Agus Somia I Ketut, Purwanta Made Lady Adelaida, Winarti Ni Wayan, Dwija Ida Bagus Nyoman Putra, Pidari Desak Made Putri, Sawitri Anak Agung Sagung, Gayatri Anak Agung Ayu Yuli, Budiana I Nyoman Gede, Pinatih Komang Januartha Putra, Merati Ketut Tuti Parwati
Department of Internal Medicine, Tropical and Infectious Disease Division, Udayana University/Ngoerah Hospital, City of Denpasar, Province of Bali, Indonesia.
Faculty of Medicine, Udayana University, City of Denpasar, Province of Bali, Indonesia.
BMC Infect Dis. 2025 Mar 28;25(1):432. doi: 10.1186/s12879-025-10827-4.
Women living with Human Immunodeficiency Virus (HIV) are at higher risk of cervical cancer, particularly in regions like Indonesia where cervical cancer screening programs are limited. Bali has seen a rise in both HIV and cervical cancer cases, prompting the need for targeted interventions. This study investigates the prevalence of cervical cytological abnormalities and associated risk factors among women with HIV in Bali, focusing on their relationship with high-risk Human Papillomavirus (HR-HPV) types.
A cross-sectional study was conducted from July to December 2023, recruiting 245 women from HIV outpatient clinics in Bali. Demographic and clinical data were collected via interviews and physical examinations, including cervical swabs and blood samples. HPV genotyping was performed using ThinPrep cytology followed by a two-stage PCR process. The first stage utilized universal primers (MY09/11) for HPV detection, while the second stage employed type-specific primers to identify high-risk strains, (16,18,31,33,35,39,45,51,52,56,58,59,66 and 68. Blood samples were analyzed to determine CD4 and CD8 T-cell counts.
Of 239 participants, 26 (10.87%) had abnormal cytology (6 cases (2.5%) of atypical squamous cells with high risk (ASC-H), 9 cases (3.8%) of atypical squamous cells of undetermined significance (ASC-US), 4 cases (1.7%) of high-grade squamous intraepithelial lesions (H-SIL), and 7 cases (2.9%) of low-grade squamous intraepithelial lesions (L-SIL)). Furthermore, 58 participants (24%) were tested positive for HPV DNA, with HPV type 18 being the most prevalent (28% in all HPV-positive samples). HPV-positive women had a seven-fold higher risk of abnormal cytology (PR = 7.022, 95% CI = 3.223-15.295). Multivariate analysis revealed HPV 18 as an independent risk factor (ExpB = 9.029, p = 0.007) and a history of pap smear screening reduced HR-HPV risk (ExpB = 0.358, p = 0.013).
This study highlights that 10.87% of HIV-positive women in Bali had abnormal cytology, with HPV 18 significantly linked to higher risk. A history of pap smear screening reduced HR-HPV risk. These findings underscore the need for robust cervical cancer screening and HPV vaccination, particularly for younger women, to improve health outcomes in Indonesia.
感染人类免疫缺陷病毒（HIV）的女性患宫颈癌的风险更高，尤其是在印度尼西亚等宫颈癌筛查项目有限的地区。巴厘岛的HIV和宫颈癌病例均有所增加，因此需要有针对性的干预措施。本研究调查了巴厘岛感染HIV的女性宫颈细胞学异常的患病率及相关风险因素，重点关注其与高危人乳头瘤病毒（HR-HPV）类型的关系。
2023年7月至12月进行了一项横断面研究，从巴厘岛的HIV门诊招募了245名女性。通过访谈和体格检查收集人口统计学和临床数据，包括宫颈拭子和血液样本。使用ThinPrep细胞学方法进行HPV基因分型，随后进行两阶段PCR过程。第一阶段使用通用引物（MY09/11）进行HPV检测，而第二阶段使用型特异性引物鉴定高危毒株（16、18、31、33、35、39、45、51、52、56、58、59、66和68）。对血液样本进行分析以确定CD4和CD8 T细胞计数。
在239名参与者中，26名（10.87%）有细胞学异常（6例（2.5%）高危非典型鳞状细胞（ASC-H），9例（3.8%）意义不明确的非典型鳞状细胞（ASC-US），4例（1.7%）高级别鳞状上皮内病变（H-SIL），7例（2.9%）低级别鳞状上皮内病变（L-SIL））。此外，58名参与者（24%）HPV DNA检测呈阳性，其中HPV 18型最为常见（在所有HPV阳性样本中占28%）。HPV阳性女性细胞学异常的风险高出七倍（PR = 7.022，95% CI = 3.223 - 15.295）。多变量分析显示HPV 18是一个独立风险因素（ExpB = 9.029，p = 0.007），而巴氏涂片筛查史可降低HR-HPV风险（ExpB = 0.358，p = 0.013）。
本研究强调，巴厘岛10.87%的HIV阳性女性有细胞学异常，HPV 18与更高风险显著相关。巴氏涂片筛查史可降低HR-HPV风险。这些发现强调了加强宫颈癌筛查和HPV疫苗接种的必要性，特别是对于年轻女性，以改善印度尼西亚的健康状况。
