Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities
Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities
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DOI：
10.1097/01.aog.0000172429.45130.1f
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发表时间：
2005-09-01
影响因子：
7.2
通讯作者：
Passaro, DJ
中科院分区：
文献类型：
--
作者：
Massad, LS;Evans, CT;Passaro, DJ
目的：评估宫颈细胞学异常但阴道镜检查阴性的人类免疫缺陷病毒（HIV）血清阳性女性进展的风险和危险因素。方法：在一项前瞻性队列研究中，391 名 HIV 血清阳性和 103 名宫颈细胞学血清阴性女性被解读为非典型鳞状细胞（ASQ 或低度鳞状上皮内病变（LSIL）但阴道镜检查阴性），平均随访 4.0 年，每 6 个月进行一次细胞学检查，检查是否有任何上皮异常。结果：47 名 (12%) HIV 血清阳性女性和 4 名 (4%) HIV 血清阴性女性进展为 CIN2、CIN3、高级 SIL/严重增生或癌症 (P = 0.02)。多变量分析，高风险而非低风险 HPV 检测（风险比 [HR] 2.46-95% 置信区间 [01 1.18-5.12，P = .02（高风险），HR 1.41，95% CI 0.62-3.21，P.42（低风险）），令人满意的阴道镜检查（HR 2.01，95% CI 1.11-3.65， P =.02）和非西班牙裔非裔美国人（HR 5.08，95% CI 1.72-14.98，P =.003）是与进展相关的唯一因素，而 HIV 血清状态则略有显着性（HR 2.53，95% CI 0.85-7.50，P =.09）。结论：人类免疫缺陷病毒血清阳性女性，阴性临界细胞学检查后进行阴道镜检查比血清阴性女性面临更高的进展风险，但绝对风险较低，并且在控制 HPV 风险类型、种族和阴道镜检查结果后变得不显着。
Objective: To estimate the risk of and risk factors for progression among human immunodeficiency virus (HIV)-seropositive women with abnormal cervical cytology but negative colposcopy.Methods: In a prospective cohort study, 391 HIV-seropositive and 103 seronegative women with cervical cytology read as atypical squamous cells (ASQ or low-grade squamous intraepithelial lesion (LSIL) but negative colposcopy were followed up for a mean of 4.0 years with cytology at 6-month intervals. Colposcopy was prescribed for any epithelial abnormality.Results: Progression to CIN2, CIN3, high-grade SIL/severe clysplasia, or cancer occurred in 47 (12%) HIV-seropositive women and 4 (4%) HIV-seronegative women (P =.02). Progression to CIN1 was seen in an additional 12 HIVseropositive women and I seronegative woman. In multivariate analysis, high-risk but not low-risk HPV detection (hazard ratio [HR] 2.46-95% confidence interval [01 1.18-5.12, P = .02 for high risk, HR 1.41, 95% CI 0.62-3.21, P.42 for low risk), satisfactory colposcopy (HR 2.01, 95% CI 1.11-3.65, P =.02), and non-Hispanic African-American ethnicity (HR 5.08, 95% CI 1.72-14.98, P =.003) were the only factors associated with progression, while HIV serostatus was marginally significant (HR 2.53, 95% CI 0.85-7.50, P =.09).Conclusion: Human immunodeficiency virus-seropositive women with negative colposcopy after borderline cytology face a higher risk of progression than seronegative women, but the absolute risk is low and becomes nonsignificant after controlling for HPV risk type, ethnicity, and colposcopic findings. Observation is appropriate.