillus crispatus LBV88 | Reduced Detection of Cervical Intraepithelial Neoplasia | Beneficial | Moderate |
| Lactobacillus crispatus LBV88 | Reduced Detection of High-Risk HPV Infection | Beneficial | Moderate |
| Lactobacillus crispatus LCr86 | Reduced Detection of Cervical Intraepithelial Neoplasia | Beneficial | Moderate |
| Lactobacillus crispatus LCr86 | Reduced Detection of High-Risk HPV Infection | Beneficial | Moderate |
| Lactobacillus crispatus LV5 88 | Reduced Detection of Cervical Intraepithelial Neoplasia | Beneficial | Moderate |
| Lactobacillus crispatus LV5 88 | Reduced Detection of High-Risk HPV Infection | Beneficial | Moderate |
| Lactobacillus crispatus UALcr-35 | Reduced Detection of Cervical Intraepithelial Neoplasia | Beneficial | Moderate |
| Lactobacillus crispatus UALcr-35 | Reduced Detection of High-Risk HPV Infection | Beneficial | Moderate |
| Lactobacillus crispatus VPro 31 | Reduced Detection of Cervical Intraepithelial Neoplasia | Beneficial | Moderate |
| Lactobacillus crispatus VPro 31 | Reduced Detection of High-Risk HPV Infection | Beneficial | Moderate |