Médecins sans Frontières, Mumbai, India ; Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
Int J Womens Health. 2013 Aug 13;5:487-94. doi: 10.2147/IJWH.S47710. eCollection 2013.
HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Ninety-five women were screened. Median age was 38 years (IQR: 33-41); median nadir CD4-count 143 cells/μL (IQR: 79-270); and median time on ART 23 months (IQR:10-41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3-34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
与普通人群中的女性相比，HIV 感染者患宫颈上皮内瘤变（CIN）和宫颈癌的风险更高，部分原因是持续性人乳头瘤病毒（HPV）感染的高发率。本研究旨在评估在印度孟买一个人口过多的城市贫民窟中，接受抗逆转录病毒治疗（ART）的 HIV 感染者队列中 HPV 感染、宫颈异常和宫颈癌的负担。
2010 年 5 月至 10 月期间，无国界医生组织和塔塔纪念医院孟买为参加抗逆转录病毒治疗诊所的妇女提供了常规年度巴氏涂片检查和 HPV DNA 检测，并进行了 12 个月的随访。对检测结果异常的妇女进行了宫颈活检和治疗，包括性传播感染（STI）的治疗。
95 名妇女接受了筛查。中位年龄为 38 岁（IQR：33-41）；中位 CD4 计数最低值为 143 个细胞/μL（IQR：79-270）；ART 治疗中位时间为 23 个月（IQR：10-41）。94 名妇女中有 30 名（32%）检测到 HPV DNA，18 名（19%）巴氏涂片显示低级别或高级别鳞状上皮内病变（LSIL/HSIL）。总的来说，超过 50%的妇女有宫颈炎症反应，包括 STI。在 43 名接受宫颈活检的妇女中，8 名（8.4%）患有 CIN-1，5 名（5.3%）患有 CIN-2，2 名（2.1%）患有原位癌。除 1 名外，其余均检测到 HPV DNA（风险比：11，95%置信区间：3.3-34）。截至 2011 年 10 月，56 名妇女完成了 12 个月的随访并接受了重新筛查。未发现新的 HPV 感染/LSIL/HSIL 病例。
接受抗逆转录病毒治疗诊所治疗的妇女中 HPV 感染、STI 和宫颈病变的高患病率表明需要进行常规筛查。需要采用简单的一站式筛查策略。特别是在资源有限的情况下，需要确定最佳的筛查间隔时间。
