Maiman M, Tarricone N, Vieira J, Suarez J, Serur E, Boyce J G
Department of Obstetrics and Gynecology, Brooklyn Hospital, New York.
Obstet Gynecol. 1991 Jul;78(1):84-8.
To determine the effect of human immunodeficiency virus (HIV) infection on cervical histology, 32 known HIV-seropositive women underwent cervical colposcopic evaluation. All had cervical cytology, colposcopically directed biopsy, and T-cell studies performed. Thirteen of 32 patients (41%) had cervical intraepithelial neoplasia (CIN). Another 14 of 32 patients (44%) had histologic evidence of cervicitis. Abnormal cytology, noted in only three women, suggested CIN in one and inflammatory atypia in two. All (five of five) patients with a clinical diagnosis of AIDS had CIN, compared with 30% (eight of 27) of non-AIDS HIV-positive patients (P less than .05). Patients diagnosed with CIN had significantly lower CD4 cell counts (221/mm3 versus 408/mm3; P less than .06) and CD4:CD8 ratios (0.33 versus 0.62; P less than .02) than those without CIN. Patients with cervicitis had greater T-cell immunosuppression than did those with normal histology. In addition, patients with AIDS were more likely to have higher-grade lesions than were non-AIDS HIV-seropositive patients. Seven of 12 CIN specimens available for analysis by polymerase chain reaction using consensus sequence primers detected human papillomavirus (HPV) DNA, including three patients with three or more HPV types. Our data suggest that abnormal cervical pathology is common among HIV-positive women and that cytologic screening is not predictive of CIN in this population. In addition, the presence and severity of cervical dysplasia correlates with quantitative T-cell function. We strongly recommend that cervical colposcopy be part of the routine management of HIV-seropositive women.
为确定人类免疫缺陷病毒（HIV）感染对宫颈组织学的影响，对32名已知HIV血清学阳性的女性进行了宫颈阴道镜评估。所有患者均接受了宫颈细胞学检查、阴道镜引导下活检以及T细胞研究。32例患者中有13例（41%）患有宫颈上皮内瘤变（CIN）。另外32例患者中有14例（44%）有宫颈炎的组织学证据。仅3名女性出现异常细胞学检查结果，其中1例提示CIN，2例提示炎性异型性。所有临床诊断为艾滋病的患者（5例中的5例）均患有CIN，而非艾滋病HIV阳性患者中这一比例为30%（27例中的8例）（P<0.05）。诊断为CIN的患者的CD4细胞计数（221/立方毫米对408/立方毫米；P<0.06）和CD4:CD8比值（0.33对0.62；P<0.02）显著低于未患CIN的患者。宫颈炎患者的T细胞免疫抑制程度高于组织学正常的患者。此外，艾滋病患者比非艾滋病HIV血清学阳性患者更易出现高级别病变。在12份可用于使用共有序列引物进行聚合酶链反应分析的CIN标本中，7份检测到人类乳头瘤病毒（HPV）DNA，其中3例患者感染了三种或更多HPV类型。我们的数据表明，宫颈病理异常在HIV阳性女性中很常见，并且细胞学筛查在该人群中不能预测CIN。此外，宫颈发育异常的存在和严重程度与T细胞定量功能相关。我们强烈建议宫颈阴道镜检查应成为HIV血清学阳性女性常规管理的一部分。
