ЕФИКАСНОСТА НА ТРИХЛОРОЦЕТНА КИСЕЛИНА ВО ТРЕТМАНОТ НА СУБКЛИНИЧКИТЕ ФОРМИ НА HPV ИНФЕКЦИИ НА ГРЛО НА МАТКА. (Bulgarian)

Cervical cancer is the fourth leading cause of death among the female population worldwide and represent 6,5% of all female cancers. According to World health organization our country, North Macedonia is among the countries with middle high age standardized rate of 7,5. Statistical review of Institute of public health of North Macedonia showed that in average there are 150 new diagnosed cases of cervical cancer per year in our country, and one third of them died. Papillomaviruses are ubiquitous and more than 200 types were recognized by DNA sequence data showing genomic differences.There are over 200 types of human papilloma virus (HPV), 40 of which are specific to the anogenital region, while 14 are high-risk types, which are the most common causes of cervical cancer. The most important viral proteins that affect gene regulation and cell transformation are the E6 and E7 prooncogenes, which bind to p53 and retinoblastoma (Rb) proteins, thus cell apoptosis and cause immortalization of the cells is prevented. The period from infection to the onset of an intraepithelial lesion is three weeks to three months, that is the time needed for basal keratinocytes to move through the cervical epithelium, to differentiate, and to desquamate. And the time that is usually needed for high squamous intraepithelial lesions to progress to microinvasive cancer usually takes decades. Because there is no cytolysis or cytological death due to viral replication, there is no inflammation throughout the life cycle of HPV and the production of cytokines is absent or they are produced in a very small amount. Therefore, the virus can be tolerated by the host for a a longer period of time, thus it would be able to persist without causing an immune response. Persistent high-risk types are the most common cause of high-grade cervical intraepithelial lesions and cervical cancer. Over time, the greater the viral load or the infection is, the greater the possibility of progression of the subclinical infection to a cervical intraepithelial lesion is. The topical action of trichloroacetic acid (TCA) on eradication of HPV is well established. The results of this procedure are promising, and the procedure is easy, inexpensive, does not require specific and special training of the staff performing it. This treatment and therapy with TCA protects the cervical mucosa from long-term exposure to HPV, thereby reducing the risk of developing high-grade intraepithelial lesions. In this way, patients avoid the surgical treatment and intervention that is necessary for higher degrees of cervical lesions caused by HPV. This is very important because the patients affected by high squamous intraepithelial lesions caused by HPV that require a surgical treatment, are often in reproductive age and this noninvasive treatment can indirectly reduce the risk of preterm delivery. [ABSTRACT FROM AUTHOR]

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