Atashili Julius, Miller William C, Smith Jennifer S, Ndumbe Peter M, Ikomey George M, Eron Joseph, Rinas Allen C, Myers Evan, Adimora Adaora A
University of Buea, Box 63, Molyko Buea, Cameroon.
BMC Res Notes. 2012 Oct 29;5:590. doi: 10.1186/1756-0500-5-590.
Cervical squamous intra-epithelial lesions (SIL) are more frequent in HIV-positive women overall. However the appropriate age at which to begin and end cervical cancer screening for early detection of lesions in HIV-positive women is not clear. We assessed the age-specific prevalence of any SIL and SIL requiring colposcopy in HIV-positive women in Cameroon.
We enrolled, interviewed and conducted conventional cervical cytology in 282 women, aged 19-68 years, initiating antiretroviral therapy in three clinics in Cameroon. In bivariable analyses, the crude relationship between age and the presence of lesions was assessed using locally weighted regression (LOWESS) methods. In multivariate analyses, generalized linear models with prevalence as the outcome, an identity link and a binomial distribution, were used to estimate prevalence differences. Bias analyses were conducted to assess the potential effect of inaccuracies in cytology.
SIL were detected in 43.5% of the 276 women with satisfactory samples, 17.8% of whom had ASC-H/HSIL. On average, women aged 26 to 59 tended to have a slightly higher prevalence of any SIL than other women (Prevalence difference PD: 6.5%; 95%CI: -11.4, 24.4%). This PD was a function of CD4 count (heterogeneity test p-value =0.09): amongst patients with CD4 counts less than 200cells/uL, the prevalence was higher in patients aged 26-59, while there was essentially no difference amongst women with CD4 counts greater than 200 cells/uL. ASC-H/HSIL were present in women as young as 19 and as old as 62. Overall the prevalence of ASC-H/HSIL increased by 0.7% (95%CI: -3.8%, 5.1%) per decade increase in age.
Both severe and less severe lesions were prevalent at all ages suggesting little utility of age-targeted screening among HIV-positive women. Nevertheless, the long-term evolution of these lesions needs to be assessed in prospective studies.
总体而言，宫颈鳞状上皮内病变（SIL）在HIV阳性女性中更为常见。然而，对于HIV阳性女性，开始和结束宫颈癌筛查以早期发现病变的合适年龄尚不清楚。我们评估了喀麦隆HIV阳性女性中任何SIL以及需要阴道镜检查的SIL的年龄特异性患病率。
我们在喀麦隆的三家诊所招募、访谈并对282名年龄在19至68岁之间开始接受抗逆转录病毒治疗的女性进行了传统宫颈细胞学检查。在双变量分析中，使用局部加权回归（LOWESS）方法评估年龄与病变存在之间的粗略关系。在多变量分析中，使用以患病率为结果、恒等连接和二项分布的广义线性模型来估计患病率差异。进行偏差分析以评估细胞学不准确的潜在影响。
在276名样本满意的女性中，43.5%检测出SIL，其中17.8%患有ASC-H/HSIL。平均而言，26至59岁的女性中任何SIL的患病率往往略高于其他女性（患病率差异PD：6.5%；95%CI：-11.4，24.4%）。该PD是CD4计数的函数（异质性检验p值=0.09）：在CD4计数低于200细胞/微升的患者中，26至59岁患者的患病率较高，而在CD4计数高于200细胞/微升的女性中基本没有差异。ASC-H/HSIL在年仅19岁和高达62岁的女性中均有出现。总体而言，年龄每增加十岁，ASC-H/HSIL的患病率增加0.7%（95%CI：-3.8%，5.1%）。
严重和不太严重的病变在所有年龄段都很普遍，这表明在HIV阳性女性中进行针对性年龄筛查的效用不大。然而，这些病变的长期演变需要在前瞻性研究中进行评估。
