环型电切术治疗肯尼亚 HIV 阳性和 HIV 阴性妇女的宫颈上皮内瘤变 2/3

Loop Electrosurgical Excision Procedure Treats Cervical Intraepithelial Neoplasia 2/3 Among HIV- and HIV+ Women in Kenya.

机构信息

Moi University, Eldoret, Kenya.

Brown University, Providence, RI.

出版信息

J Low Genit Tract Dis. 2020 Jan;24(1):21-26. doi: 10.1097/LGT.0000000000000493.

DOI:10.1097/LGT.0000000000000493

PMID:31860571

Abstract

OBJECTIVE

The aim of the study was to compare loop electrosurgical excision procedure (LEEP) as treatment for cervical intraepithelial neoplasia (CIN) 2/3 in HIV- versus HIV+ women.

MATERIALS AND METHODS

Seventy-five HIV- and 75 HIV+ women at 6 months or more after LEEP for CIN 2/3 were enrolled between September 2013 and November 2014 in this prospective cohort study at the cervical cancer screening clinic in Eldoret, Kenya. Visual inspection with acetic acid (VIA), followed by cervical cytology with conventional cytology, was performed on all women. Women with positive VIA or abnormal cervical cytology underwent colposcopy/biopsy. Lesion progression, persistence, and regression were assessed to quantify the efficacy of LEEP.

RESULTS

Post-loop electrosurgical excision procedure screening test showed both a negative VIA and normal cervical cytology in 64 (85%) of HIV- and 57 (77%) HIV+ women (risk difference = 8.3%, CI = -4.2% to 21%, p = .20). Eleven (15%) HIV- and 17 (23%) HIV+ (p = .20) women had positive VIA, abnormal cervical cytology, or both and were referred for colposcopy/biopsy. Twenty-one (8 HIV-, 13 HIV+) women were biopsied. Of the 8 HIV- women, 4 (50%) had CIN lesions that regressed, 3 (38.0%) persisted, and 1 (12%) progressed to invasive cancer after LEEP. Of the 13 HIV+ women, 6 (46%) had CIN lesions that regressed, 7 (54%) had CIN lesions that persisted, and no HIV+ women had CIN lesions that progressed after LEEP. There was no difference in estimated efficacies of LEEP for HIV- and HIV+ women (92.7% versus 89.4%, risk difference = 3.3%, CI = -4.8% to 15.3%, p = .85).

CONCLUSIONS

Loop electrosurgical excision procedure for CIN 2/3 is effective treatment for HIV- and HIV+ women in low-resource settings. Future efforts should improve follow-up after treatment.

摘要

目的

本研究旨在比较经阴道环形电切术（LEEP）治疗人类免疫缺陷病毒（HIV）阴性和 HIV 阳性的宫颈上皮内瘤变（CIN）2/3 患者的效果。

材料和方法

2013 年 9 月至 2014 年 11 月，肯尼亚埃尔多雷特宫颈癌筛查诊所进行了这项前瞻性队列研究，共纳入 75 例 HIV 阴性和 75 例 HIV 阳性的女性，均在 LEEP 治疗 CIN 2/3 后 6 个月或以上。所有女性均行醋酸视觉检查（VIA）和常规巴氏细胞学检查。VIA 阳性或巴氏细胞学异常的女性行阴道镜检查/活检。评估病变进展、持续和消退情况以量化 LEEP 的疗效。

结果

LEEP 后筛查试验显示，64 例（85%）HIV 阴性和 57 例（77%）HIV 阳性女性的 VIA 均为阴性且巴氏细胞学正常（风险差异=8.3%，CI=-4.2%至 21%，p=.20）。11 例（15%）HIV 阴性和 17 例（23%）HIV 阳性（p=.20）女性 VIA 阳性、巴氏细胞学异常或两者均有，转诊行阴道镜检查/活检。21 例（8 例 HIV 阴性，13 例 HIV 阳性）接受了活检。8 例 HIV 阴性女性中，4 例（50%）的 CIN 病变消退，3 例（38.0%）持续存在，1 例（12%）进展为浸润性癌。13 例 HIV 阳性女性中，6 例（46%）的 CIN 病变消退，7 例（54%）的 CIN 病变持续存在，没有 HIV 阳性女性的 CIN 病变在 LEEP 后进展。LEEP 对 HIV 阴性和 HIV 阳性女性的疗效估计无差异（92.7%比 89.4%，风险差异=3.3%，CI=-4.8%至 15.3%，p=.85）。