Briggs Aparna, Partridge David G, Bates Sylvia
Department of Genitourinary Medicine, The Royal Hallamshire Hospital, Sheffield, UK.
J Fam Plann Reprod Health Care. 2011 Oct;37(4):201-3. doi: 10.1136/jfprhc-2011-100106. Epub 2011 Aug 11.
The 2008 National HIV testing guidelines produced jointly by the British Association of Sexual Health and HIV, British HIV Association and British Infection Society recommend HIV testing for patients attending termination of pregnancy (TOP) services and patients diagnosed with cervical intraepithelial neoplasia (CIN) Grade 2 or above. The aim is to reduce the time between acquisition and diagnosis of HIV by encouraging testing in settings where patients present with indicator diseases. Benefits of earlier HIV diagnosis include improved survival, prevention of onward transmission, and optimisation of maternal health when planning pregnancy. There is evidence that HIV reduces the effectiveness of standard treatment for CIN 2/3 and cervical cancer. The experience of antenatal screening indicates that the majority of women accept HIV screening if it is offered as part of a package of care.
This retrospective case notes review of 60 HIV-positive women, diagnosed between 1 January 2006 and 31 July 2009, collected data on age, ethnicity, length of time in the UK, timing of HIV diagnosis and possible timing of acquisition relative to attendance at colposcopy or TOP services, CD4 count and symptoms at diagnosis and cervical cytology history.
The authors found that three (5%) women were diagnosed with CIN Grade 2 or above prior to HIV diagnosis; HIV testing at the time of TOP may have resulted in earlier diagnosis for three (5%) women. There was at least one missed opportunity for earlier diagnosis in five (8%) cases.
The authors suggest further work should be undertaken to establish HIV prevalence in TOP and colposcopy services and that HIV testing should become standard practice in the management of CIN 2/3 and cervical cancer.
英国性健康与艾滋病协会、英国艾滋病协会和英国感染学会联合制定的2008年国家艾滋病检测指南建议，为接受终止妊娠（TOP）服务的患者以及被诊断为2级或以上宫颈上皮内瘤变（CIN）的患者进行艾滋病检测。目的是通过鼓励在患者出现指示性疾病的环境中进行检测，减少艾滋病感染与诊断之间的时间间隔。早期艾滋病诊断的益处包括提高生存率、预防病毒传播以及在计划怀孕时优化孕产妇健康。有证据表明，艾滋病会降低CIN 2/3和宫颈癌标准治疗的效果。产前筛查的经验表明，如果将艾滋病筛查作为一揽子护理的一部分提供，大多数女性会接受。
对2006年1月1日至2009年7月31日期间诊断出的60名艾滋病病毒阳性女性进行回顾性病例记录审查，收集了有关年龄、种族、在英国的停留时间、艾滋病诊断时间以及相对于接受阴道镜检查或TOP服务的可能感染时间、诊断时的CD4细胞计数和症状以及宫颈细胞学病史的数据。
作者发现，三名（5%）女性在艾滋病诊断之前被诊断为2级或以上CIN；在TOP时进行艾滋病检测可能使三名（5%）女性得到更早诊断。在五例（8%）病例中至少有一次错过更早诊断的机会。
作者建议应进一步开展工作，以确定TOP和阴道镜检查服务中的艾滋病病毒流行情况，并且艾滋病检测应成为CIN 2/3和宫颈癌管理中的标准做法。
