Incidence of cervical precancers among HIV-seropositive women.
Incidence of cervical precancers among HIV-seropositive women.
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DOI：
10.1016/j.ajog.2014.12.003
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发表时间：
2015-05
影响因子：
9.8
通讯作者：
Strickler, Howard D.
中科院分区：
文献类型：
--
作者：
Massad, L. Stewart;Xie, Xianhong;D'Souza, Gypsyamber;Darragh, Teresa M.;Minkoff, Howard;Wright, Rodney;Colie, Christine;Sanchez-Keeland, Lorraine;Strickler, Howard D.
关键词：
目的评估HIV感染对宫颈高级别上皮内瘤变（CIN）发生率的影响。在一项前瞻性美国队列研究中，HIV血清阳性和比较血清阴性的妇女每半年进行一次巴氏涂片检查，并进行阴道镜检查任何异常。检索组织学结果，鉴定CIN3+ (CIN3)、原位腺癌和癌+ CIN2 （CIN2和CIN3+）。计算年检出率并采用Cox分析比较风险。HIV血清阴性妇女的中位随访（IQR）为11.0（5.4-17.2）年，HIV血清阳性妇女的中位随访（IQR）为9.9（2.5-16.0）年。139例（5%）HIV血清阳性妇女和19例（2%）血清阴性妇女被诊断为CIN3+ (P < 0.0001)， 316例（12%）和34例（4%）被诊断为CIN2+ (P < 0.0001)。血清HIV阳性妇女的年CIN3+检出率为0.6/100人年，血清阴性妇女的年CIN3+检出率为0.2/100人年（P < 0.0001）。研究开始两年后，CIN3+检出率下降，在随后的随访中，CIN3+检出率从HIV血清阳性妇女的0.9/100人年下降到0.4/100人年（P < 0.0001）。这些妇女的CIN2+发病率随着时间的推移相似地下降，从入组后前两年的2.5/100人年降至随后的0.9/100人年（p < 0.0001）。在控制年龄的Cox分析中，CD4计数<200/cmm的HIV血清阳性妇女与HIV血清阴性妇女相比，CIN3+的风险比为8.1 (95% C.I. 4.8, 13.8)， CIN2+的风险比为9.3 (95% C.I. 6.3, 13.7) （P < 0.0001）。尽管艾滋病毒血清阳性的妇女比血清阴性的妇女有更多的CIN3+，但CIN3+并不常见，在开始定期子宫颈筛查后甚至更少。
To estimate the impact of HIV infection on the incidence of high grade cervical intraepithelial neoplasia (CIN). HIV seropositive and comparison seronegative women enrolled in a prospective U.S. cohort study were followed with semiannual Pap testing, with colposcopy for any abnormality. Histology results were retrieved to identify CIN3+ (CIN3, adenocarcinoma in situ, and cancer and CIN2+ (CIN2 and CIN3+). Annual detection rates were calculated and risks compared using Cox analysis. Median follow-up (IQR) was 11.0 (5.4–17.2) years for HIV seronegative and 9.9 (2.5–16.0) for HIV seropositive women. CIN3+ was diagnosed in 139 (5%) HIV seropositive and 19 (2%) seronegative women (P < 0.0001), with CIN2+ in 316 (12%) and 34 (4%) (P < 0.0001). The annual CIN3+ detection rate was 0.6/100 person-years in HIV seropositive women and 0.2/100 person years in seronegative women (P < 0.0001). The CIN3+ detection rate fell after the first two years of study, from 0.9/100 person-years among HIV seropositive women to 0.4/100 person-years during subsequent follow-up (P < 0.0001). CIN2+ incidence among these women fell similarly with time, from 2.5/100 person-years during the first two years after enrollment to 0.9/100 person-years subsequently (p < 0.0001). In Cox analyses controlling for age, the hazard ratio for HIV seropositive women with CD4 counts <200/cmm compared to HIV seronegative women was 8.1 (95% C.I. 4.8, 13.8) for CIN3+ and 9.3 (95% C.I. 6.3, 13.7) for CIN2+ (P < 0.0001). Although HIV seropositive women have more CIN3+ than seronegative women, CIN3+ is uncommon and becomes even less frequent after initiation of regular cervical screening.
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影响因子：
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