Joshi Smita, Kulkarni Vinay, Darak Trupti, Mahajan Uma, Srivastava Yogesh, Gupta Sanjay, Krishnan Sumitra, Mandolkar Mahesh, Bharti Alok Chandra
Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Jehangir Hospital Premises, Pune, Maharashtra, India.
Prayas Health Group, Amrita Clinic, Pune, India.
Int J Womens Health. 2015 May 4;7:477-83. doi: 10.2147/IJWH.S80624. eCollection 2015.
Female sex workers (FSWs) are at an increased risk of human immunodeficiency virus (HIV) as well as human papillomavirus (HPV) infections and thus have an increased risk of cervical intraepithelial neoplasia (CIN) and cervical cancer. We evaluated the feasibility of "screen and treat approach" for cervical cancer prevention and the performance of different screening tests among FSWs.
Women were screened using cytology, VIA (visual inspection with acetic acid), and VILI (visual inspection with Lugol's iodine) and underwent colposcopy, biopsy, and immediate treatment using cold coagulation, if indicated, at the same visit.
We screened 300 FSWs of whom 200 (66.67%) were HIV uninfected and 100 (33.34%) were HIV infected. The overall prevalence of CIN 2-3 lesions was 4.7%. But all women with CIN 2-3 lesions were HIV infected, and thus the prevalence of CIN 2-3 lesions in HIV-infected FSWs was 14/100 (14%, 95% confidence interval: 7.2-20.8). All of them screened positive by all three screening tests. Cold coagulation was well tolerated, with no appreciable side effects.
Cervical cancer prevention by "screen and treat" approach using VIA, followed by ablative treatment, in this high-risk group of women is feasible and can be implemented through various targeted intervention programs.
女性性工作者感染人类免疫缺陷病毒（HIV）以及人乳头瘤病毒（HPV）的风险增加，因此患宫颈上皮内瘤变（CIN）和宫颈癌的风险也增加。我们评估了“筛查和治疗方法”预防宫颈癌的可行性以及不同筛查检测在女性性工作者中的表现。
使用细胞学检查、醋酸肉眼观察法（VIA）和卢戈氏碘液肉眼观察法（VILI）对女性进行筛查，并在同一次就诊时进行阴道镜检查、活检，如有指征则立即采用冷凝治疗。
我们筛查了300名女性性工作者，其中200名（66.67%）未感染HIV，100名（33.34%）感染了HIV。CIN 2 - 3级病变的总体患病率为4.7%。但所有CIN 2 - 3级病变的女性均感染了HIV，因此HIV感染的女性性工作者中CIN 2 - 3级病变的患病率为14/100（14%，95%置信区间：7.2 - 20.8）。她们通过所有三种筛查检测均呈阳性。冷凝治疗耐受性良好，无明显副作用。
在这一高危女性群体中，采用VIA“筛查和治疗”方法预防宫颈癌，随后进行消融治疗是可行的，并且可以通过各种有针对性的干预项目来实施。
