Ezechi Oliver Chukwujekwu, Pettersson Karen Odberg, Okolo Clement Abu, Ujah Innocent Achaya O, Ostergren Per Olof
Clinical Sciences Division, Nigerian Institute of Medical Research Yaba, Lagos, Nigeria; Social Medicine and Global Health, Faculty of Medicine, Lund University, Lund Sweden.
Social Medicine and Global Health, Faculty of Medicine, Lund University, Lund Sweden.
PLoS One. 2014 May 8;9(5):e97150. doi: 10.1371/journal.pone.0097150. eCollection 2014.
Findings from studies that evaluated the effect of antiretroviral drug use on the development of cervical squamous intraepithelial lesion differed in their conclusions. This study investigated the association between HIV infection, antiretroviral drug use and cervical squamous intraepithelial lesion in a high HIV and cervical cancer burden setting- Nigeria.
A cross sectional study among 1140 women of known HIV status enrolled in a randomised study to determine the test characteristics of visual inspection in detecting cytology diagnosed squamous intraepithelial lesion. Multivariate analysis was used to determine the association between HIV infection, antiretroviral drug use and the twin outcome variables of cervical squamous intraepithelial lesion (SIL) and High grade squamous intraepithelial lesion (HSIL) while controlling for confounders.
Prevalence of cervical squamous intraepithelial lesion was 8.5%, with a higher prevalence of 14.3% in HIV positive compared to 3.3% in HIV negative women (aOR: 5.4; 95% CI: 2.9-8.8). Not using antiretroviral drugs was found to be associated with an increased risk of SIL (aOR: 2.1; 95% CI: 1.4-3.5) and HSIL (aOR: 2.6; 95% CI: 1.1-6.4). Participants who had a CD4 cell count <200 cells/mm3, were also found to be at increased risk for SIL (aOR: 1.9; 95% CI: 1.1-5.9) and HSIL (aOR: 5.7; 95% CI: 1.1-7.2).
HIV infection and severe immunosuppression were found to be associated with increased risk of cervical squamous intraepithelial lesion but not viral load. For the first time, in the West African sub-region with specific HIV type and strains, we established the protective effect of antiretroviral drug use against the development of SIL. Integration of cervical cancer screening programme into HIV services and early initiation of antiretroviral drug in HIV positive women especially those with severe immune-suppression could therefore prove to be useful in preventing and controlling cervical cancer development in HIV positive women.
评估抗逆转录病毒药物使用对宫颈鳞状上皮内病变发展影响的研究结果，其结论存在差异。本研究在尼日利亚这一艾滋病毒和宫颈癌负担较高的地区，调查了艾滋病毒感染、抗逆转录病毒药物使用与宫颈鳞状上皮内病变之间的关联。
对1140名已知艾滋病毒感染状况的女性进行横断面研究，这些女性参与了一项随机研究，以确定视觉检查在检测细胞学诊断的鳞状上皮内病变中的检测特征。在控制混杂因素的同时，采用多变量分析来确定艾滋病毒感染、抗逆转录病毒药物使用与宫颈鳞状上皮内病变（SIL）和高级别鳞状上皮内病变（HSIL）这两个双重结局变量之间的关联。
宫颈鳞状上皮内病变的患病率为8.5%，艾滋病毒阳性女性的患病率较高，为14.3%，而艾滋病毒阴性女性的患病率为3.3%（调整后比值比：5.4；95%置信区间：2.9 - 8.8）。未使用抗逆转录病毒药物与SIL风险增加相关（调整后比值比：2.1；95%置信区间：1.4 - 3.5）以及HSIL风险增加相关（调整后比值比：2.6；95%置信区间：1.1 - 6.4）。CD4细胞计数<200个细胞/mm³的参与者，也被发现患SIL风险增加（调整后比值比：1.9；95%置信区间：1.1 - 5.9）以及HSIL风险增加（调整后比值比：5.7；95%置信区间：1.1 - 7.2）。
发现艾滋病毒感染和严重免疫抑制与宫颈鳞状上皮内病变风险增加相关，但与病毒载量无关。在具有特定艾滋病毒类型和毒株的西非次区域，我们首次证实了使用抗逆转录病毒药物对SIL发展具有保护作用。因此，将宫颈癌筛查计划纳入艾滋病毒服务，并在艾滋病毒阳性女性尤其是那些有严重免疫抑制的女性中尽早开始使用抗逆转录病毒药物，可能有助于预防和控制艾滋病毒阳性女性宫颈癌的发展。
