Department of Obstetrics and Gynecology, L. Sacco Hospital, ASST-Fatebenefratelli-Sacco, University of Milan, Milan, Italy.
Woman's Health Sciences Department, Gynecologic Section, Università Politecnica delle Marche, Ancona, Italy.
Int J Gynaecol Obstet. 2021 Dec;155(3):442-449. doi: 10.1002/ijgo.13674. Epub 2021 Jun 10.
To evaluate the risk factors for recurrence of high-grade disease after cervical excision in women living with HIV (WLWH), with a specific interest in the role of high-risk (HR-) HPV positivity.
Multicentric retrospective study conducted on WLWH who underwent cervical excision between January 1987 and June 2017 in six Italian institutions. The rate of high-grade recurrence was determined. Risk factors for recurrence and HR-HPV positivity were determined with the Log-rank test and Cox proportional hazards regression models.
A total of 271 WLWH were included in the final analysis. A high-grade recurrence was found in 58 (21.4%) patients. Age 41 years or more at inclusion and HR-HPV positivity during follow up were independently associated with a higher risk of disease recurrence with relative risks of 4.15 (95% confidence interval [CI] 2.01-8.58, P < 0.001) and 5.18 (95% CI 2.12-12.67, P < 0.01), respectively. Age 41 years or more (relative risk 1.75, 95% CI 1.01-3.04, P = 0.047) resulted as a risk factor for HR-HPV positivity during follow up.
HR-HPV positivity is a risk factor for recurrence after cervical excision in WLWH. Women older than 41 years may benefit from a long-term yearly follow up. Future studies regarding HPV vaccination after treatment in WLWH may be useful, considering the protective role of the higher probability of HPV negativity in vaccinated women.
评估人免疫缺陷病毒（HIV）感染者（WLWH）行宫颈切除术后高级别病变（HSIL）复发的危险因素，特别关注高危型（HR）-HPV 阳性的作用。
对 1987 年 1 月至 2017 年 6 月期间在意大利六家机构接受宫颈切除术的 WLWH 进行了多中心回顾性研究。确定高级别复发率。使用对数秩检验和 Cox 比例风险回归模型确定复发和 HR-HPV 阳性的危险因素。
共纳入 271 例 WLWH 进行最终分析。58 例（21.4%）患者出现高级别复发。纳入时年龄≥41 岁和随访期间 HR-HPV 阳性与疾病复发风险增加独立相关，相对风险分别为 4.15（95%置信区间[CI]2.01-8.58，P<0.001）和 5.18（95%CI2.12-12.67，P<0.01）。纳入时年龄≥41 岁（相对风险 1.75，95%CI1.01-3.04，P=0.047）是随访期间 HR-HPV 阳性的危险因素。
HR-HPV 阳性是人免疫缺陷病毒感染者宫颈切除术后复发的危险因素。年龄大于 41 岁的女性可能受益于长期每年随访。考虑到接种疫苗女性 HPV 阴性的可能性更高，对 WLWH 治疗后 HPV 疫苗接种的未来研究可能有用。
