Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa
Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa
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DOI：
10.1007/s10552-009-9475-z
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发表时间：
2010-03-01
影响因子：
2.3
通讯作者：
Smith, Jennifer S.
中科院分区：
文献类型：
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作者：
Firnhaber, Cynthia;Van Le, Hoa;Smith, Jennifer S.
目的探讨CD 4计数、HPV感染与HIV血清阳性妇女宫颈癌发生风险之间的关系。使用线性阵列基因分型检测（罗氏）对191名患者的子集进行了HPV DNA检测。结果在1,010例HIV阳性妇女中，AGC/ASCUS、LSIL和HSIL及以上的患病率分别为8.3%、23.5%和18.0%。CD 4 < 200 cells/mm（3）与CD 4水平> 500/mm（3）相比，宫颈病变的风险更高。HPV 16型（41.7%）和HPV 56型（22.2%）是HSIL中最常见的型别。CD 4水平< 200/mm（3）的女性HPV 16型（p < 0.01）和66型（p = 0.04）的患病率较高。结论HPV感染和HSIL的负担较高，且与HIV诱导的免疫抑制有关。HPV 16是HSIL中最常见的类型，并且随着免疫抑制的增加而增加。预防性HPV 16疫苗接种可预防约40%的HSIL病例。在这一人群中加强筛查计划势在必行。
Objective To examine the association between CD4 counts, HPV infection and the risk of cervical neoplasia among HIV-seropositive women.Methods A cross-sectional observational study was conducted among 1,010 HIV-seropositive women using cytology-based Pap smears. HPV DNA testing using Linear Array genotyping assay (Roche) was carried out in a subset of 191 patients. Multivariable-adjusted prevalence ratios (mPR) and 95% confidence intervals (CIs) were estimated with log-binomial regression.Results Among 1,010 HIV-seropositive women, the prevalence of AGC/ASCUS, LSIL and HSIL or greater was 8.3, 23.5 and 18.0%, respectively. The risk of cervical lesions was higher with CD4 < 200 cells/mm(3) vs. CD4 levels > 500/mm(3). HPV types 16 (41.7%) and HPV 56 (22.2%) were the most common types in HSIL cases. Women with CD4 levels < 200/mm(3) had a higher prevalence of HPV types 16 (p < 0.01) and 66 (p = 0.04). No statistical relationship between cervical lesions and HAART use was found.Conclusion The burden of HPV infection and HSIL was high and correlated with HIV-induced immunosuppression. HPV 16 was the most common type in HSIL and increased in prevalence with greater immune suppression. Prophylactic HPV 16 vaccination could prevent approximately 40% of HSIL cases. Strengthening screening programs is imperative in this population.