Conley Lois J, Ellerbrock Tedd V, Bush Timothy J, Chiasson Mary Ann, Sawo Dorothy, Wright Thomas C
Division of HIV/AIDS Prevention, Surveillance, and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA, USA.
Lancet. 2002 Jan 12;359(9301):108-13. doi: 10.1016/S0140-6736(02)07368-3.
Information about vulvovaginal and perianal condylomata acuminata and intraepithelial neoplasia in women infected with HIV-1 is needed to develop guidelines for clinical care. Our aim was to investigate the incidence of these lesions in HIV-1-positive and HIV-1-negative women and to examine risk factors for disease.
In a prospective cohort study, 925 women had a gynaecological examination twice yearly-including colposcopy and tests for human papillomavirus DNA in cervicovaginal lavage-for a median follow-up of 3.2 years (IQR 0.98-4.87).
Vulvovaginal and perianal condylomata acuminata or intraepithelial neoplasia were present in 30 (6%) of 481 HIV-1-positive and four (1%) of 437 HIV-1-negative women (p<0.0001) at enrollment. Women without lesions at enrollment were included in an incidence analysis. 33 (9%) of 385 HIV-1-positive and two (1%) of 341 HIV-1-negative women developed vulvovaginal or perianal lesions, resulting in an incidence of 2.6 and 0.16 cases per 100 person-years, respectively (relative risk 16, 95% CI 12.9-20.5; p < 0.0001). Risk factors for incident lesions included HIV-1 infection (p = 0.013), human papillomavirus infection (p=0.0013), lower CD4 T lymphocyte count (p = 0.0395), and history of frequent injection of drugs (p=0.0199).
Our results suggest that HIV-1-positive women are at increased risk of development of invasive vulvar carcinoma. Thus, we recommend that, as part of every gynaecological examination, HIV-1-positive women should have a thorough inspection of the vulva and perianal region, and women with abnormalities-except for typical, exophytic condylomata acuminata-should undergo colposcopy and biopsy.
为制定临床护理指南，需要了解感染人类免疫缺陷病毒1型（HIV-1）的女性的外阴阴道和肛周尖锐湿疣及上皮内瘤变情况。我们的目的是调查HIV-1阳性和HIV-1阴性女性中这些病变的发生率，并检查疾病的危险因素。
在一项前瞻性队列研究中，925名女性每年接受两次妇科检查，包括阴道镜检查和宫颈阴道灌洗中的人乳头瘤病毒DNA检测，中位随访时间为3.2年（四分位间距0.98 - 4.87）。
入组时，481名HIV-1阳性女性中有30名（6%）存在外阴阴道和肛周尖锐湿疣或上皮内瘤变，437名HIV-1阴性女性中有4名（1%）存在此类病变（p<0.0001）。入组时无病变的女性纳入发病率分析。385名HIV-1阳性女性中有33名（9%）出现外阴阴道或肛周病变，341名HIV-1阴性女性中有2名（1%）出现此类病变，发病率分别为每100人年2.6例和0.16例（相对风险16，95%可信区间12.9 - 20.5；p<0.0001）。新发病变的危险因素包括HIV-1感染（p = 0.013）、人乳头瘤病毒感染（p = 0.0013）、较低的CD4 T淋巴细胞计数（p = 0.0395）以及频繁注射毒品史（p = 0.0199）。
我们的结果表明，HIV-1阳性女性发生浸润性外阴癌的风险增加。因此，我们建议，作为每次妇科检查的一部分，HIV-1阳性女性应彻底检查外阴和肛周区域，异常女性（典型的外生性尖锐湿疣除外）应接受阴道镜检查和活检。
