From the Washington University School of Medicine, Springfield, Illinois; Albert Einstein College of Medicine, Bronx, New York; University of California, San Francisco, California; Maimonides Medical Center, Brooklyn, New York; City of Hope National Medical Center, Duarte, California, and Keck School of Medicine, University of Southern California, Los Angeles, California; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Montefiore Medical Center, Bronx, New York; Georgetown University, Washington, DC; Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, Maryland; Albert Einstein College of Medicine, Bronx, New York.
Obstet Gynecol. 2009 Nov;114(5):1063-1068. doi: 10.1097/AOG.0b013e3181bc6ce0.
To estimate the frequency and histologic correlates of glandular abnormalities in cervical cytology among women with the human immunodeficiency virus (HIV) and to compare findings with those of women without HIV.
In a cohort study of HIV-infected and uninfected women followed between 1994 and 2007, Pap tests were obtained every 6 months. Glandular abnormalities, including atypical glandular cells (AGC), adenocarcinoma in situ (AIS), and adenocarcinoma, were identified and correlated with biopsy histology. Multivariate models to summarize data across visits used generalized estimating equations. The association of Pap and histology results was assessed using chi tests.
Of 48,362 Pap tests from 3,766 women, glandular abnormalities were found in 341 (0.7%) tests from 244 (6%) women, including 93 (1.0%) of 9,564 Pap tests among HIV-seropositive women with CD4 lymphocyte counts less than 250/mm, 103 (0.8%) of 13,023 tests among those with counts 250-500/mm, 68 (0.6%) of 12,470 tests among women with counts greater than 500/mm, and 70 (0.6%) of 11,769 tests among HIV-seronegative women (P for trend=.006). Colposcopy was documented for only 148 (61%) of 244 index Pap tests in women with glandular abnormalities. After index abnormal tests, endocervical curettings were obtained from 106 (43%) women, cervical biopsies from 76 (38%), and endometrial biopsies from 19 (8%). Squamous lesions predominated among histologic findings and histology results did not differ by HIV serostatus (P=.16).
Although immunosuppression increased the risk of glandular Pap test abnormalities in women with HIV, these remained uncommon. Compliance with management guidelines can improved.
II.
评估人类免疫缺陷病毒（HIV）感染妇女的宫颈细胞学检查中腺上皮异常的频率和组织学相关性，并与未感染 HIV 的妇女进行比较。
在 1994 年至 2007 年间对 HIV 感染和未感染的妇女进行的队列研究中，每 6 个月进行一次巴氏涂片检查。确定腺上皮异常，包括非典型腺细胞（AGC）、原位腺癌（AIS）和腺癌，并与活检组织学相关联。使用广义估计方程对各次就诊数据进行多变量模型汇总。使用卡方检验评估巴氏涂片和组织学结果的相关性。
在 3766 名妇女的 48362 份巴氏涂片检查中，在 244 名（6%）妇女的 341 份（0.7%）检查中发现腺上皮异常，包括 9564 份 HIV 阳性妇女（CD4 淋巴细胞计数<250/mm）的巴氏涂片检查中有 103 份（0.8%），250-500/mm 的有 68 份（0.6%），大于 500/mm 的有 12470 份中有 68 份（0.6%），HIV 阴性妇女的 11769 份中有 70 份（0.6%）（P 值趋势=0.006）。在有腺上皮异常的 244 例巴氏涂片检查中，仅记录了 148 例（61%）的阴道镜检查。在异常巴氏涂片检查后，106 名妇女（43%）接受了宫颈刮宫术，76 名（38%）接受了宫颈活检，19 名（8%）接受了子宫内膜活检。组织学发现以鳞状病变为主，组织学结果与 HIV 血清状态无关（P=.16）。
尽管免疫抑制增加了 HIV 感染妇女的腺上皮巴氏涂片异常风险，但这种情况仍然少见。如果能遵守管理指南，可能会有所改善。
II 级。
