Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
BJOG. 2021 Nov;128(12):1986-1996. doi: 10.1111/1471-0528.16758. Epub 2021 Jun 14.
Evaluate 1-year outcomes of cervical cancer screening and treatment using primary high-risk human papillomavirus (HPV) testing in women living with human immunodeficiency virus (HIV).
Prospective cohort study.
HIV treatment centre in Botswana.
Women living with HIV.
Participants underwent cervical cancer screening with high-risk HPV testing and triage evaluation at baseline and 1-year follow up. Excisional treatment was offered as indicated. Histopathology was the reference standard.
Persistence, clearance and incidence of high-risk HPV infection; and persistence, progression, regression, cure and incidence of cervical dysplasia.
Among 300 women screened at baseline, 237 attended follow up (79%). High-risk HPV positivity significantly decreased from 28% at baseline to 20% at 1 year (P = 0.02). High-risk HPV persistence was 46% and clearance was 54%; incidence was high at 9%. Prevalence of cervical intraepithelial neoplasia Grade 2 (CIN2) or higher was most common in participants with incident high-risk HPV (53%). CIN2 or higher was also common in those with persistent high-risk HPV (32%) and even in those who cleared high-risk HPV (30%). Of the high-risk HPV-positive participants at baseline with <CIN2, 40% progressed to CIN2 or higher at follow up.
The high incidence of high-risk HPV and high-grade cervical dysplasia in women living with HIV after one round of high-risk HPV-based screening and treatment raises concern about the rate of progression of high-risk HPV infection to dysplasia. Persistent disease is common. Caution in spacing cervical cancer screening intervals using high-risk HPV testing in women living with HIV is warranted.
High incidence and persistence of HPV and CIN2+ in women living with HIV 1 year after screening and treatment.
评估人免疫缺陷病毒（HIV）感染者中采用主要高危型人乳头瘤病毒（HPV）检测进行宫颈癌筛查和治疗的 1 年结果。
前瞻性队列研究。
博茨瓦纳的 HIV 治疗中心。
HIV 感染者。
参与者在基线和 1 年随访时接受宫颈癌筛查，包括高危 HPV 检测和分流评估。根据需要提供切除性治疗。组织病理学是参考标准。
高危 HPV 感染的持续、清除和发生率；以及宫颈上皮内瘤变（CIN）的持续、进展、消退、治愈和发生率。
在基线筛查的 300 名女性中，有 237 名（79%）参加了随访。高危 HPV 阳性率从基线时的 28%显著下降到 1 年时的 20%（P=0.02）。高危 HPV 持续感染率为 46%，清除率为 54%；发病率为 9%。在有新发高危 HPV 的参与者中，CIN2 或更高级别（CIN2+）的患病率最高（53%）。高危 HPV 持续感染的参与者中也常见 CIN2+（32%），甚至高危 HPV 清除的参与者中也常见 CIN2+（30%）。在基线时高危 HPV 阳性且 <CIN2 的参与者中，有 40%在随访时进展为 CIN2 或更高级别。
高危 HPV 和高级别宫颈上皮内瘤变在接受一轮高危 HPV 检测为基础的筛查和治疗后的 HIV 感染者中发生率较高，这让人对高危 HPV 感染向上皮内瘤变进展的速度感到担忧。持续性疾病很常见。因此，在使用高危 HPV 检测对 HIV 感染者进行宫颈癌筛查时，需要谨慎考虑筛查间隔的设置。
在高危 HPV 检测筛查和治疗后 1 年，HIV 感染者的 HPV 和 CIN2+发病率和持续性较高。
