The Effect of Highly Active Antiretroviral Therapy on Human Papillomavirus Clearance and Cervical Cytology
The Effect of Highly Active Antiretroviral Therapy on Human Papillomavirus Clearance and Cervical Cytology
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DOI：
10.1097/aog.0b013e31819225cb
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发表时间：
2009-01-01
影响因子：
7.2
通讯作者：
Duerr, Ann
中科院分区：
文献类型：
--
作者：
Paramsothy, Pangaja;Jamieson, Denise J.;Duerr, Ann
目的：为了研究高效抗逆转录病毒治疗（HAART）与人乳头瘤病毒（HPV）清除和进展或消退的宫颈细胞学异常的妇女与人类免疫缺陷病毒（HIV）。方法：537名妇女参加艾滋病毒流行病学研究，一个观察，多站点队列研究，从1996年至2000年每半年进行一次评估。收集宫颈巴氏试验进行宫颈细胞学检查。通过聚合酶链反应进行HPV检测。使用考克斯比例风险模型计算风险比和95%置信区间（CI）。结果：在宫颈鳞状上皮内病变的妇女中，HAART与HPV清除的可能性增加（危险比4.5，95%CI 1.2-16.3，NNT 22.4）。在宫颈细胞学检查正常（风险比1.7，95% CI 0.9-3.1，NNT 6.5）或细胞学检查结果不确定的非典型鳞状细胞（风险比1.0，95% CI 0.4-2.5，NNT 174.0）的女性中，HAART的使用与HPV清除的可能性增加无关。HAART的使用与宫颈细胞学消退的可能性增加无显著相关性（风险比1.3，95% CI 1.0-1.7，NNT 10.9）或宫颈细胞学进展（风险比0.7，95% CI 0.6-1.0，NNT 12.8）。在已有宫颈细胞学异常的妇女中，HAART与HPV清除增强相关，但与巴氏试验消退无关。无论HAART治疗状态如何，都需要密切监测HIV感染妇女的宫颈细胞学异常。
OBJECTIVE: To examine the association of highly active antiretroviral therapy (HAART) with human papillomavirus (HPV) clearance and progression or regression of cervical cytological abnormalities in women with human immunodeficiency virus (HIV).METHODS: Five hundred thirty-seven women with HIV participating in the HIV Epidemiology Research Study, an observational, multisite cohort study, were evaluated semiannually from 1996 to 2000. Cervical Pap tests were collected for cervical cytology. Testing for HPV was conducted by polymerase chain reaction. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals (CIs). Number needed to treat (NNT) at 2 years was calculated for HAART.RESULTS: Among women with cervical squamous intra-epithelial lesions, HAART was associated with an increased likelihood of HPV clearance (hazard ratio 4.5, 95% CI 1.2-16.3, NNT 22.4). Use of HAART was not associated with an increased likelihood of HPV clearance among women with normal cervical cytology (hazard ratio 1.7, 95% CI 0.9-3.1, NNT 6.5) or atypical squamous cells of undetermined significance cytology (hazard ratio 1.0, 95% CI 0.4-2.5, NNT 174.0). Use of HAART was not significantly associated with an increased likelihood of cervical cytologic regression (hazard ratio 1.3, 95% CI 1.0-1.7, NNT 10.9) or cervical cytologic progression (hazard ratio 0.7, 95% CI 0.6-1.0, NNT 12.8).CONCLUSION: Among women with preexisting abnormal cervical cytology, HAART was associated with enhanced HPV clearance but not with Pap test regression. Close monitoring of women with HIV for cervical cytologic abnormalities, regardless of HAART treatment status, is warranted.