Progression and persistence of low-grade cervical squamous intraepithelial lesions in women living with human immunodeficiency virus.
Progression and persistence of low-grade cervical squamous intraepithelial lesions in women living with human immunodeficiency virus.
复制标题
感染人类免疫缺陷病毒的女性低度宫颈鳞状上皮内病变的进展和持续性。
DOI：
10.1097/lgt.0b013e3182403d18
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发表时间：
2012
影响因子：
3.7
通讯作者：
Nachega,JeanB
中科院分区：
文献类型：
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作者：
Zeier,MicheleDesire;Botha,MatthysHendrik;vanderMerwe,FrederickHaynes;Eshun-Wilson,Ingrid;vanSchalkwyk,Marije;laGrange,Marina;Mason,Deidre;Louw,Mercia;Nachega,JeanB
目的探讨人类免疫缺陷病毒（HIV）感染妇女低级别鳞状上皮内病变（SILs）的进展和持续性。方法本回顾性队列研究的研究对象为1,720名首次进行LSIL子宫颈抹片检查异常的妇女。使用Kaplan-Meier方法对hiv阳性、hiv阴性或未知状态的女性进行了无进展到高级别SIL的生存时间和无清除病变的SIL生存时间的比较。采用多变量Cox比例风险回归模型确定疾病进展或持续的独立危险因素。结果我们发现LSIL的进展在HIV组之间没有差异，但在HIV阳性妇女中持久性发生率更高（63.8% vs 35.0%, p< 0.05）。001)。对于HIV组，在第一次LSIL之前开始抗逆转录病毒治疗与未接受抗逆转录病毒治疗相比，进展风险降低（风险比= 0.66,95% CI= 0.54-0.81, p<）。001)。经切除治疗和年龄校正后，抗逆转录病毒治疗也提高了清除率(风险比= 1.71,95% CI= 1.29-2.27, p<。001)。切除LSIL降低了进展的风险。在hiv阴性妇女中，进展从54.7%降至0.0%（p< 0.05）。在hiv阳性妇女中，从46.9%到6.4% （p< 0.001）。001)。切除也使hiv阴性妇女的持久性从39.5%降低到7.1%(p=。001)，但对于hiv阳性妇女，效果较小(从66.3%到45.5%,p<。001)。结论抗逆转录病毒治疗降低了hiv感染妇女LSIL进展和持续的风险。
ObjectiveThis study aimed to investigate the progression and persistence of low-grade squamous intraepithelial lesions (SILs) in human immunodeficiency virus (HIV)–infected women.MethodsStudy participants for this retrospective cohort study were 1,720 women who had LSIL as their first abnormal Pap smear. A comparison of the survival of LSIL without progression to high-grade SIL as progression-free time and the survival of SIL without clearance of the lesion as persistence of SIL was done for women of HIV-positive, HIV-negative, or unknown status using the Kaplan-Meier method. Multivariable Cox proportional hazards regression model was applied to identify independent risk factors for disease progression or persistence.ResultsWe found progression of LSIL not different between HIV groups but that persistence occurred more in HIV-positive women (63.8% vs 35.0%, p<. 001). For the HIV group, antiretroviral therapy that was started before the first LSIL was associated with decreased risk for progression compared with no antiretroviral therapy (hazard ratio= 0.66, 95% CI= 0.54–0.81, p<. 001). Antiretroviral therapy also improved clearance when corrected for excision treatment and age (hazard ratio= 1.71, 95% CI= 1.29–2.27, p<. 001). Excision of LSIL reduced the risk of progression. In HIV-negative women, progression was reduced from 54.7% to 0.0%(p<. 001), and from 46.9% to 6.4% in HIV-positive women (p<. 001). Excision also reduced persistence in HIV-negative women from 39.5% to 7.1%(p=. 001), but for HIV-positive women, the effect was smaller (from 66.3% to 45.5%, p<. 001).ConclusionsAntiretroviral treatment reduced the risk for progression and persistence of LSIL in HIV-infected women.