Holcomb K, Abulafia O, Matthews R P, Chapman J E, Borges A, Lee Y C, Buhl A
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brooklyn, New York, 11203, USA.
Gynecol Oncol. 1999 Oct;75(1):118-21. doi: 10.1006/gyno.1999.5554.
The aim of this study was to determine the incidence and severity of dysplasia associated with a cytologic diagnosis of atypical cells of undetermined significance (ASCUS) in women infected with the human immunodeficiency virus (HIV).
A cross-sectional analysis of cervical cytology, colposcopic impression, and cervical biopsy results was performed on 261 HIV-positive women diagnosed with ASCUS. The prevalence and grade of histologically documented cervical intraepithelial neoplasia (CIN) was determined. Patients with CD4 counts above and below 200 cells/mm(3) were compared using chi(2) analysis to determine any effect of worsening immunosuppression on the rates of associated dysplasia.
Seven hundred sixty-one Pap smears were performed during the study period. Two hundred nine (27%) were diagnosed as ASCUS. All patients (pts) received colposcopic evaluation. The incidence of human papilloma virus (HPV) effect, low-grade CIN (I), and high-grade CIN (II, III, and carcinoma in situ) documented by cervical biopsy, cervical conization or endocervical curettings was 40, 17, and 15%, respectively. No cases of invasive cancer were found. These results are similar to those of previous cytohistologic studies of ASCUS in HIV-untested populations. There was no significant difference in frequency or severity of CIN in pts with severe immunosuppression (P = 0.4).
A cytologic diagnosis of ASCUS in HIV-positive women identifies a group at significant risk for histologic abnormalities. The majority of pts will be diagnosed with HPV or low-grade CIN. HIV infection and severe immunosuppression do not appear to increase the frequency or severity of CIN associated with ASCUS. Given the 32% risk of associated CIN, all HIV-positive women with ASCUS cytology should undergo colposcopic evaluation.
本研究旨在确定感染人类免疫缺陷病毒（HIV）的女性中，与意义不明确的非典型细胞（ASCUS）细胞学诊断相关的发育异常的发生率和严重程度。
对261例诊断为ASCUS的HIV阳性女性进行宫颈细胞学、阴道镜印象及宫颈活检结果的横断面分析。确定组织学记录的宫颈上皮内瘤变（CIN）的患病率和分级。使用卡方分析比较CD4细胞计数高于和低于200个细胞/mm³的患者，以确定免疫抑制恶化对相关发育异常发生率的任何影响。
研究期间共进行了761次巴氏涂片检查。209例（27%）被诊断为ASCUS。所有患者均接受了阴道镜评估。通过宫颈活检、宫颈锥切术或宫颈管刮除术记录的人乳头瘤病毒（HPV）感染、低级别CIN（I级）和高级别CIN（II级、III级和原位癌）的发生率分别为40%、17%和15%。未发现浸润癌病例。这些结果与之前在未检测HIV的人群中进行的ASCUS细胞组织学研究结果相似。严重免疫抑制患者的CIN频率或严重程度无显著差异（P = 0.4）。
HIV阳性女性的ASCUS细胞学诊断表明这是一组有显著组织学异常风险的人群。大多数患者将被诊断为HPV感染或低级别CIN。HIV感染和严重免疫抑制似乎不会增加与ASCUS相关的CIN的频率或严重程度。鉴于有32%的相关CIN风险，所有ASCUS细胞学检查的HIV阳性女性均应接受阴道镜评估。
