Balandya Belinda S, Pembe Andrea B, Mwakyoma Henry A
Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
East Afr J Public Health. 2011 Sep;8(3):185-9.
The aims of this study was to determine proportion of HIV infected women with cervical pre-malignant lesions; and compare the use of Visual Inspection of the cervix after application of Acetic acid (VIA) and Papanicolau (Pap) smear in screening for cervical premalignant lesions in HIV positive women attending Care and Treatment Centre (CTC) at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. A total of 316 women aged 18-70 years had a Pap smear taken for cytology, followed by spraying onto the cervix with 4% acetic acid and then inspecting it. Cytology was considered negative when there was no Cervical Intraepithelial Neoplasia (CIN) lesion reported from the Pap smear taken, and positive if CIN lesion 1, 2 or 3 was reported. Detection of a well-defined, opaque acetowhite lesion close to the squamocolumnar junction or close to the external cervical os constituted a positive VIA. Out of 316 women, 132 women had acetowhite lesions on VIA, making the proportion of abnormal cervical lesions to be 42.4%. One hundred and one out of 312 women (32.4%) had CIN lesions detected on Pap smear. The proportion of agreement between these two tests was 0.3. The proportion of agreement was moderate in women with advanced WHO HIV clinical stage of the disease and in women not on ART (Anti Retroviral Therapy). Women with CD-4 count less than 200 cells/mm3 had more abnormal cervical lesions. There is considerable proportion of HIV positive women with premalignant lesions of the cervix. Considering the proportion of HIV women with abnormal lesions and the difficulty in logistics of doing Pap smear in low resource settings, these results supports the recommendation to introduce screening of premalignant lesions of the cervix using VIA to all HIV infected women.
本研究的目的是确定感染艾滋病毒的女性中宫颈癌前病变的比例；并比较在坦桑尼亚达累斯萨拉姆穆希姆比利国家医院（MNH）的护理与治疗中心（CTC）就诊的艾滋病毒阳性女性中，应用醋酸后宫颈视诊（VIA）和巴氏涂片法在筛查宫颈癌前病变中的应用情况。共有316名年龄在18至70岁的女性进行了巴氏涂片细胞学检查，随后在宫颈上喷洒4%的醋酸，然后进行检查。如果所取巴氏涂片未报告宫颈上皮内瘤变（CIN）病变，则细胞学检查被视为阴性；如果报告有CIN 1、2或3级病变，则为阳性。在鳞柱交界或宫颈外口附近检测到明确的、不透明的醋酸白病变构成VIA阳性。在316名女性中，132名女性VIA检查有醋酸白病变，宫颈病变异常比例为42.4%。312名女性中有101名（32.4%）在巴氏涂片检查中检测到CIN病变。这两种检查的一致率为0.3。在世界卫生组织艾滋病毒疾病临床晚期的女性和未接受抗逆转录病毒治疗（ART）的女性中，一致率中等。CD-4细胞计数低于200个细胞/mm3的女性宫颈病变异常更多。有相当比例的艾滋病毒阳性女性患有宫颈癌前病变。考虑到艾滋病毒感染女性中病变异常的比例以及在资源匮乏地区进行巴氏涂片检查的后勤困难，这些结果支持向所有艾滋病毒感染女性推荐使用VIA筛查宫颈癌前病变的建议。
