Six C, Heard I, Bergeron C, Orth G, Poveda J D, Zagury P, Cesbron P, Crenn-Hébert C, Pradinaud R, Sobesky M, Marty C, Babut M L, Malkin J E, Odier A, Fridmann S, Aubert J P, Brunet J B, de Vincenzi I
European Centre for the Epidemiological Monitoring of AIDS, Saint-Maurice, France.
AIDS. 1998 Jun 18;12(9):1047-56.
To investigate the impact of HIV infection on the prevalence, incidence and short-term prognosis of squamous intraepithelial lesions (SIL), in a prospective study with 1-year follow-up.
Between 1993 and 1995, 271 HIV-positive and 171 HIV-negative women at high risk of HIV infection were recruited, 365 (82.6%) of whom completed the 1-year follow-up. The women underwent a Papanicolaou smear test at inclusion and at 6 and 12 months. Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR.
The SIL prevalence ranged from 7.5% for HIV-negative to 31.3% for HIV-positive women with CD4 cell counts < 500 x 10(6)/l (P < 0.001). Other factors associated independently and significantly with SIL prevalence were HPV-16, 18, 33 and related types, HPV-31, -35, -39 and related types, lifetime number of partners, younger age, past history of SIL and lack of past cervical screening. The SIL incidence ranged from 4.9% in HIV-negative women to 27% in HIV-positive women with CD4 cells < 500 x 10(6)/l (P < 0.001). Progression from low- to high-grade SIL during follow-up was detected in 38.1% of HIV-positive women with CD4 cells < or = 500 x 10(6)/l but in no HIV-negative nor HIV-positive women with CD4 cells > 500 x 10(6)/l. HPV-16, 18, 33 and related types were also associated with higher incidence of SIL and progression from low- to high-grade SIL.
HIV-induced immunodeficiency is associated with high prevalence, incidence and persistence/progression of SIL. A pejorative influence of HIV infection without marked immunodeficiency is less clear. HIV-positive women with SIL may thus benefit from early treatment when a useful immune response is still present.
在一项为期1年随访的前瞻性研究中，调查HIV感染对鳞状上皮内病变（SIL）的患病率、发病率及短期预后的影响。
1993年至1995年，招募了271名HIV阳性和171名有HIV感染高风险的HIV阴性女性，其中365名（82.6%）完成了1年随访。这些女性在入组时、6个月和12个月时接受了巴氏涂片检查。入组时通过Southern印迹法和PCR检测人乳头瘤病毒（HPV）。
CD4细胞计数<500×10⁶/l的HIV阴性女性SIL患病率为7.5%，HIV阳性女性为31.3%（P<0.001）。与SIL患病率独立且显著相关的其他因素有HPV-16、18、33及相关类型，HPV-31、-35、-39及相关类型，性伴侣终生数量，年龄较小，既往SIL病史及既往未进行宫颈筛查。CD4细胞计数<500×10⁶/l的HIV阴性女性SIL发病率为4.9%，HIV阳性女性为27%（P<0.001）。随访期间，CD4细胞≤500×10⁶/l的HIV阳性女性中38.1%检测到从低级别SIL进展为高级别SIL，但CD4细胞>500×10⁶/l的HIV阴性和HIV阳性女性均未出现这种情况。HPV-16、18、33及相关类型也与SIL的较高发病率及从低级别SIL进展为高级别SIL有关。
HIV诱导的免疫缺陷与SIL的高患病率、发病率及持续存在/进展相关。HIV感染无明显免疫缺陷时的不良影响尚不清楚。因此，有SIL的HIV阳性女性在仍存在有效免疫反应时可能会从早期治疗中获益。
