Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India.
Molecular Biology Group, ICMR-National Institute of Cancer Prevention and Research, Noida, India.
Acta Cytol. 2022;66(6):496-506. doi: 10.1159/000525340. Epub 2022 Jun 27.
Women living with HIV (WLHIV) are at an increased risk of developing cervical precancerous lesions and cervical human papillomavirus (HPV) infection. This study aimed at evaluating the prevalence of cervical lesions and high-risk HPV (HR-HPV) infection in WLHIV in comparison to the HIV-negative women undergoing opportunistic screening. In addition, these findings among WLHIV were correlated with the clinic-demographic factors.
A cross-sectional study was conducted among WLHIVs at a tertiary hospital and linked antiretroviral therapy (ART) center, while HIV-negative women were recruited from the health promotion clinic at our institute. With informed consent, a semi-structured questionnaire was filled on demographic and epidemiological parameters. Conventional cervical smears and samples for HPV DNA detection by HC2 high-risk HPV DNA test were collected in all participants. Cervical smears were reported using the Bethesda system 2014. Appropriate statistical analysis was performed for bivariate and multivariate logistic regression analysis for comparison between WLHIV and HIV-negative women and for correlation of abnormal cervical cytology and HR-HPV infection among WLHIVs.
The clinic-demographic characteristics of WLHIVs and HIV-negative women were similar. On cytology, the prevalence of cervical cytological abnormalities were significantly higher (p < 0.001) among WLHIVs (14.1%) compared to HIV-negative women (3.1%). High-grade lesions were seen in 3.7% of WLHIVs, while no high-grade lesions were detected in HIV-negative women. Cervical HR-HPV infection was also significantly higher (p < 0.001) in WLHIVs (28.9%) than HIV-negative women (9.3%). Cervical precancerous lesions in WLHIVs showed positive association with current sexually transmitted infection (STI), multiple sexual partners, tobacco use, and CD4 count less than 200/µL, while cervical HPV was positively associated with current STI, tobacco use, CD4 count less than 200/µL and negatively with ART intake. On multivariate logistic regression, cervical cytological abnormalities showed a significant association with multiple sexual partners (p < 0.001), while cervical HR-HPV infection was positively associated with current STI (p = 0.01), nadir CD4 count <200/µL (p = 0.004), abnormal cervical cytology (p = 0.002) and negatively with ART intake (p = 0.03).
Women living with HIV have a significantly higher prevalence of cervical precancerous lesions and HR-HPV infection compared to the general population. Considering the lack of an organized population-based cervical cancer screening program in many low-resource countries like ours, specific focus on screening this highly vulnerable population to reduce the morbidity and mortality due to cervical cancer is imperative.
感染 HIV 的女性（WLHIV）患宫颈癌前病变和人乳头瘤病毒（HPV）感染的风险增加。本研究旨在评估 WLHIV 与接受机会性筛查的 HIV 阴性女性相比，宫颈癌前病变和高危型 HPV（HR-HPV）感染的发生率。此外，还对 WLHIV 中的这些发现与临床-人口统计学因素进行了相关性分析。
在一家三级医院和联合抗逆转录病毒治疗（ART）中心进行了一项横断面研究，而 HIV 阴性女性则从我们研究所的健康促进诊所招募。在获得知情同意后，所有参与者均填写了一份半结构式问卷，内容包括人口统计学和流行病学参数。对所有参与者均采集了常规宫颈涂片和 HC2 高危型 HPV DNA 检测 HPV DNA。宫颈涂片的报告采用 2014 年的巴氏系统。对 WLHIV 和 HIV 阴性女性之间的双变量和多变量逻辑回归分析进行了适当的统计分析，以及对 WLHIV 中异常宫颈细胞学和 HR-HPV 感染的相关性分析。
WLHIV 和 HIV 阴性女性的临床人口统计学特征相似。在细胞学方面，WLHIV 中宫颈细胞学异常的发生率明显更高（p < 0.001）（14.1%），而 HIV 阴性女性为（3.1%）。WLHIV 中发现了 3.7%的高级别病变，而 HIV 阴性女性中未发现高级别病变。WLHIV 中宫颈 HR-HPV 感染也明显高于 HIV 阴性女性（p < 0.001）（28.9% vs. 9.3%）。WLHIV 中的宫颈癌前病变与当前性传播感染（STI）、多个性伴侣、吸烟和 CD4 计数低于 200/µL 呈正相关，而 HPV 与当前 STI、吸烟、CD4 计数低于 200/µL 呈正相关，与 ART 摄入呈负相关。多变量逻辑回归显示，宫颈细胞学异常与多个性伴侣显著相关（p < 0.001），而宫颈 HR-HPV 感染与当前 STI（p = 0.01）、CD4 计数最低 <200/µL（p = 0.004）、异常宫颈细胞学（p = 0.002）和 ART 摄入呈负相关（p = 0.03）。
与一般人群相比，感染 HIV 的女性宫颈癌前病变和高危型 HPV 感染的发生率明显更高。考虑到在我们这样的资源匮乏国家缺乏有组织的基于人群的宫颈癌筛查计划，针对这一高度脆弱人群进行特定的筛查以降低宫颈癌发病率和死亡率至关重要。
