Massad L Stewart, Schneider Michael F, Watts D Heather, Strickler Howard D, Melnick Sandra, Palefsky Joel, Anastos Kathryn, Levine Alexandra M, Minkoff Howard
Department of Obstetrics and Gynecology, Southern Illinois School of Medicine, Springfield, Illinois 62794, USA.
J Womens Health (Larchmt). 2004 Mar;13(2):147-53. doi: 10.1089/154099904322966128.
To assess the utility of testing for high-risk human papillomavirus (HPV) DNA as a triage strategy for detecting cervical intraepithelial neoplasia (CIN) grade 2/3 in women with human immunodeficiency virus-1 (HIV-1) infection and cytology read as atypical cells of uncertain significance (ASCUS).
Conventional cervical cytology and cervicovaginal lavage were obtained at 6-month intervals between October 1, 1994, and September 30, 2002, from women enrolled in the Women's Interagency HIV Study, a multicenter cohort studying the natural history of HIV in women. HPV typing was performed by PCR. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 were classified as carrying high oncogenic risk. Women with ASCUS smears were referred for colposcopy. Analyses of the sensitivity of HPV testing were cross-sectional, using colposcopy results within 90 days of first ASCUS result.
Of the 270 women evaluated, 7 (3%) had CIN 2, and 3 (1%) had CIN3 or adenocarcinoma in situ. High-risk HPV DNA was found in 81 (30%) of the 270 participants. The sensitivity of high-risk HPV DNA detection for CIN 2/3 was 50% (95% CI 0.19, 0.81), the specificity was 71% (95% CI 0.65, 0.76), the positive predictive value was 6% (95% CI 0.01, 0.11), and the negative predictive value was 97% (95% CI 0.95, 1.00). HPV of any risk type was found in 176 (65%) of the 270 women, including 9 of 10 women with CIN 2/3, for a sensitivity of 90% (95% CI 0.56, 1.00), a specificity of 36% (95% CI 0.30, 0.42), a positive predictive value of 5% (95% CI 0.02, 0.08), and a negative predictive value of 99% (95% CI 0.94, 1.00).
For women with HIV and Papanicolaou smears read as ASCUS, DNA testing for high risk HPV may not be sensitive enough for clinical use.
评估检测高危型人乳头瘤病毒（HPV）DNA作为一种分流策略，用于检测感染人类免疫缺陷病毒1型（HIV-1）且细胞学检查结果为意义不明确的非典型细胞（ASCUS）的女性中宫颈上皮内瘤变（CIN）2/3级的效用。
在1994年10月1日至2002年9月30日期间，每隔6个月从参与女性机构间HIV研究的女性中获取常规宫颈细胞学检查和宫颈阴道灌洗样本，该研究是一项多中心队列研究，旨在研究女性HIV的自然史。通过聚合酶链反应（PCR）进行HPV分型。HPV 16、18、31、33、35、39、45、51、52、56、58、59和68型被归类为具有高致癌风险。ASCUS涂片的女性被转诊进行阴道镜检查。HPV检测敏感性分析为横断面分析，使用首次ASCUS结果后90天内的阴道镜检查结果。
在评估的270名女性中，7名（3%）患有CIN 2，3名（1%）患有CIN3或原位腺癌。在270名参与者中，81名（30%）检测到高危型HPV DNA。高危型HPV DNA检测CIN 2/3的敏感性为50%（95%可信区间0.19，0.81），特异性为71%（95%可信区间0.65，0.76），阳性预测值为6%（95%可信区间0.01，0.11），阴性预测值为97%（95%可信区间0.95，1.00）。在270名女性中，176名（65%）检测到任何风险类型的HPV，包括10名CIN 2/3女性中的9名，敏感性为90%（95%可信区间0.56，1.00），特异性为36%（95%可信区间0.30，0.42），阳性预测值为5%（95%可信区间0.02，0.08），阴性预测值为99%（95%可信区间0.94，1.00）。
对于HIV感染且巴氏涂片结果为ASCUS的女性，高危型HPV DNA检测在临床上可能不够敏感。
