Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2021 Jul 30;16(7):e0255124. doi: 10.1371/journal.pone.0255124. eCollection 2021.
A screening centre in Soweto, South Africa (SA), investigated high-risk human papillomavirus (HR-HPV), HIV, cervical cancer risk amongst women.
This cross-sectional study (June 2018-March 2019) describes screening results (Roche Linear Array HPV test and Pap smear liquid based cytology) and history of screening (known HIV status, antiretroviral therapy [ART] use, previous Pap smears). Data were stratified by age group (18-29, 30+ years), HIV status, Pap smear results and tested for statistical significance.
Of 280 women, 20.4% were HIV-positive, 18.2% had abnormal Pap smears, 41.8% had HR-HPV. Of older women, 48.2% (n = 78/162) had never had a Pap smear. Of younger women, 89.0% (n = 105/118) never had a Pap smear, but had significantly more low-grade squamous intraepithelial lesions (LSIL) and other HR-HPV infection than older women (12.7%[n = 15/118] vs 4.9%[n = 8/162], p = 0.0193; and 49.2%[n = 58/118] vs 29.0%[n = 47/162], p = 0.0006; respectively). HIV-positive women had more abnormal cytology results and infection with other HR-HPV types or co-infection with other HR-HPV type(s)/HPV-16 compared to HIV-negative women (35.1%[n = 20/57] vs 13.9%[n = 31/223], p = 0.0002; 56.1%[n = 32/57] vs 32.7%[n = 73/223], p = 0.001; and 12.3%[n = 7/57] vs 4.9%[n = 11/223], p = 0.044; respectively). Of 57 HIV-positive women, 45.6% (n = 26) already knew their HIV status; of which 69.2% were on ART and 34.6% never had a Pap smear.
South African women have high rates of HIV, Pap smear abnormalities and HR-HPV, with low cervical cancer screening coverage. SA cervical cancer screening policy excludes (undiagnosed) HIV-positive and HIV-negative women <30 years, both populations found to have high prevalence of HR-HPV. HPV-based primary screening from 25 years could improve outcomes.
南非索韦托的一个筛查中心调查了高危型人乳头瘤病毒（HR-HPV）、HIV 和宫颈癌风险在女性中的情况。
本横断面研究（2018 年 6 月至 2019 年 3 月）描述了筛查结果（罗氏线性阵列 HPV 检测和巴氏涂片液基细胞学）和筛查史（已知的 HIV 状态、抗逆转录病毒治疗[ART]的使用情况、之前的巴氏涂片）。数据按年龄组（18-29 岁，30 岁以上）、HIV 状态、巴氏涂片结果进行分层，并进行了统计学意义检验。
在 280 名女性中，20.4%为 HIV 阳性，18.2%的巴氏涂片异常，41.8%的 HR-HPV 感染。在年龄较大的女性中，48.2%（n=78/162）从未进行过巴氏涂片检查。在年龄较小的女性中，89.0%（n=105/118）从未进行过巴氏涂片检查，但低级别鳞状上皮内病变（LSIL）和其他 HR-HPV 感染的比例明显高于年龄较大的女性（12.7%[n=15/118] vs 4.9%[n=8/162]，p=0.0193；49.2%[n=58/118] vs 29.0%[n=47/162]，p=0.0006）。HIV 阳性女性的细胞学异常结果和其他 HR-HPV 型感染或其他 HR-HPV 型/HPV-16 合并感染的比例高于 HIV 阴性女性（35.1%[n=20/57] vs 13.9%[n=31/223]，p=0.0002；56.1%[n=32/57] vs 32.7%[n=73/223]，p=0.001；和 12.3%[n=7/57] vs 4.9%[n=11/223]，p=0.044）。在 57 名 HIV 阳性女性中，45.6%（n=26）已经知道自己的 HIV 状态；其中 69.2%正在接受 ART 治疗，34.6%从未进行过巴氏涂片检查。
南非女性 HIV、巴氏涂片异常和 HR-HPV 感染率较高，宫颈癌筛查覆盖率较低。南非的宫颈癌筛查政策排除了（未确诊的）HIV 阳性和 HIV 阴性的 30 岁以下女性，这两个群体都发现 HR-HPV 感染率较高。从 25 岁开始进行 HPV 初筛可以改善结局。
