Highly active antiretroviral therapy and cervical dysplasia in HIV-positive women in South Africa
Highly active antiretroviral therapy and cervical dysplasia in HIV-positive women in South Africa
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DOI：
10.7448/ias.15.2.17382
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发表时间：
2012-06-07
影响因子：
6
通讯作者：
Smith, Jennifer S.
中科院分区：
文献类型：
--
作者：
Firnhaber, Cynthia;Westreich, Daniel;Smith, Jennifer S.
背景：HIV阳性女性发生鳞状上皮内病变（SIL）的风险较高。随着这些妇女开始由于高效抗逆转录病毒治疗（HAART）而活得更长，她们患宫颈癌的风险可能会增加。关于HAART对HIV阳性非洲妇女SIL发生率和进展的影响的数据很少。本研究的目的是评估HAART对艾滋病毒阳性妇女在南非的SIL的发病率和进展的影响。方法：艾滋病毒血清阳性妇女的前瞻性观察研究进行了5年以上的艾滋病毒治疗诊所在南非约翰内斯堡。参与者包括601名接受和不接受HAART的妇女，她们重复进行巴氏涂片检查的间隔超过6个月。使用HAART对SIL的发病率和进展率的影响，确定使用多变量泊松回归，以获得发病率比（IRR），调整年龄，CD 4计数和其他潜在的confers.Results：中位随访时间为445天（四分位数间距383，671）。任何SIL的粗发生率为每100人年15.9次（95%置信限（CL）12.7，19.9）;妇女宫颈发育不良所有进展的粗发生率为每100人年13.5次（95% CL 11.3，16.1）。HAART的使用与宫颈病变的发生率和进展率的显著降低相关，校正的IRR = 0.55（95% CL 0.37，0.80）。敏感性分析证实，这主要协会举行的发病率和进展时，他们被认为是分开的，结果是不依赖于HAART exposure.Conclusion的长度：HAART的使用与艾滋病毒阳性妇女宫颈病变的发病率和进展率的降低。
Background: The risk of squamous intra-epithelial lesions (SIL) is higher in HIV-positive women. As these women begin to live longer due to highly active antiretroviral therapy (HAART), their risk of cervical cancer may increase. Few data exist regarding the effect of HAART on the incidence and progression of SIL in HIV-positive African women. The aim of this study was to evaluate the effect of HAART on the incidence and progression of SIL in HIV-positive women in South Africa.Methods: A prospective observational study of HIV-seropositive women was conducted over 5 years in an HIV treatment clinic in Johannesburg, South Africa. The participants consisted of 601 women on and off HAART who had repeat Pap smears greater than 6 months apart. The effect of HAART use on incidence and progression rates of SIL was determined using multivariate Poisson regression to obtain incidence rate ratios (IRRs), adjusted for age, CD4 count and other potential confounders.Results: Median follow-up time was 445 days (inter-quartile range 383, 671). The crude rate of incidence of any SIL was 15.9 episodes (95% confidence limit (CL) 12.7, 19.9) per 100 person-years; the crude rate of all progression of cervical dysplasia among women was 13.5 episodes (95% CL 11.3, 16.1) per 100 person-years. HAART use was associated with a robust reduction in the rate of incidence and progression of cervical lesions, adjusted IRR = 0.55 (95% CL 0.37, 0.80). Sensitivity analyses confirmed this main association held for incidence and progression when they were considered separately, and that the result was not dependent on the length of HAART exposure.Conclusion: HAART use was associated with a reduction in the rate of both incidence and progression of cervical lesions among HIV-positive women.