Screening of cervical neoplasia in HIV-infected women in India
Screening of cervical neoplasia in HIV-infected women in India
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DOI：
10.1097/qad.0b013e32835b1041
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发表时间：
2013-02-20
期刊：
影响因子：
3.8
通讯作者：
Divate, Uma
中科院分区：
文献类型：
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作者：
Joshi, Smita;Sankaranarayanan, Rengaswamy;Divate, Uma
目的：探讨一种准确、经济、可行的筛查和治疗艾滋病毒感染妇女的方法，以预防她们患宫颈癌。设计：在印度进行了一项横断面研究，其中符合条件的hiv感染妇女接受了醋酸目视检查（VIA）、卢戈尔碘目视检查（VILI）、细胞学检查、人乳头瘤病毒（HPV）检测和阴道镜检查。方法：我们对女性进行细胞学、HPV检测、VIA和VILI筛查。所有接受筛查的妇女都进行了阴道镜检查，阴道镜检查异常的妇女进行了定向活检。阴道镜检查怀疑宫颈上皮内瘤变（CIN）的妇女采用冷凝或环切除治疗。计算筛选试验的敏感性、特异性和预测值。结果：在1128名筛查的女性中，55名（4.9%）有CIN2-3病变。对于CIN2/3病变，VIA、VILI、细胞学未确定意义（ASCUS）阈值和HPV检测的敏感性分别为83.6、89.1、63.3和94.6%，特异性分别为88.8、89.3、94.5和77.4%。与VIA、VILI和HPV检测相比，细胞学检测的敏感性明显降低，特异性更高。序列检测VIA/VILI、HPV检测/VIA、HPV检测/VILI和HPV检测/VIA /VILI比单一检测具有更平衡的敏感性和特异性。根据6个月至1年随访期的初步结果，冷凝耐受性良好，80%的CIN2-3患者治愈。结论：在资源匮乏的国家，VIA和VILI序贯检测是对hiv感染妇女进行宫颈癌筛查最可行的方法。当HPV检测变得可行和负担得起时，可以考虑HPV检测之后进行VIA/VILI。[3] [j] .中国艾滋病防治杂志，2013,27 (2):557 - 557 .
Objective: To evaluate an accurate, affordable, and feasible method to screen and treat HIV-infected women so that cervical cancer can be prevented among them.Design: A cross-sectional study was conducted in India in which eligible HIV-infected women underwent visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VILI), cytology, human papillomavirus (HPV) testing, and colposcopy.Methods: We screened women with cytology, HPV testing, VIA, and VILI. All screened women had colposcopy and women with colposcopic abnormalities had directed biopsies. Women with suspected cervical intraepithelial neoplasia (CIN) on colposcopy were treated with cold coagulation or loop excision. Sensitivity, specificity, and predictive values of the screening tests were calculated.Results: Among 1128 women screened, 55 (4.9%) had CIN2-3 lesions. Sensitivity for VIA, VILI, cytology at atypical squamous cells of undetermined significance (ASCUS) threshold and HPV testing was 83.6, 89.1, 63.3, and 94.6%, and specificity was 88.8, 89.3, 94.5, and 77.4%, respectively, in detecting CIN2/3 lesions. Cytology had significantly lower sensitivity and higher specificity than VIA, VILI, and HPV testing. Sequential testing with VIA/VILI, HPV testing/VIA, HPV testing/VILI, and HPV testing/ VIA/VILI had more balanced sensitivity and specificity than the single tests. Cold coagulation was well tolerated and cured 80% of CIN2-3 based on preliminary results at 6-month to 1-year follow-up periods.Conclusions: Sequential testing with VIA and VILI is the most feasible screening approach for cervical cancer screening in HIV-infected women in low-resource countries. When HPV testing becomes feasible and affordable, HPV testing followed by VIA/VILI may be considered. (C) 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2013, 27:607-615