Department of Medicine, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2012;7(10):e47570. doi: 10.1371/journal.pone.0047570. Epub 2012 Oct 15.
There is an urgent need to improve our understanding of the mucosal immuno-pathogenesis of HIV acquisition in the female genital tract, particularly in high-risk women such as female sex workers (FSWs). Cervical biopsy samples offer technical advantages over cytobrush sampling, but there are concerns that this might increase HIV acquisition, particularly if healing is slow and/or women do not abstain from sex during healing.
METHODOLOGY/PRINCIPAL FINDINGS: Cervical biopsy samples and cervico-vaginal swabs for co-infection diagnostics, prostate specific antigen (PSA) and immune studies were collected from 59 women, including HIV seropositive and HIV-exposed seronegative (HESN) FSWs as well as lower risk women from Nairobi, Kenya. A clinical-demographic questionnaire was administered and women were instructed to avoid sexual intercourse, douching and the insertion of tampons for 14 days. All participants underwent a repeat exam to assess healing within the 14 days, and had HIV diagnostics at six months. Cervical sampling was well tolerated, and 82% of participants had healed macroscopically by 5 days. Both self-report and PSA screening suggested high levels of compliance with pre- and post-procedure abstinence. Delayed healing was associated with vulvovaginal candidiasis (VVC) and HESN status. At six-month follow up all low-risk and HESN participants remained HIV seronegative.
Cervical biopsy sampling is a safe and well-tolerated method to obtain cervical biopsies in this context, particularly if participants with VVC are excluded. As healing could be delayed up to 11 days, it is important to support (both financially and with rigorous counseling) a period of post-procedure abstinence to minimize HIV risk.
迫切需要提高我们对女性生殖道中 HIV 获得的黏膜免疫发病机制的理解，尤其是在高危女性（如性工作者）中。宫颈活检样本比 cytobrush 采样具有技术优势，但人们担心这可能会增加 HIV 的获得风险，特别是如果愈合缓慢且/或女性在愈合期间不禁欲。
方法/主要发现：从 59 名女性中收集了宫颈活检样本和用于合并感染诊断的阴道宫颈拭子、前列腺特异性抗原 (PSA) 和免疫研究，包括肯尼亚内罗毕的 HIV 血清阳性和 HIV 暴露但血清阴性 (HESN) 的性工作者以及低危女性。进行了临床人口统计学问卷调查，并告知女性在 14 天内避免性交、冲洗和使用卫生棉条。所有参与者都接受了重复检查以评估 14 天内的愈合情况，并在六个月时进行了 HIV 诊断。宫颈采样耐受性良好，82%的参与者在 5 天内宏观上愈合。自我报告和 PSA 筛查均表明遵守了术前和术后禁欲的要求很高。愈合延迟与外阴阴道念珠菌病 (VVC) 和 HESN 状况有关。在六个月的随访中，所有低危和 HESN 参与者均保持 HIV 血清阴性。
在这种情况下，宫颈活检采样是一种安全且耐受性良好的获取宫颈活检的方法，特别是如果排除患有 VVC 的参与者。由于愈合可能延迟长达 11 天，因此重要的是要支持（在经济上和通过严格的咨询）术后禁欲期，以最大程度地降低 HIV 风险。
