Zhao Ran, Sekar Preethiya, Bennis Sarah L, Kulasingam Shalini
University of Minnesota School of Public Health, Division of Epidemiology and Community Health, 300 West Bank Office Building, 1300 S 2nd St, Minneapolis, MN 55454, USA.
University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, USA.
Prev Med. 2023 May;170:107494. doi: 10.1016/j.ypmed.2023.107494. Epub 2023 Mar 29.
This study aims to evaluate the association between smoking exposure and human papillomavirus (HPV)-related cervical abnormalities among women living with HIV (WLWH). By conducting a systematic review of the current literature, we evaluated the association between current active smoking and/or exposure to secondhand smoke (SHS) and the risk of cervical HPV incidence, prevalence, and clearance, as well as high-grade cervical intraepithelial neoplasm (HGCIN) incidence, prevalence, progression, and regression among WLWH. We conducted the literature search in Ovid Medline, Embase, and Scopus following the PRISMA guidelines. We determined the risk of bias of included studies using the Risk of Bias Assessment Tool for Nonrandomized Studies. Studies with the same effect measure were combined for a pooled estimate. We identified 15 studies that met the inclusion criteria for the final analysis, with a limited number of studies evaluating each study question. Among WLWH, current active smoking is associated with an increased risk of new HPV infections (HR = 1.33, 95% CI 1.10-1.60), HPV prevalence (OR = 1.55, 95% CI 1.26-1.91), HGCIN incidence (HR = 1.5, 95% CI 1.2-2.0), and HGCIN prevalence (PR = 3.69, 95% CI 1.54-8.78). There was no significant association between current active smoking and HPV clearance. We did not identify any study that evaluated the association between SHS exposure and HPV-related cervical abnormalities among WLWH. Active smoking increases the risk of HPV infection and pre-cancer lesion development in WLWH. Considering smoking as an additional risk factor when designing tailored cervical cancer screening programs for WLWH is necessary in high smoking prevalence regions.
本研究旨在评估感染艾滋病毒的女性（WLWH）中吸烟暴露与人类乳头瘤病毒（HPV）相关宫颈异常之间的关联。通过对当前文献进行系统综述，我们评估了当前主动吸烟和/或接触二手烟（SHS）与WLWH中宫颈HPV感染率、患病率和清除率，以及高级别宫颈上皮内瘤变（HGCIN）的发病率、患病率、进展和消退风险之间的关联。我们按照PRISMA指南在Ovid Medline、Embase和Scopus中进行文献检索。我们使用非随机研究的偏倚风险评估工具确定纳入研究的偏倚风险。对具有相同效应量的研究进行合并以获得汇总估计值。我们确定了15项符合最终分析纳入标准的研究，评估每个研究问题的研究数量有限。在WLWH中，当前主动吸烟与新的HPV感染风险增加（HR = 1.33，95% CI 1.10 - 1.60）、HPV患病率（OR = 1.55，95% CI 1.26 - 1.91）、HGCIN发病率（HR = 1.5，95% CI 1.2 - 2.0）和HGCIN患病率（PR = 3.69，95% CI 1.54 - 8.78）相关。当前主动吸烟与HPV清除之间无显著关联。我们未找到任何评估WLWH中SHS暴露与HPV相关宫颈异常之间关联的研究。主动吸烟会增加WLWH中HPV感染和癌前病变发展的风险。在吸烟率高的地区，为WLWH设计量身定制的宫颈癌筛查计划时，将吸烟视为一个额外的风险因素是必要的。
