HPV AND GENITAL NEOPLASIA IN HIV-INFECTED WOMEN

一个确定的明确的女性队列，患有或处于高风险的 HIV感染将扩大到研究人类自然历史 人乳头瘤病毒感染与人乳头瘤病毒相关性生殖器疾病 感染艾滋病毒的妇女。受试者将从女性中招募 参与艾滋病毒感染自然史的研究 在吸毒者身上。这一群体将提供一个独特的机会来研究 HIV感染和宿主免疫的影响及其相互作用 影响HPV感染发展和后果的其他危险因素。 每隔六个月，受试者将接受标准化的面试， 身体检查，包括盆腔检查、巴氏涂片、测试 以防性传播疾病，并收集宫颈阴道灌洗液 用于检测HPV存在、类型和数量的细胞，由 Southern杂交和聚合酶链式反应(PCR)。具体目标 包括：1)确定生殖器HPV的发病率和危险因素 感染和未感染艾滋病毒的高危妇女的感染情况和使用情况 多变量分析以确定艾滋病毒感染的重要性，年龄， 性行为，吸毒习惯，吸烟，口服避孕药使用， 胎次、免疫抑制程度是HPV感染的危险因素，2) 暴发性鳞状细胞癌发生的多因素原因研究 上皮内病变(SIL)，重点是确定其作用 由HIV感染所起的作用，其相关免疫抑制作用自然 HPV感染史，4)决定宫颈病变的严重程度 经筛查的HIV感染妇女在诊断时出现肿瘤 定期宫颈涂片检查与未感染艾滋病毒的妇女不同，而且 5)比较HIV感染者宫颈肿瘤的治疗结果 在没有感染艾滋病毒的高危妇女中，关于 A)复发的宫颈肿瘤和b)相关的免疫抑制 HPV感染和生殖器肿瘤的自然病史。使用这个 信息是管理HPV相关生殖器的最佳方法 将确定感染艾滋病毒的妇女中的疾病。研究对象 将主要由少数族裔和 种族背景和经常有免疫缺陷；因此他们会 可能处于HPV感染和宫颈感染的特别高风险 肿瘤。

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.