Liu Enju, McCree Renicha, Mtisi Expeditho, Fawzi Wafaie W, Aris Eric, Lema Irene A, Hertzmark Ellen, Chalamilla Guerino, Li Nan, Vermund Sten H, Spiegelman Donna
Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
National Cancer Institute, Center for Global Health, Rockville, MD, USA.
Int J STD AIDS. 2016 Mar;27(3):219-25. doi: 10.1177/0956462415584466. Epub 2015 May 7.
To determine the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Tanzania, a cross-sectional study was conducted among HIV-infected women at HIV care and treatment clinics. A Papanicolaou (Pap) smear was used as a screening tool for detection of cervical SIL. From December 2006 to August 2009, 1365 HIV-infected women received cervical screening. The median age was 35 (interquartile range [IQR]: 30-42) years, and the median CD4 + cell count was 164 (IQR: 80-257) cells/mm(3). The prevalence of cervical SIL was 8.7% (119/1365). In multivariate analysis, older age (≥50 versus 30-<40 years: prevalence ratio [PR], 2.36; 95% confidence interval [CI], 1.45-3.84, p for trend = 0.001), lower CD4 + cell counts (<100 versus ≥200 cells/mm(3): PR, 1.55; 95% CI, 1.01-2.36, p for trend = 0.03) and cervical inflammation (PR, 1.73; 95% CI, 1.16-2.60, p = 0.008) were associated with an increased risk of cervical SIL. Women with advanced WHO HIV disease stage (IV versus I/II: PR, 3.45; 95% CI, 1.35-8.85, p for trend = 0.01) had an increased risk for high-grade SIL. In resource-limited settings where it is not feasible to provide cervical cancer prevention services to all HIV-infected women, greater efforts should focus on scaling-up services among those who are older than 50 years, with lower CD4 cell counts and advanced HIV disease stage.
为了确定坦桑尼亚感染艾滋病毒妇女中宫颈鳞状上皮内病变（SIL）的患病率及预测因素，在艾滋病毒护理和治疗诊所对感染艾滋病毒的妇女开展了一项横断面研究。采用巴氏涂片作为检测宫颈SIL的筛查工具。2006年12月至2009年8月，1365名感染艾滋病毒的妇女接受了宫颈筛查。中位年龄为35岁（四分位间距[IQR]：30 - 42岁），CD4 +细胞计数中位数为164（IQR：80 - 257）个细胞/mm³。宫颈SIL的患病率为8.7%（119/1365）。多因素分析显示，年龄较大（≥50岁与30 - <40岁相比：患病率比[PR]，2.36；95%置信区间[CI]，1.45 - 3.84，趋势p值 = 0.001）、CD4 +细胞计数较低（<100个细胞/mm³与≥200个细胞/mm³相比：PR，1.55；95% CI，1.01 - 2.36，趋势p值 = 0.03）以及宫颈炎症（PR，1.73；95% CI，1.16 - 2.60，p = 0.008）与宫颈SIL风险增加相关。世界卫生组织艾滋病毒疾病晚期（IV期与I/II期相比：PR，3.45；95% CI，1.35 - 8.85，趋势p值 = 0.01）的妇女患高级别SIL的风险增加。在资源有限的环境中，向所有感染艾滋病毒的妇女提供宫颈癌预防服务不可行，应加大力度，为年龄超过50岁、CD4细胞计数较低且处于艾滋病毒疾病晚期的妇女扩大服务范围。
