Durante Amanda J, Williams Ann B, Da Costa Maria, Darragh Teresa M, Khoshnood Kaveh, Palefsky Joel M
Connecticut Emerging Infections Program, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Cancer Epidemiol Biomarkers Prev. 2003 Jul;12(7):638-42.
Little is known about the natural history of anal human papillomavirus (HPV) infection in HIV-infected women because, to date, no longitudinal studies have been reported in the scientific literature. This article estimates the incidence of anal cytological abnormalities in a cohort of HIV-infected women. It also examines potential risk factors for the development of an anal cytological abnormality. A cohort of HIV-infected women underwent interview, anal cytology, and anogenital HPV DNA testing. Women with a normal baseline anal cytology were followed for the development of an anal cytological abnormality. The incidence of an abnormality was calculated. Survival analyses were performed to examine risk factors for the development of an abnormality. Fourteen of 100 HIV-infected women had an abnormal anal cytology at baseline. Among the 86 women with a normal baseline cytology, the incidence of an abnormality was 22 [95% confidence interval (CI), 14-33] per 100 person-years. In a multivariate analysis, women were at increased risk if, at baseline, they had a CD4+ T-cell count of <500 cells/mm(3) [relative hazard (RH) = 4.11; 95% CI, 1.18-14.25], high-risk type anal HPV infection (RH = 2.54; 95% CI, 0.91-7.14) or were cigarette smokers (RH = 3.88; 95% CI, 1.12-13.42). The incidence of anal cytological abnormalities was high among this cohort of HIV-infected women, indicating that they are at high risk of anal squamous intraepithelial lesions. HIV-infected women are likely to be at higher risk than their HIV-uninfected counterparts because immune suppression conferred substantially increased risk. Continued research on the association between smoking and the development of squamous intraepithelial lesions in HIV-infected women is warranted.
对于感染艾滋病毒的女性肛门人乳头瘤病毒（HPV）感染的自然史，人们了解甚少，因为迄今为止，科学文献中尚未报道过纵向研究。本文估计了一组感染艾滋病毒女性肛门细胞学异常的发生率。它还研究了发生肛门细胞学异常的潜在风险因素。一组感染艾滋病毒的女性接受了访谈、肛门细胞学检查和肛门生殖器HPV DNA检测。基线肛门细胞学正常的女性被随访观察是否出现肛门细胞学异常。计算异常发生率。进行生存分析以检查出现异常的风险因素。100名感染艾滋病毒的女性中有14名在基线时肛门细胞学异常。在86名基线细胞学正常的女性中，异常发生率为每100人年22例[95%置信区间（CI），14 - 33]。在多变量分析中，如果女性在基线时CD4 + T细胞计数<500个细胞/mm³[相对风险（RH）= 4.11；95% CI，1.18 - 14.25]、感染高危型肛门HPV（RH = 2.54；95% CI，0.91 - 7.14）或吸烟（RH = 3.88；95% CI，1.12 - 13.42），则风险增加。在这组感染艾滋病毒的女性中，肛门细胞学异常的发生率很高，表明她们患肛门鳞状上皮内病变的风险很高。感染艾滋病毒的女性可能比未感染艾滋病毒的女性风险更高，因为免疫抑制会大幅增加风险。有必要继续研究吸烟与感染艾滋病毒女性鳞状上皮内病变发生之间的关联。
