HPV AND GENITAL NEOPLASIA IN HIV-INFECTED WOMEN

一个确定的和明确定义的妇女队列， HIV感染将扩大到研究人类的自然史 乳头瘤病毒（HPV）感染和HPV相关生殖器疾病 感染艾滋病毒的妇女。 受试者将从女性中招募 参与一项关于艾滋病毒感染自然史的研究 在吸毒者中。 这个队列将提供一个独特的机会来研究 艾滋病毒感染和宿主免疫的影响及其与 其他危险因素对HPV感染的发展和后果。 每隔六个月，受试者将接受标准化访谈， 体格检查，包括盆腔检查、子宫颈抹片检查、试验 性传播疾病和宫颈阴道灌洗收集 用于检测HPV的存在、类型和数量的细胞， Southern印迹分析和聚合酶链反应（PCR）。 具体目标 包括：1）确定生殖器HPV的发病率和危险因素 艾滋病毒感染和未感染的高危妇女的感染情况， 多变量分析，以确定艾滋病毒感染，年龄， 性行为、吸毒习惯、吸烟、口服避孕药使用、 产次、免疫抑制程度为HPV感染的危险因素，2） 研究偶发性鳞状细胞癌发生的多因素原因 上皮内病变（SIL），重点是确定作用 受艾滋病病毒感染后，其相关免疫抑制作用就自然 HPV感染史，4）确定宫颈癌的严重程度 在诊断HIV感染妇女时， 定期宫颈涂片检查与未感染艾滋病毒的妇女不同， 5)HIV感染者宫颈癌治疗效果的比较 就未感染艾滋病毒的高危女性而言， a）复发性宫颈瘤变和B）相关免疫抑制， HPV感染和生殖器肿瘤的自然史。 使用此 信息，管理HPV相关生殖器感染的最佳方法 艾滋病毒感染妇女的疾病将得到确定。 研究受试者 将主要由少数民族妇女组成， 种族背景和经常免疫缺陷;因此，他们将 可能是在特别高的风险，HPV感染和宫颈癌 肿瘤形成

An established and well-defined cohort of women with or at high risk for HIV infection will be expanded to study the natural history of human papillomavirus (HPV) infection and HPV-associated genital disease in women with HIV infection. Subjects will be recruited from among women participating in a research study of the natural history of HIV infection in drug users. This cohort will provide a unique opportunity to study the effects of HIV infection and host immunity and their interaction with other risk factors on the development and consequences of HPV infection. At six month intervals, subjects will undergo standardized interviews, physical examinations including pelvic examinations, PAP smears, tests for sexually transmitted diseases, and cervicovaginal lavage to collect cells for detection of HPV presence, type, and quantity as determined by Southern blot assay and polymerase chain reaction (PCR). Specific aims include: 1) Determine the incidence of and risk factors for genital HPV infection among HIV infected and uninfected high risk women, and use multivariate analyses to determine the importance of HIV infection, age, sexual behaviors, drug use habits, smoking, oral contraceptive use, parity, and degree immunosuppression as risk factors HPV infection, 2) Study the multifactorial causes for development of incident squamous intraepithelial lesions (SIL), with an emphasis on determining the role played by HIV infection, its associated immunosuppression on the natural history of HPV infection, 4) Determine whether the severity of cervical neoplasia at the time of diagnosis in HIV infected women screened by periodic PAP smears differs from that in women without HIV infection, and 5) Compare the outcome of treated cervical neoplasia in HIV infected women with that in high risk women without HIV infection, with regard to a) recurrent cervical neoplasia and b) associated immunosuppression on the natural histories of HPV infection and genital neoplasia. Using this information, the best approach to management of HPV-associated genital disease in HIV infected women will be determined. The study subjects will be comprised predominantly of women who are of minority ethnic and racial backgrounds and frequently immunodeficient; therefore they will likely be at particularly high risk for HPV infection and cervical neoplasia.