Project 2

项目2 2008年，宫颈癌导致275,000人死亡，其中约88%发生在低收入和中等收入国家(1，2)。宫颈癌是全球女性中第三常见的癌症，也是许多LMIC中最常见的癌症。在大多数病例中，从非典型细胞到宫颈上皮内瘤变(CIN)再到浸润性癌的进展缓慢。癌前病变是可以治疗的，浸润性宫颈癌是可以预防的。目前可用的筛查方法包括细胞学涂片(巴氏涂片)、醋酸目视检查(VIA)和人乳头瘤病毒(HPV)检测。CIN的诊断可以通过组织学(活检)来确认，无论有没有阴道镜检查。也有许多可用的治疗方法，包括冷冻、LEEP/大环转移区切除术(LLETZ)、冷刀锥切术(CKC)、激光汽化、冷凝和子宫切除术。 许多资源有限的国家在筛查结果呈阳性后采用了“一次检查”或“筛查治疗”的方法，采用冷冻疗法。冷冻治疗因其可行性和阴道镜/活检/LEEP的有限可用性而成为最初的治疗模式。艾滋病毒已被证明增加了CIN的发展、进展和复发的风险(3-5)。一些研究一直表明，感染艾滋病毒的妇女在接受标准治疗后，CIN持续存在或复发的风险更高(6-14)。在有LEEP可用和可获得的环境中，世界卫生组织建议使用LEEP而不是冷冻治疗。这项建议适用于妇女，无论其艾滋病毒状况如何。然而，在LMIC中，很少有研究评估冷冻治疗或LEEP的疗效以及与HIV感染妇女成功治疗结果相关的因素。此外，在LMIC专门针对感染艾滋病毒的妇女的治疗方面还没有达成共识。 该应用程序的核心目标是增加我们对癌前病变不同治疗方式的有效性的了解，这有助于指导最佳治疗算法的实施，特别是在LMIC中对患有艾滋病毒感染的妇女宫颈肿瘤的治疗。

Project 2 In 2008,' cervical cancer was responsible for 275,000 deaths, of which about 88% occurred in low- and middle-income countries (LMIC) (1,2). Cervical cancer is the third most common cancer in women worldwide and the most common cancer in many LMIC. In most cases, there is a slow progression from atypical cells to cervical intraepithelial neoplasia (CIN) to invasive carcinoma. Precancerous lesions can be treated and invasive cervical cancer be prevented. The screening methods currently available include cytological smears (Pap smear), visual inspection with acetic acid (VIA), and human papillomavirus (HPV) testing. A diagnosis of CIN can be confirmed by histology (biopsy), with or without colposcopy. There are also many treatment methods that are available, including cryotherapy, LEEP/ large loop excision of the transformation zone(LLETZ), cold knife conization (CKC), laser vaporization, cold coagulation, and hysterectomy. Many resource-limited countries have adopted a "single visit" or "screen-and-treat" approach using cryotherapy following a positive screening test. Cryotherapy has become the initial mode of treatment because of its feasibility and the limited availability of colposcopy/biopsy/LEEP. HIV has been shown to increase the risk of the development, progression and recurrence of CIN (3-5). Several studies have consistently shown that HIV-infected women present higher risk of CIN persistence or recurrence after standard therapy (6-14). In settings where LEEP is available and accessible, treatment with LEEP over cryotherapy is recommended by the WHO. This recommendation applies to women regardless of HIV status. However, there is a paucity of studies assessing the efficacy of cryotherapy or LEEP and the factors associated with successful treatment outcomes among HIV-infected women in LMIC. Moreover, there is no consensus in the treatment specifically for HIV-infected women in LMIC. The core objective of this application is to increase our knowledge about the efficacy of different treatment modalities for precancerous lesions which can help inform the implementation of the best treatment algorithms particularly for HIV-infected women with cervical neoplasia in LMIC.