Garzetti G G, Ciavattini A, Butini L, Vecchi A, Montroni M
Institute of Obstetrics and Gynecology, University of Ancona, Italy.
Gynecol Obstet Invest. 1995;40(1):52-6. doi: 10.1159/000292302.
In the present study we investigated the cytologic and colposcopic characteristics of a cohort of HIV-infected women, with the aim to determine a relationship between immunologic status and frequency and/or severity of cervical abnormalities.
21 women, who tested positive for the HIV antibody and who were admitted as outpatients because of various gynecologic complications or because of an HIV infection that was under regular clinical surveillance. A pelvic examination was performed and Papanicolaou smears were obtained from endocervix and ectocervix before colposcopic examination. Cytologic samples for human papillomavirus (HPV) detection by polymerase chain reaction were also collected. Results obtained in the group of HIV-infected women were compared with findings in a group of 473 seronegative women recruited consecutively from our outpatient population. Serum samples for T lymphocytes were drawn within 2 weeks of cytologic and colposcopic examination. CD4 and CD8 monoclonal antibodies were purchased from Becton Dickinson (Mountain View, Calif., USA).
HIV-infected women had a significantly higher percentage of HPV DNA positivity with respect to the outpatient population (67 vs. 7%, respectively, p < 0.001). Analysis of cytologic specimens revealed 9 women (43%) with cytologic evidence of cervical dysplasia in the HIV-seropositive group vs. 23 (5%) of 473 in the outpatient population (p < 0.001). All the HIV-seropositive women with cervical dysplasia presented an associated HPV DNA positivity; in particular, the percentage of associated HPV DNA type 16 in cervical dysplasia was 78% (7/9 cases). In HIV-infected women, the evaluation of T lymphocyte subset distribution suggested a significant relationship between CD4+ cell decrease and severity of cytologic findings (p = 0.03).
The HIV-infected women had a tenfold higher prevalence of both HPV infection and cervical dysplasia than the outpatient population; this increased risk seems to be limited mainly to those who also had genital HPV infection. The analysis of immunologic status confirmed previous observations that an impaired immune system results in increased cervical disease.
在本研究中，我们调查了一组感染HIV的女性的细胞学和阴道镜检查特征，旨在确定免疫状态与宫颈异常的频率和/或严重程度之间的关系。
21名女性，她们的HIV抗体检测呈阳性，因各种妇科并发症或因接受定期临床监测的HIV感染而作为门诊患者入院。进行盆腔检查，并在阴道镜检查前从子宫颈管内膜和子宫颈外膜获取巴氏涂片。还收集了用于通过聚合酶链反应检测人乳头瘤病毒（HPV）的细胞学样本。将感染HIV的女性组的结果与从我们的门诊人群中连续招募的473名血清阴性女性组的结果进行比较。在细胞学和阴道镜检查的2周内采集用于T淋巴细胞检测的血清样本。CD4和CD8单克隆抗体购自美国加利福尼亚州山景城的Becton Dickinson公司。
与门诊人群相比，感染HIV的女性HPV DNA阳性率显著更高（分别为67%和7%，p<0.001）。细胞学标本分析显示，HIV血清阳性组中有9名女性（43%）有宫颈发育异常的细胞学证据，而门诊人群的473名中有23名（5%）（p<0.001）。所有有宫颈发育异常的HIV血清阳性女性均伴有HPV DNA阳性；特别是，宫颈发育异常中相关HPV 16型的百分比为78%（7/9例）。在感染HIV的女性中，T淋巴细胞亚群分布的评估表明CD4+细胞减少与细胞学结果的严重程度之间存在显著关系（p = 0.03）。
感染HIV的女性HPV感染和宫颈发育异常的患病率比门诊人群高十倍；这种增加的风险似乎主要限于那些也有生殖器HPV感染的女性。免疫状态分析证实了先前的观察结果，即免疫系统受损会导致宫颈疾病增加。
