Comparing Papanicolau smear, visual inspection with acetic acid and human papillomavirus cervical cancer screening methods among HIV-positive women by immune status and antiretroviral therapy
Comparing Papanicolau smear, visual inspection with acetic acid and human papillomavirus cervical cancer screening methods among HIV-positive women by immune status and antiretroviral therapy
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DOI：
10.1097/01.aids.0000432472.92120.1b
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发表时间：
2013-11-28
期刊：
影响因子：
3.8
通讯作者：
Mugo, Nelly R.
中科院分区：
文献类型：
--
作者：
Chung, Michael H.;McKenzie, Kevin P.;Mugo, Nelly R.
背景：尚未在hiv阳性妇女中对利用免疫状态、抗逆转录病毒治疗（ART）和阴道镜指导活检数据的宫颈癌筛查方法进行严格比较。方法：2009年6月至11月，500名艾滋病毒阳性妇女在肯尼亚内罗毕的一家艾滋病毒治疗诊所登记，接受了巴氏涂片（Pap）、醋酸目视检查（VIA）、人乳头瘤病毒（HPV）和阴道镜指导活检（金标准）。巴氏涂片阳性（ASCUS+、LSIL+、HSIL+）、VIA、HPV及其组合与CIN2/3+比较。采用两两检验和多变量logistic回归模型（包括年龄、CD4（+）细胞计数和ART持续时间）比较敏感性、特异性和AUC（敏感性和1-特异性）。结果：入选500例，共收集样本498例。组织学上，正常172例（35%），CIN1 186例（37%），CIN2 66例（13%），CIN3 47例（9%），不确定27例（5%）。Pap （ASCUS+）是最敏感的筛查方法（92.7%），Pap （HSIL+）和VIA阳性联合筛查最特异性（99.1%），Pap （HSIL+）的AUC最高（0.85）。在多变量分析中，CD4（+）细胞计数为350细胞/升或更低与HPV特异性降低相关（P=0.002）；抗逆转录病毒治疗持续时间少于2年与HPV （P=0.01）和VIA （P=0.03）特异性降低相关；年龄小于40岁与VIA敏感性增加相关(P
Background:A rigorous comparison of cervical cancer screening methods utilizing data on immune status, antiretroviral therapy (ART) and colposcopy-directed biopsy has not been performed among HIV-positive women.Methods:Between June and November 2009, 500 HIV-positive women were enrolled at an HIV treatment clinic in Nairobi, Kenya, and underwent Papanicolau (Pap) smear, visual inspection with acetic acid (VIA), human papillomavirus (HPV) and colposcopy-directed biopsy (gold standard). Positive Pap smear (ASCUS+, LSIL+, HSIL+), VIA, HPV and their combinations were compared with CIN2/3+. Sensitivity, specificity and AUC (sensitivity and 1-specificity) were compared using pairwise tests and multivariate logistic regression models that included age, CD4(+) cell count and ART duration.Results:Of 500 enrolled, 498 samples were collected. On histology, there were 172 (35%) normal, 186 (37%) CIN1, 66 (13%) CIN2, 47 (9%) CIN3 and 27 (5%) indeterminate. Pap (ASCUS+) was the most sensitive screening method (92.7%), combination of both Pap (HSIL+) and VIA positive was the most specific (99.1%) and Pap (HSIL+) had the highest AUC (0.85). In multivariate analyses, CD4(+) cell count of 350cells/l or less was associated with decreased HPV specificity (P=0.002); ART duration of less than 2 years was associated with decreased HPV (P=0.01) and VIA (P=0.03) specificity; and age less than 40 years was associated with increased VIA sensitivity (P