Lehtovirta Päivi, Paavonen Jorma, Heikinheimo Oskari
Department of Obstetrics and Gynaecology, University of Helsinki, PO Box 140, SF00029, Helsinki, Finland.
Int J STD AIDS. 2008 Jan;19(1):37-41. doi: 10.1258/ijsa.2007.005672.
The prevalence of cervical intraepithelial neoplasia (CIN) is high among HIV-infected women. Decreased CD4 lymphocytes, high human immunodeficiency viral load (HIVL) and human papillomavirus (HPV) infection are risk factors for CIN. We characterized the prevalence, risk factors and prognosis of histologically-verified CIN among systematically followed HIV-infected women enrolled from a low HIV-prevalence population. The study population comprised 153 HIV-infected women followed between 1989 and 2006. The mean +/- SD duration of follow-up was 5.6 +/- 3.8 years. Demographic as well as treatment-related data were derived from medical reports. During the follow-up, 51 subjects (33%) displayed CIN (16% CIN 1 and 18% CIN 2 +), whereas 102 subjects had Pap smear results of normal cells, atypical squamous cells of uncertain significance, or signs of low-grade squamous intraepithelial lesion (LSIL) but no CIN in histological specimens from the cervix. Only one case of cancer of the uterine cervix was detected. Pap smears were reliable in screening for CIN; 75% of patients with CIN had high-grade squamous intraepithelial lesion (HSIL) or LSIL in Pap smears taken at the time of dysplasia. The incidence of CIN decreased from 12.7 to 3.5 (per 100 subjects) between 2000 and 2005 (P = 0.07). The risk of CIN was not associated with decreased levels of CD4 lymphocytes, duration of HIV infection, use of antiretroviral medication or plasma HIVL. In univariate analysis, bacterial vaginosis (BV) was associated with a significantly increased risk of CIN, whereas parity was associated with lower risk of CIN. Each delivery lowered the risk of CIN by 30% (P = 0.02). The significantly lower risk of CIN among parous women (P = 0.04) persisted in multivariate analysis. CIN was treated by means of loop electrosurgical excision procedure (LEEP), (n = 34). The recurrence rate was low; seven subjects (14%) had a recurrence of CIN during follow-up. The nadir of CD4 lymphocytes was lower (P = 0.04) and the HIVL higher (P = 0.03) among subjects with recurrence of CIN. Duration of HIV infection, use of antiretroviral medication and positive margins in LEEP specimens were indistinguishable among subjects with vs. without recurrence of CIN. The prevalence of CIN is high among systematically managed HIV-infected women. However, the incidence of CIN decreased during the 21st century. BV was associated with an increased risk of CIN whereas parous women had lower risk of CIN. However, the patients with and without CIN could not be distinguished on the basis of previously described risk factors. Regular follow-up by means of Pap smears is warranted in all HIV-infected women.
宫颈上皮内瘤变（CIN）在感染HIV的女性中患病率较高。CD4淋巴细胞减少、高人类免疫缺陷病毒载量（HIVL）和人乳头瘤病毒（HPV）感染是CIN的危险因素。我们对来自低HIV流行率人群的系统性随访的感染HIV女性中经组织学证实的CIN的患病率、危险因素及预后进行了特征分析。研究人群包括1989年至2006年间随访的153例感染HIV的女性。随访的平均时间（±标准差）为5.6±3.8年。人口统计学及治疗相关数据来自医疗报告。随访期间，51例受试者（33%）出现CIN（16%为CIN 1，18%为CIN 2+），而102例受试者宫颈涂片结果为正常细胞、意义不明确的非典型鳞状细胞或低度鳞状上皮内病变（LSIL）迹象，但宫颈组织学标本中无CIN。仅检测到1例宫颈癌病例。宫颈涂片在筛查CIN方面可靠；75%的CIN患者在发育异常时进行的宫颈涂片中有高级别鳞状上皮内病变（HSIL）或LSIL。2000年至2005年间，CIN的发病率从每100名受试者12.7降至3.5（P = 0.07）。CIN的风险与CD4淋巴细胞水平降低、HIV感染持续时间、抗逆转录病毒药物使用或血浆HIVL无关。单因素分析中，细菌性阴道病（BV）与CIN风险显著增加相关，而经产与CIN风险较低相关。每次分娩使CIN风险降低30%（P = 0.02）。经产女性中CIN风险显著较低（P = 0.04）在多因素分析中仍然存在。CIN通过环形电切术（LEEP）治疗（n = 34）。复发率较低；7例受试者（14%）在随访期间CIN复发。CIN复发的受试者中CD4淋巴细胞最低点较低（P = 0.04），HIVL较高（P = 0.03）。HIV感染持续时间、抗逆转录病毒药物使用及LEEP标本切缘阳性在CIN复发与未复发的受试者中无差异。在系统性管理的感染HIV女性中CIN患病率较高。然而，21世纪期间CIN发病率下降。BV与CIN风险增加相关，而经产女性CIN风险较低。然而，根据先前描述的危险因素无法区分有和无CIN的患者。所有感染HIV的女性均需通过宫颈涂片进行定期随访。
