Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population
Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population
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DOI：
10.1111/hiv.12271
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发表时间：
2016-01-01
期刊：
影响因子：
3
通讯作者：
Lebech, A-M
中科院分区：
文献类型：
--
作者：
Thorsteinsson, K.;Ladelund, S.;Lebech, A-M
目的据报道，携带艾滋病毒（WLWH）的妇女患浸润性宫颈癌（ICC）的风险增加。最近的一份出版物发现，丹麦的WLWH参加国家ICC筛查计划的频率低于普通人群中的女性。我们的目的是估计丹麦WLWH中宫颈发育不良和ICC的发生率与一般人群中女性的发生率相比。方法：我们研究了1999-2010年期间全国范围内的WLWH队列和每个WLWH中15名年龄匹配的普通人群的队列。病理样本从丹麦病理数据库获得，该数据库包含所有病理标本的全国记录。估计从包涵到第一次宫颈上皮内瘤变(CIN)/ICC以及从第一次宫颈细胞学检查结果正常到第一次宫颈上皮内瘤变/ICC的累积发生率和风险比（hr）。进行敏感性分析，包括先前的筛查结果、筛查强度和CIN/ICC的治疗，以解释结果。结果我们随访了1140例无子宫内膜癌或子宫切除术史的WLWH和17046例无子宫内膜癌或子宫切除术史的对照组，随访时间分别为9491人和155665人年。与对照组相比，WLWH中CIN1或更坏（CIN1+）、CIN2+和CIN3+的总发生率（ICC除外）更高，并可通过年轻和CD4计数< 200细胞/ μ l来预测。在基线细胞学正常的女性中，WLWH中CIN1+和CIN2+的发生率更高。然而，当我们比较WLWH和对照组的亚组时，两组妇女都坚持国家ICC筛查计划，并且基线细胞学正常，CIN和ICC的发生率是可比的。结论总体而言，妊高征妇女发生宫颈疾病的比例高于对照组。然而，在遵循国家ICC筛查计划和正常基线细胞学的WLWH和对照组中，CIN和ICC的发生率是可比的。
ObjectivesWomen living with HIV (WLWH) are reportedly at increased risk of invasive cervical cancer (ICC). A recent publication found that WLWH in Denmark attend the national ICC screening programme less often than women in the general population. We aimed to estimate the incidence of cervical dysplasia and ICC in WLWH in Denmark compared with that in women in the general population.MethodsWe studied a nationwide cohort of WLWH and a cohort of 15 age-matched women per WLWH from the general population for the period 1999-2010. Pathology samples were obtained from The Danish Pathology Data Bank, which contains nationwide records of all pathology specimens. The cumulative incidence and hazard ratios (HRs) for time from inclusion to first cervical intraepithelial neoplasia (CIN)/ICC and time from first normal cervical cytology result to first CIN/ICC were estimated. Sensitivity analyses were performed to include prior screening outcome, screening intensity and treatment of CIN/ICC in the interpretation of results.ResultsWe followed 1140 WLWH and 17 046 controls with no prior history of ICC or hysterectomy for 9491 and 156 865 person-years, respectively. Compared with controls, the overall incidences of CIN1 or worse (CIN1+), CIN2+ and CIN3+, but not ICC, were higher in WLWH and predicted by young age and a CD4 count < 200 cells/mu L. In women with normal baseline cytology, incidences of CIN1+ and CIN2+ were higher in WLWH. However, when we compared subgroups of WLWH and controls where women in both groups were adherent to the national ICC screening programme and had a normal baseline cytology, incidences of CIN and ICC were comparable.ConclusionsOverall, WLWH developed more cervical disease than controls. Yet, in WLWH and controls adherent to the national ICC screening programme and with normal baseline cytology, incidences of CIN and ICC were comparable.