Smeltzer Stephanie, Yu Xioying, Schmeler Kathleen M, Peters Yvette, Levison Judy
Baylor COM, Houston, TX.
Obstet Gynecol. 2016 May;127(Suppl 1):4S. doi: 10.1097/01.AOG.0000483629.84944.db.
To evaluate the prevalence of abnormal vaginal cytology and vaginal intraepithelial neoplasia (VAIN) and vaginal cancer in human immunodeficiency virus (HIV)-infected women with no history of abnormal cytologic screening who had a hysterectomy for conditions other than cervical dysplasia and cancer; and to explore the risk factors associated with VAIN and vaginal cancer.
A retrospective cohort study was performed identifying 238 women between January 2000 to January 2015 with a history of HIV, previous hysterectomy, and no previous abnormal Pap tests. Medical records from patients with both HIV and history of hysterectomy were reviewed from Thomas Street Health Center and Northwest Community Health Center.
Among 238 women, 164(69%) had normal Pap test results, 12(5%) had results showing atypical cells of undermined significance and human papillomavirus-positive, 55(23.1%) had results showing low-grade squamous intraepithelial lesion, and 7(2.9%) had results showing high-grade squamous intraepithelial lesion. No demographic risk factor was associated with abnormal Pap test after hysterectomy. Median follow-up time for the Pap test was 16 years. Of those who underwent vaginal biopsies for an abnormal Pap test, 15(28%) were normal, 23(43%) were VAIN1, 9(16%) were VAIN2, and 7(13%) were VAIN3. No patients had invasive vaginal cancer.
Over 30% of HIV-infected women who had no pre-hysterectomy history of an abnormal Pap test had abnormal vaginal Pap tests. Among those who had vaginal biopsies, 29% had VAIN2 or VAIN3, suggesting that Pap tests post-hysterectomy in the HIV population may be indicated.
评估在因宫颈发育异常和癌症以外的疾病接受子宫切除术、且无异常细胞学筛查史的人类免疫缺陷病毒（HIV）感染女性中，阴道细胞学异常、阴道上皮内瘤变（VAIN）及阴道癌的患病率；并探讨与VAIN和阴道癌相关的危险因素。
进行一项回顾性队列研究，确定了2000年1月至2015年1月期间238名有HIV病史、既往子宫切除术且既往无异常巴氏试验的女性。对托马斯街健康中心和西北社区健康中心有HIV和子宫切除病史患者的病历进行了回顾。
在238名女性中，164名（69%）巴氏试验结果正常，12名（5%）结果显示意义不明确的非典型细胞且人乳头瘤病毒阳性，55名（23.1%）结果显示低级别鳞状上皮内病变，7名（2.9%）结果显示高级别鳞状上皮内病变。子宫切除术后，没有人口统计学危险因素与异常巴氏试验相关。巴氏试验的中位随访时间为16年。在因巴氏试验异常接受阴道活检的患者中，15名（28%）正常，23名（43%）为VAIN1，9名（16%）为VAIN2，7名（13%）为VAIN3。没有患者患有浸润性阴道癌。
超过30%的在子宫切除术前无异常巴氏试验病史的HIV感染女性阴道巴氏试验异常。在接受阴道活检的女性中，29%患有VAIN2或VAIN3，这表明HIV人群子宫切除术后的巴氏试验可能是必要的。
