Cubie H A, Seagar A L, Beattie G J, Monaghan S, Williams A R
Regional Clinical Virology Laboratory, Lothian University Hospitals NHS Trust.
Sex Transm Infect. 2000 Aug;76(4):257-61. doi: 10.1136/sti.76.4.257.
To monitor the presence and persistence of high risk (HR) human papillomavirus (HPV) in cervical brushings from HIV infected women.
Prospective observational cohort study of HIV infected women. Women were enrolled from the cohort of 164 HIV infected women who attend the colposcopy clinic at the Edinburgh Regional Infectious Diseases Unit. A single cervical brush scrape was obtained from 39 women and two or more samples from 63 women who attended regularly at approximately 6 monthly intervals. HPV typing was carried out using a commercial hybrid capture assay (HCA). Details of antiretroviral therapy, cytological assessment, and histological evaluation were made available and the interrelation with HR-HPV detection analysed.
Abnormal cervical cytology, particularly of low grade, was common in these HIV infected women. HR-HPV types were detected in 25% of the women with normal cytology, while over 80% of those with abnormal cytology of any grade were HR-HPV positive. Persistent HR-HPV, as defined by two or more consecutive HPV positive results, was common and found in 27/63 women from whom multiple samples were obtained. HR-HPV was detected at high levels whether or not patients were receiving antiretroviral therapy. Profound immunosuppression was not necessarily associated with progression of cervical disease and no cases of invasive cervical disease were seen.
While mild dyskaryosis (low grade squamous intraepithelial lesion (LSIL)) and persistence of HR-HPV are common in HIV infected women in Edinburgh, regular cytological and colposcopic evaluation with appropriate intervention and treatment appears to limit the progression of cervical disease.
监测HIV感染女性宫颈刷片高危(HR)人乳头瘤病毒(HPV)的存在及持续情况。
对HIV感染女性进行前瞻性观察队列研究。研究对象来自爱丁堡地区传染病科阴道镜门诊的164名HIV感染女性队列。39名女性采集了单次宫颈刷片样本,63名定期(约每6个月一次)就诊的女性采集了两份或更多样本。采用商业杂交捕获试验(HCA)进行HPV分型。提供抗逆转录病毒治疗、细胞学评估和组织学评估的详细信息,并分析与HR-HPV检测的相关性。
宫颈细胞学异常,尤其是低级别异常,在这些HIV感染女性中很常见。细胞学正常的女性中有25%检测到HR-HPV型,而任何级别的细胞学异常女性中超过80%为HR-HPV阳性。连续两次或更多次HPV阳性结果定义的持续性HR-HPV很常见,在采集了多个样本的63名女性中有27名检测到。无论患者是否接受抗逆转录病毒治疗,均检测到高水平的HR-HPV。严重免疫抑制不一定与宫颈疾病进展相关,未观察到浸润性宫颈癌病例。
在爱丁堡,虽然轻度核异质(低级别鳞状上皮内病变(LSIL))和HR-HPV持续存在在HIV感染女性中很常见,但定期进行细胞学和阴道镜评估并给予适当干预和治疗似乎可限制宫颈疾病的进展。