Risk factors for human papillomavirus and cervical precancerous lesions, and the role of concurrent HIV-1 infection
Risk factors for human papillomavirus and cervical precancerous lesions, and the role of concurrent HIV-1 infection
复制标题
DOI：
10.1016/s0020-7292(99)00043-0
复制
发表时间：
1999-05-01
影响因子：
3.8
通讯作者：
Quint, W
中科院分区：
文献类型：
--
作者：
Temmerman, M;Tyndall, MW;Quint, W
目的：确定人乳头瘤病毒（HPV）感染和宫颈鳞状上皮内病变（SIL）的危险因素，并测量并发HIV-1感染的影响。方法：在肯尼亚内罗毕的一家计划生育诊所对妇女进行研究。通过半结构化问卷获得人口统计和历史信息，并收集性传播疾病（std）、HPV、宫颈细胞学和HIV-1检测样本。结果：513例女性中有87例（17%）检出HPV，其中81例（93%）为致癌型（16、18、31、33等），6例（7%）为非致癌型（6、11）。HIV-1患病率为10%。HPV检测与HIV-1感染相关[调整优势比（aOR） 3.9, 95%可信区间（CI） 2.0-7.7]，性行为指标包括性伴侣和炎性性传播疾病的数量，以及怀孕次数（0或1 vs大于等于3，aOR 0.4; 95% CI 0.2-0.9）。61名女性（11.9%）检测到SIL，其中28名（46%）为低级别病变（LSIL）， 33名（54%）为高级别病变（HSIL）。HPV感染与HSIL密切相关（OR 14.9; 95% CI, 6.8-32.8）。在多变量模型中，HSIL的预测因子包括HIV-1血清阳性（aOR为4.8；95% CI为1.8-12.4）、终生性伴侣数量（aOR为3.8；95% CI为1.1-13.5）和年龄（< 26 vs. bbb30； or为3.9；95% CI为1.1-13.6）。一项HIV-1分层分析显示，HPV和HSIL在HIV-1阴性女性中（OR 17.0, 95% CI, 6.4-46.3）比在HIV-1阳性女性中（OR 4.5, 95% CI, 0.8-27.4）有更强的相关性。结论：我们的研究结果表明，HSIL甚至浸润性癌症在被认为是性传播疾病低风险的育龄妇女中非常普遍，这表明常规的巴氏涂片检查可以挽救生命。(C) 1999年国际妇产科联合会。
Objectives: To identify risk factors for human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) of the cervix, and to measure the impact of concurrent HIV-1 infection. Methods: Women were studied at a family planning clinic in Nairobi, Kenya. Demographic and historical information was obtained using a semi-structured questionnaire and specimens were collected for sexually transmitted diseases (STDs), HPV, cervical cytology, and HIV-1 testing. Results: HPV was detected in 87 of 513 women (17%), including 81 (93%) oncogenic types (16, 18, 31, 33 and others) and six (7%) non-oncogenic types (6 and 11). HIV-1 prevalence was 10%. HPV detection was associated with HIV-1 infection [adjusted odds ratio (aOR) 3.9, 95% confidence interval (CI), 2.0-7.7], sexual behavior indicators including the number of sex partners and inflammatory STDs, as well as the number of pregnancies (0 or 1 vs. greater than or equal to 3, aOR 0.4; 95% CI, 0.2-0.9). SIL was detected in 61 women (11.9%), including 28 (46%) with low-grade lesions (LSIL) and 33 (54%) with high-grade lesions (HSIL). HPV infection was strongly associated with HSIL (OR 14.9; 95% CI, 6.8-32.8). In a multivariate model predictors of HSIL included HIV-1 serpositivity (aOR 4.8; 95% CI, 1.8-12.4), the number of lifetime sex partners (0-1 vs. greater than or equal to 4; aOR 3.8; 95% CI, 1.1-13.5), and older age (< 26 vs. > 30; OR 3.9; 95% CI, 1.1-13.6). An analysis stratified by HIV-1 showed a stronger association between HPV and HSIL in HIV-1 negative women (OR 17.0; 95% CI, 6.4-46.3) then in HIV-1 positive women (OR 4.5; 95% CI, 0.8-27.4). Conclusions: Our results indicate that HSIL and even invasive cancer are highly prevalent in this setting of women on reproductive age considered to be at low risk for STDs, suggesting that routine Pap smear screening may save lives. (C) 1999 International Federation of Gynecology and Obstetrics.