HIV感染对意义未明的非典型鳞状细胞的影响。

Effect of HIV infection on atypical squamous cells of undetermined significance.

作者信息

Duerr Ann, Paramsothy Pangaja, Jamieson Denise J, Heilig Charles M, Klein Robert S, Cu-Uvin Susan, Schuman Paula, Anderson Jean R

机构信息

Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.

出版信息

Clin Infect Dis. 2006 Mar 15;42(6):855-61. doi: 10.1086/500404. Epub 2006 Feb 10.

DOI:10.1086/500404

PMID:16477565

Abstract

BACKGROUND

Detection of atypical squamous cells of undetermined significance (ASCUS) is a cervical cytologic finding that is suggestive but not definitive of squamous intraepithelial lesions (SILs).

METHODS

We examined the risk, characteristics, and progression of ASCUS in women with and without human immunodeficiency virus (HIV) infection. Cervical Papanicolou (Pap) test and colposcopy data were obtained at the first 10 semiannual visits for the HIV Epidemiology Research study of 774 HIV-infected and 480 demographically similar, HIV-uninfected women in the United States. Multiple logistic regression models and Cox proportional hazards models were utilized.

RESULTS

ASCUS was more common among HIV-infected women (odds ratio [OR], 1.6 [95% confidence interval {CI}, 1.3-2.0] to 2.6 [95% CI, 1.9-3.6]) after adjustment for human papillomavirus (HPV) infection and other risk factors (e.g., race, condyloma, and prior Pap test result). Among women with normal Pap test results at enrollment, the cumulative incidence of ASCUS was 78% among HIV-infected women and 38% among HIV-uninfected women. HIV-infected and HIV-uninfected women with ASCUS did not differ by prevalence of indices of inflammation (inflammation on Pap test and leukocytes on cervical gram stain). HPV infection, including high risk types, was more common among HIV-infected women with ASCUS. Among women with ASCUS, 60% of HIV-infected and 25% of HIV-uninfected women developed SILs (P < .01). Compared with HIV-infected women with higher CD4+ lymphocyte counts, HIV-infected women with CD4+ lymphocyte counts < 200 cells/microL were more likely to present subsequently with a SIL detected by Pap test (OR, 1.7; 95% CI, 0.8-3.6).

CONCLUSIONS

Higher risk of SIL following the appearance of ASCUS among HIV-infected women, especially women with low CD4+ lymphocyte counts, supports the need for follow up with colposcopy and histologic examination, as indicated, to allow early detection and treatment of SIL.

摘要

背景

意义不明确的非典型鳞状细胞（ASCUS）的检测是一种宫颈细胞学检查结果，提示但不能确诊为鳞状上皮内病变（SIL）。

方法

我们研究了感染和未感染人类免疫缺陷病毒（HIV）的女性中ASCUS的风险、特征及进展情况。在美国对774名感染HIV和480名人口统计学特征相似的未感染HIV的女性进行HIV流行病学研究，在前10次半年随访中获取宫颈巴氏试验和阴道镜检查数据。使用了多重逻辑回归模型和Cox比例风险模型。

结果

在调整了人乳头瘤病毒（HPV）感染及其他风险因素（如种族、尖锐湿疣和既往巴氏试验结果）后，ASCUS在感染HIV的女性中更为常见（优势比[OR]为1.6[95%置信区间{CI}，1.3 - 2.0]至2.6[95%CI，1.9 - 3.6]）。在入组时巴氏试验结果正常的女性中，ASCUS的累积发病率在感染HIV的女性中为78%，在未感染HIV的女性中为38%。感染HIV和未感染HIV且患有ASCUS的女性在炎症指标（巴氏试验中的炎症和宫颈革兰氏染色中的白细胞）患病率方面无差异。HPV感染，包括高危型，在患有ASCUS的感染HIV的女性中更为常见。在患有ASCUS的女性中，60%感染HIV的女性和25%未感染HIV的女性发展为SIL（P < 0.01）。与CD4 + 淋巴细胞计数较高的感染HIV的女性相比，CD4 + 淋巴细胞计数 < 200个细胞/微升的感染HIV的女性随后更有可能通过巴氏试验检测出SIL（OR，1.7；95%CI，0.8 - 3.6）。