人类免疫缺陷病毒1型（HIV）阳性和高危HIV阴性女性的宫颈阴道人乳头瘤病毒感染

Cervicovaginal human papillomavirus infection in human immunodeficiency virus-1 (HIV)-positive and high-risk HIV-negative women.

作者信息

Palefsky J M, Minkoff H, Kalish L A, Levine A, Sacks H S, Garcia P, Young M, Melnick S, Miotti P, Burk R

机构信息

Department of Laboratory Medicine, University of California, San Francisco 94143, USA.

出版信息

J Natl Cancer Inst. 1999 Feb 3;91(3):226-36. doi: 10.1093/jnci/91.3.226.

DOI:10.1093/jnci/91.3.226

PMID:10037100

Abstract

BACKGROUND

Human papillomavirus (HPV) infection is associated with precancerous cervical squamous intraepithelial lesions commonly seen among women infected with human immunodeficiency virus-1 (HIV). We characterized HPV infection in a large cohort of HIV-positive and HIV-negative women participating in the Women's Interagency HIV Study to determine the prevalence of and risk factors for cervicovaginal HPV infection in HIV-positive women.

METHODS

HIV-positive (n = 1778) and HIV-negative (n = 500) women were tested at enrollment for the presence of HPV DNA in a cervicovaginal lavage specimen. Blood samples were tested for HIV antibody status, level of CD4-positive T cells, and HIV RNA load (copies/mL). An interview detailing risk factors was conducted. Univariate and multivariate analyses were performed.

RESULTS

Compared with HIV-negative women, HIV-positive women with a CD4+ cell count of less than 200/mm3 were at the highest risk of HPV infection, regardless of HIV RNA load (odds ratio [OR] = 10.13; 95% confidence interval [CI] = 7.32-14.04), followed by women with a CD4+ count greater than 200/mm3 and an HIV RNA load greater than 20,000 copies/mL (OR = 5.78; 95% CI = 4.17-8.08) and women with a CD4+ count greater than 200/mm3 and an HIV RNA load less than 20,000 copies/mL (OR = 3.12; 95% CI = 2.36-4.12), after adjustment for other factors. Other risk factors among HIV-positive women included racial/ethnic background (African-American versus Caucasian, OR = 1.64; 95% CI = 1.19-2.28), current smoking (yes versus no; OR = 1.55; 95% CI = 1.20-1.99), and younger age (age < 30 years versus > or = 40 years; OR = 1.75; 95% CI = 1.23-2.49).

CONCLUSIONS

Although the strongest risk factors of HPV infection among HIV-positive women were indicators of more advanced HIV-related disease, other factors commonly found in studies of HIV-negative women, including racial/ethnic background, current smoking, and age, were important in HIV-positive women as well.

摘要

背景

人乳头瘤病毒（HPV）感染与癌前宫颈鳞状上皮内病变相关，这在感染人类免疫缺陷病毒1型（HIV）的女性中很常见。我们对参与女性机构间HIV研究的一大群HIV阳性和HIV阴性女性中的HPV感染进行了特征分析，以确定HIV阳性女性宫颈阴道HPV感染的患病率及危险因素。

方法

在入组时，对1778名HIV阳性女性和500名HIV阴性女性的宫颈阴道灌洗标本进行HPV DNA检测。检测血样的HIV抗体状态、CD4阳性T细胞水平及HIV RNA载量（拷贝数/毫升）。进行了一项详细询问危险因素的访谈。进行了单因素和多因素分析。

结果

与HIV阴性女性相比，无论HIV RNA载量如何，CD4 +细胞计数低于200/mm³的HIV阳性女性HPV感染风险最高（优势比[OR]=10.13；95%置信区间[CI]=7.32 - 14.04），其次是CD4 +细胞计数大于200/mm³且HIV RNA载量大于20,000拷贝/毫升的女性（OR = 5.78；95% CI = 4.17 - 8.08）以及CD4 +细胞计数大于200/mm³且HIV RNA载量小于20,000拷贝/毫升的女性（OR = 3.12；95% CI = 2.36 - 4.12），在对其他因素进行调整后。HIV阳性女性中的其他危险因素包括种族/族裔背景（非裔美国人与白种人相比，OR = 1.64；95% CI = 1.19 - 2.28）、当前吸烟情况（是与否；OR = 1.55；95% CI = 1.20 - 1.99）以及较年轻的年龄（年龄<30岁与≥40岁相比；OR = 1.75；95% CI = 1.23 - 2.49）。