Spinillo A, Tenti P, Baltaro F, Piazzi G, Iasci A, De Santolo A
Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico S. Matteo, Italy.
Eur J Obstet Gynecol Reprod Biol. 1996 Sep;68(1-2):175-8. doi: 10.1016/0301-2115(96)02505-5.
The purpose of this study was to evaluate the frequency and natural history of cervical intraepithelial neoplasia (CIN) during pregnancy in past or current intravenous drug users infected with human immunodeficiency virus type 1 (HIV-1).
We prospectively evaluated 48 pregnant HIV-1 seropositive patients and 38 HIV seronegative controls. All the subjects were current or past intravenous drug users. Follow-up visits were carried out each trimester of pregnancy and 8-12 weeks post-partum with Papanicolau smears, colposcopic examinations and, when necessary, colposcopically directed cervical biopsies.
Thirteen of 48 HIV-seropositive women (27.1%) and three of 38 HIV-seronegative controls (7.9%) (P = 0.027 by Fisher exact test) had biopsy-proven CIN at the beginning of pregnancy. High-grade CIN was detected in 10 cases (20.8%) and in two (5.3%) controls (P = 0.058 by Fisher exact test). None of the cervical squamous intraepithelial lesions progressed throughout pregnancy, in both cases and controls. Post-partum cold-knife cervical conization was performed on seven patients with CIN III and examination of the cone biopsy specimens demonstrated persistence of CIN III.
HIV-infected intravenous drug users are at high risk of CIN during pregnancy, thus requiring adequate screening programs. Our preliminary data suggest that the progression rate of CIN during gestation is low in this high-risk group.
本研究旨在评估既往或目前感染1型人类免疫缺陷病毒（HIV-1）的静脉吸毒者在孕期宫颈上皮内瘤变（CIN）的发生频率及自然病史。
我们前瞻性地评估了48例HIV-1血清学阳性的孕妇和38例HIV血清学阴性的对照者。所有受试者均为目前或既往静脉吸毒者。在孕期的每个 trimester 以及产后8 - 12周进行随访，采用巴氏涂片、阴道镜检查，必要时进行阴道镜引导下的宫颈活检。
48例HIV血清学阳性女性中有13例（27.1%），38例HIV血清学阴性对照者中有3例（7.9%）（Fisher确切概率检验，P = 0.027）在妊娠开始时经活检证实有CIN。10例（20.8%）检测到高级别CIN，2例（5.3%）对照者检测到高级别CIN（Fisher确切概率检验，P = 0.058）。在病例组和对照组中，整个孕期宫颈鳞状上皮内病变均无进展。对7例CIN III患者进行了产后冷刀宫颈锥切术，锥切活检标本检查显示CIN III持续存在。
感染HIV的静脉吸毒者在孕期发生CIN的风险较高，因此需要适当的筛查方案。我们的初步数据表明，在这个高危组中，妊娠期CIN的进展率较低。
