Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA.
Information Management Services, Calverton, MD, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
Prev Med. 2022 Sep;162:107157. doi: 10.1016/j.ypmed.2022.107157. Epub 2022 Jul 8.
As the US moves increasingly towards using human papillomavirus (HPV) testing with or without concurrent cytology for cervical cancer screening, it is unknown what the corresponding risks are following a screening result for women living with HIV (WLWH), which will dictate the optimal clinical follow-up. Therefore, using medical records data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in women aged 30-64 years in 2003, we compared risks of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnoses (CIN2+) in women not known to have HIV (HIV[-] women) (n = 67,488) frequency matched 111:1 on age and year of the first co-test to the 608 WLWH (n = 608). WLWH were more likely to test HPV positive (20.2% vs. 6.5%, p < 0.001) and have non-normal cytology (14.1% vs. 4.1%, p < 0.001) than HIV[-] women. Five-year CIN2+ risks for all WLWH and HIV[-] women were 3.5% (95%CI = 2.0-5.0%) and 1.6% (95%CI = 1.5-1.8%) (p = 0.01), respectively. Five-year CIN2+ risks for WLWH with positive HPV and non-normal cytology, positive HPV and normal cytology, negative HPV and non-normal cytology, and negative HPV and normal cytology were 24.9% (95%CI = 13.4-36.4%), 3.0% (95%CI = 0.0-7.4%), 3.6 (95%CI = 0.0-9.8%) and 0.3% (95%CI = 0.0-0.8%), respectively. Corresponding 5-year CIN2+ risks for HIV[-] women were 26.6% (95%CI = 24.6-28.7%), 8.5% (95%CI = 7.2-9.9%), 1.9% (95%CI = 1.0-2.8%), and 0.5% (95%CI = 0.4-0.6%), respectively. Thus, in this healthcare setting, the main cause in overall CIN2+ risk differences between WLWH and HIV[-] women was the former was more likely to screen positive and once the screening result is known, it may be reasonable to manage both populations similarly.
随着美国越来越多地将人乳头瘤病毒（HPV）检测与细胞学检查联合或不联合用于宫颈癌筛查，对于 HIV 感染者（HIV 感染者），尚不清楚在筛查后会有哪些相应的风险，这将决定最佳的临床随访。因此，我们利用 Kaiser Permanente Northern California 的医疗记录数据，该数据库于 2003 年开始对 30-64 岁的女性进行每三年一次的 HPV 和细胞学联合检测，我们比较了未感染 HIV 的女性（HIV[-]女性）（n=67488）和 608 名 HIV 感染者（n=608）在 HPV 阳性（20.2%比 6.5%，p<0.001）和非典型细胞学（14.1%比 4.1%，p<0.001）方面的宫颈上皮内瘤变 2 级（CIN2）或更严重病变（CIN2+）诊断的风险。与 HIV[-]女性相比，HIV 感染者更有可能 HPV 检测呈阳性（20.2%比 6.5%，p<0.001）且细胞学非典型（14.1%比 4.1%，p<0.001）。所有 HIV 感染者和 HIV[-]女性的 5 年 CIN2+风险分别为 3.5%（95%CI=2.0-5.0%）和 1.6%（95%CI=1.5-1.8%）（p=0.01）。HPV 阳性和非典型细胞学、HPV 阳性和正常细胞学、HPV 阴性和非典型细胞学、HPV 阴性和正常细胞学的 HIV 感染者 5 年 CIN2+风险分别为 24.9%（95%CI=13.4-36.4%）、3.0%（95%CI=0.0-7.4%）、3.6%（95%CI=0.0-9.8%）和 0.3%（95%CI=0.0-0.8%）。相应的 HIV[-]女性的 5 年 CIN2+风险分别为 26.6%（95%CI=24.6-28.7%）、8.5%（95%CI=7.2-9.9%）、1.9%（95%CI=1.0-2.8%）和 0.5%（95%CI=0.4-0.6%）。因此，在这种医疗保健环境中，HIV 感染者和 HIV[-]女性的总体 CIN2+风险差异的主要原因是前者更有可能筛查阳性，一旦筛查结果已知，对这两个群体进行类似的管理可能是合理的。
