Efficacy of human papillomavirus-based screen-and-treat for cervical cancer prevention among HIV-infected women
Efficacy of human papillomavirus-based screen-and-treat for cervical cancer prevention among HIV-infected women
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DOI：
10.1097/qad.0b013e32833e163e
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发表时间：
2010-10-23
期刊：
影响因子：
3.8
通讯作者：
Denny, Lynette
中科院分区：
文献类型：
--
作者：
Kuhn, Louise;Wang, Chunhui;Denny, Lynette
背景资料：宫颈癌预防应作为艾滋病毒感染妇女初级保健服务的一部分，但传统的筛查方案难以在资源匮乏的环境中实施。在这里，我们评估艾滋病毒感染的妇女的一个更简单的，筛查和治疗策略，所有妇女的筛查试验阳性的治疗与cryotherapy.Methods：我们进行了一项随机临床试验，6555名妇女在开普敦，南非，其中956名艾滋病毒阳性的两个筛查和治疗策略。妇女被随机分为两组，一组是使用人乳头瘤病毒DNA检测进行筛查和治疗，另一组是使用醋酸进行目视检查作为筛查方法，另一组是对照组。妇女进行了随访长达36个月后，随机阴道镜检查和活检，以确定研究终点宫颈上皮内瘤变2级或higher.Results：在对照组中，HIV阳性的妇女有较高的宫颈上皮内瘤变2级或更高的检测36个月（14.9%）比HIV阴性的妇女（4.6%）（P = 0.0006）。在HIV阳性（相对危险度= 0.20，95%可信区间0.06-0.69）和HIV阴性（相对危险度= 0.31，95%可信区间0.20-0.50）的妇女中，使用人乳头瘤病毒DNA检测进行筛查和治疗在36个月内显著降低了2级或更高级别的宫颈上皮内瘤变。用乙酸处理组的目视检查减少不太明显。冷冻治疗的并发症大多是轻微的，并没有在HIV阳性和HIV阴性women.Conclusion之间的频率不同：屏幕和治疗使用人乳头瘤病毒检测是一种简单而有效的方法，以减少高级别的宫颈癌前体在HIV感染的妇女。(C)2010年Wolters Kluwer Health竖条Lippincott威廉姆斯&威尔金斯
Background: Cervical cancer prevention should be provided as part of primary healthcare services for HIV-infected women but conventional screening programs are difficult to implement in low-resource settings. Here, we evaluate the efficacy among HIV-infected women of a simpler, screen-and-treat strategy in which all women with a positive screening test are treated with cryotherapy.Methods: We conducted a randomized clinical trial of two screen-and-treat strategies among 6555 women in Cape Town, South Africa, among whom 956 were HIV-positive. Women were randomized to screen-and-treat utilizing either human papillomavirus DNA testing or visual inspection with acetic acid as the screening method or to a control group. Women were followed for up to 36 months after randomization with colposcopy and biopsy to determine the study endpoint of cervical intraepithelial neoplasia grade 2 or higher.Results: In the control group, HIV-positive women had higher rates of cervical intraepithelial neoplasia grade 2 or higher detected by 36 months (14.9%) than HIV-negative women (4.6%) (P = 0.0006). Screen-and-treat utilizing human papillomavirus DNA testing significantly reduced cervical intraepithelial neoplasia grade 2 or higher through 36 months in both HIV-positive (relative risk = 0.20, 95% confidence interval 0.06-0.69) and HIV-negative women (relative risk = 0.31, 95% confidence interval 0.20-0.50). Reductions in the visual inspection with acetic acid-and-treat group were less marked. Complications of cryotherapy were mostly minor and did not differ in frequency between HIV-positive and HIV-negative women.Conclusion: Screen-and-treat using human papillomavirus testing is a simple and effective method to reduce high-grade cervical cancer precursors in HIV-infected women. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins