Universidade Positivo CuritibaPR Brazil Universidade Positivo, Curitiba, PR, Brazil.
Universidade Federal do Paraná CuritibaPR Brazil Universidade Federal do Paraná, Curitiba, PR, Brazil.
Rev Bras Ginecol Obstet. 2024 Oct 23;46. doi: 10.61622/rbgo/2024rbgo85. eCollection 2024.
To evaluate the role of being human immunodeficiency virus (HIV) positive for predicting the risk of recurrence in women with a cervical high grade squamous intraepithelial lesion (HSIL) diagnosis.
Retrospective observational case-control study, comprising HIV positive (case) and HIV negative (control) women in a 1:4 ratio. Women assisted by the Erasto Gaertner Hospital, between 2009-2018, with cervical HSIL diagnosis, submitted to treatment by Loop electrosurgical excision procedure (LEEP), and with a minimum follow-up of 18 months, were included. The immunological status, number and time to recurrence were analyzed, with p<0.05 considered significant. In a second analysis, only patients with free margins were evaluated.
The sample consisted of 320 women (64 cases and 256 controls). Presence of HIV, CD4 levels <200 and detectable viral load (CV) were associated with high risk of recurrence, with odds ratio (OR) of 5.4 (p<0.001/95CI:2.8-10); 3.6 (p<0.001 /IC95:0.6-21.1) and 1.8 (p=0.039 /IC95:0.3-9.3), respectively. In the sample with free margins (n=271), this risk was also higher among seropositive patients, with OR 4.18 (p=0.001/95CI:1.8-9.2).
HIV is an independent risk factor for cervical HSIL recurrence and reduced disease-free survival time. Glandular involvement, compromised margins, undetectable CV and CD4<200 also increase the risk of relapse.
评估人类免疫缺陷病毒（HIV）阳性对预测患有宫颈高级别鳞状上皮内病变（HSIL）女性复发风险的作用。
回顾性观察性病例对照研究，包括 HIV 阳性（病例）和 HIV 阴性（对照）女性，比例为 1:4。研究对象为 2009 年至 2018 年期间在 Erasto Gaertner 医院就诊的宫颈 HSIL 诊断、接受环形电切术（LEEP）治疗且随访时间至少 18 个月的 HIV 阳性女性。分析免疫状态、复发次数和时间，p<0.05 为差异有统计学意义。在二次分析中，仅评估有游离边缘的患者。
该样本包括 320 名女性（64 例病例和 256 例对照）。HIV 存在、CD4 水平<200 和可检测到的病毒载量（CV）与高复发风险相关，比值比（OR）分别为 5.4（p<0.001/95CI：2.8-10）、3.6（p<0.001/IC95：0.6-21.1）和 1.8（p=0.039/IC95：0.3-9.3）。在有游离边缘的样本（n=271）中，血清阳性患者的这种风险也更高，OR 为 4.18（p=0.001/95CI：1.8-9.2）。
HIV 是宫颈 HSIL 复发和无疾病生存时间缩短的独立危险因素。腺上皮受累、边缘不完整、不可检测的 CV 和 CD4<200 也增加了复发的风险。
