Department of Health Services, Belo Horizonte, MG, Brazil.
Braz J Infect Dis. 2012 Mar-Apr;16(2):164-9. doi: 10.1016/s1413-8670(12)70299-4.
To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN) among HIV-infected women.
Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors.
CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1). Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1), with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5), and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4). HIV viral load and antiretroviral use were not independent risk factors for CIN.
Severity of immunosuppression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.
评估人类免疫缺陷病毒（HIV）感染女性中宫颈上皮内瘤变（CIN）的流行率及其相关危险因素。
本研究为巴西在 1998 年至 2008 年间开展的一项针对 494 名 HIV 感染女性的横断面研究。所有患者均行妇科检查，采集宫颈细胞学和人乳头瘤病毒（HPV）DNA 样本。若需要，进行宫颈活检。将 HPV 感染、CD4+T 淋巴细胞计数和 HIV 病毒载量与宫颈组织病理学结果进行比较。采用单因素和多因素统计分析评估多种危险因素的相关性。
组织病理学检查发现的 CIN 患病率为 23.4%（CIN2/3 为 6%，CIN1 为 17.4%）。多因素分析证实，CD4+T 淋巴细胞计数<200 个/立方毫米（比值比[OR] 5.0，95%可信区间[CI] 2.5-10.1）、HPV DNA 阳性（OR 2.0，95%CI 1.2-3.5）和年龄<34 岁（OR 1.5，95%CI 1.0-2.4）与 CIN 独立相关。HIV 病毒载量和抗逆转录病毒药物的使用不是 CIN 的独立危险因素。
免疫抑制严重程度、HPV 感染和年龄较小是 HIV 感染女性发生 CIN 的重要预测因素。
