Association of antiretroviral therapy with high-risk human papillomavirus, cervical intraepithelial neoplasia, and invasive cervical cancer in women living with HIV: a systematic review and meta-analysis.
Association of antiretroviral therapy with high-risk human papillomavirus, cervical intraepithelial neoplasia, and invasive cervical cancer in women living with HIV: a systematic review and meta-analysis.
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DOI：
10.1016/s2352-3018(17)30149-2
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发表时间：
2018-01
期刊：
影响因子：
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通讯作者：
ART and HPV Review Group
中科院分区：
文献类型：
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作者：
Kelly H;Weiss HA;Benavente Y;de Sanjose S;Mayaud P;ART and HPV Review Group
抗逆转录病毒治疗 (ART) 与高危人乳头瘤病毒 (HPV) 之间的相互作用以及艾滋病毒感染女性宫颈病变之间的相互作用尚不清楚。我们回顾了 ART 与这些结果的关联。我们通过搜索 MEDLINE 和 Embase 数据库来查找 1996 年 1 月 1 日至 2017 年 5 月 6 日期间以英文发表的横断面或队列研究，进行了系统回顾和荟萃分析，该研究报告了 ART 与高危 HPV 的患病率或组织学或细胞学宫颈异常的患病率、发生率、进展或消退或浸润性宫颈癌的发生率之间的关联。如果研究报告了联合 ART 或高度活跃的 ART 使用与以下结果之间的关联，则研究合格：高危 HPV 患病率；鳞状上皮内病变 (SIL) 或宫颈上皮内瘤变 (CIN) 的患病率、发生率、进展或消退；以及感染艾滋病毒的女性中浸润性宫颈癌的发病率。我们进行了随机效应荟萃分析来估计汇总统计数据。我们用 I2 统计量检查了异质性。该评论已在英国约克大学评论和传播中心的 PROSPERO 数据库中注册（注册号 CRD42016039546）。我们确定了 31 项关于 ART 与高危 HPV（6537 名 HIV 感染女性）和高度宫颈病变（HSIL-CIN2+；9288 名 HIV 感染女性）患病率之间关系的研究。接受 ART 的 HIV 感染女性的高危 HPV 患病率低于未接受 ART 的女性（调整后的比值比 [aOR] 0·83，95% CI 0·70–0·99；I2=51%，根据 CD4 细胞计数和 ART 持续时间进行调整），并且有一些证据表明与 HSIL-CIN2+ 相关（0·65、0·40–1·06；I2=30%）。 17 项研究报告了 ART 与纵向宫颈病变结果的关联。 ART 与 1830 名 HIV 感染女性的 HSIL-CIN2+ 发病风险降低相关（0·59、0·40–0·87；I2=0%），与 6212 名 HIV 感染女性的 SIL 进展相关（调整后的风险比 [aHR] 0·64，95% CI 0·54–0·75；I2=18%），并且与以下人群 SIL 或 CIN 消退的可能性增加相关： 5261 名感染艾滋病毒的女性（1·54、1·30–1·82；I2=0%）。在对 15 846 名 HIV 感染女性进行的三项研究中，ART 与浸润性宫颈癌发病率降低相关（粗略 HR 0·40，95% CI 0·18–0·87，I2=33%）。早期开始 ART 并持续坚持可能会降低 SIL 和 CIN 的发生率和进展，并最终降低浸润性宫颈癌的发生率。未来的队列研究应该旨在证实这种可能的影响。英国医学研究委员会。
The interactions between antiretroviral therapy (ART) and high-risk human papillomavirus (HPV) and cervical lesions in women living with HIV are poorly understood. We reviewed the association of ART with these outcomes. We did a systematic review and meta-analysis by searching MEDLINE and Embase databases for cross-sectional or cohort studies published in English between Jan 1, 1996, and May 6, 2017, which reported the association of ART with prevalence of high-risk HPV or prevalence, incidence, progression, or regression of histological or cytological cervical abnormalities, or incidence of invasive cervcal cancer. Studies were eligible if they reported the association of combination ART or highly active ART use with the following outcomes: high-risk HPV prevalence; squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN) prevalence, incidence, progression, or regression; and invasive cervical cancer incidence among women living with HIV. We did random-effects meta-analyses to estimate summary statistics. We examined heterogeneity with the I2 statistic. This review is registered on the PROSPERO database at the Centre of Reviews and Dissemination, University of York, York, UK (registration number CRD42016039546). We identified 31 studies of the association of ART with prevalence of high-risk HPV (6537 women living with HIV) and high grade cervical lesions (HSIL-CIN2+; 9288 women living with HIV). Women living with HIV on ART had lower prevalence of high-risk HPV than did those not on ART (adjusted odds ratio [aOR] 0·83, 95% CI 0·70–0·99; I2=51%, adjusted for CD4 cell count and ART duration), and there was some evidence of association with HSIL-CIN2+ (0·65, 0·40–1·06; I2=30%). 17 studies reported the association of ART with longitudinal cervical lesion outcomes. ART was associated with a decreased risk of HSIL-CIN2+ incidence among 1830 women living with HIV (0·59, 0·40–0·87; I2=0%), SIL progression among 6212 women living with HIV (adjusted hazard ratio [aHR] 0·64, 95% CI 0·54–0·75; I2=18%), and increased likelihood of SIL or CIN regression among 5261 women living with HIV (1·54, 1·30–1·82; I2=0%). In three studies among 15 846 women living with HIV, ART was associated with a reduction in invasive cervical cancer incidence (crude HR 0·40, 95% CI 0·18–0·87, I2=33%). Early ART initiation and sustained adherence is likely to reduce incidence and progression of SIL and CIN and ultimately incidence of invasive cervical cancer. Future cohort studies should aim to confirm this possible effect. UK Medical Research Council.