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首页> 外文期刊>AIDS >Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto: a prospective cohort.
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Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto: a prospective cohort.

机译：Soweto的HIV感染妇女的宫颈癌前病变的进展和消退：前瞻性队列。

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OBJECTIVE: To ascertain progression and regression of cervical dysplasia in HIV-infected women in Soweto. DESIGN: Prospective cohort. METHODS: Women attending an HIV wellness clinic were offered cervical smears as part of care; smears were assessed using the Bethesda system. Those with high-grade lesions or worse were referred for colposcopy. Progression analyses included women with at least two smears at least 5.5 months apart. Hazard ratios were used to ascertain predictors of progression. RESULTS: Two thousand, three hundred and twenty-five women had a baseline smear; their median age and CD4 cell count was 32 years and 312 cells/mul, respectively; 17% were taking highly active antiretroviral therapy (HAART); 62, 20 and 14% had normal, low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL), respectively. Of those with baseline normal or LSIL smears, 1074 had another smear; progression from normal to LSIL was 9.6/100 person-years (95% CI 8.3-11.1) and progression from normal or LSIL to HSIL was 4.6/100 person-years (95% CI 3.9-5.5). Of 225 women with LSIL at baseline and at least one subsequent smear at least 11.5 months later, 44.0% regressed to normal (21.2/100 person-years (95% CI 17.5-25.7)). Multivariate models suggested increasing risk for progression in women with CD4 cell count below 500 cells/mul and HAART may reduce the risk of progression [adjusted hazard ratio (aHR) 0.72 (0.52-0.99)]. CONCLUSION: HIV-infected women have high rates of prevalent and incident HSIL and LSIL with relatively low risk of regression to normal from LSIL. HAART appears to protect against progression. Our findings suggest cervical screening intervals should be less than 10 years - irrespective of age in women with CD4 cell counts below 500 cells/mul.
机译：目的：确定索韦托感染艾滋病毒的妇女宫颈发育异常的进展和消退。设计：前瞻性队列。方法：向HIV健康诊所的妇女提供宫颈涂片作为护理的一部分;使用Bethesda系统评估涂片。病变严重或严重的患者应进行阴道镜检查。进展分析包括间隔至少5.5个月且至少两次涂片的女性。危险比用于确定进展的预测因子。结果：235名女性的基线涂片检查;它们的中位年龄和CD4细胞计数分别为32岁和312细胞/ mul。 17％的患者正在接受高效抗逆转录病毒疗法（HAART）; 62％，20％和14％的患者分别患有正常的低度鳞状上皮内病变（LSIL）或高度鳞状上皮内病变（HSIL）。在基线正常或LSIL涂片中，有1074涂片。从正常到LSIL的进展为9.6 / 100人年（95％CI 8.3-11.1），从正常或LSIL到HSIL的进展为4.6 / 100人年（95％CI 3.9-5.5）。在基线水平为LSIL的225名女性中，至少在11.5个月后进行了至少一次涂片检查，其中44.0％回归正常（21.2 / 100人年（95％CI 17.5-25.7））。多变量模型表明，CD4细胞计数低于500个细胞/ mul的女性，其进展风险增加，而HAART可能会降低进展风险[校正后的危险比（aHR）0.72（0.52-0.99）]。结论：感染艾滋病毒的妇女的HSIL和LSIL的流行率和发病率较高，从LSIL回归正常的风险相对较低。 HAART似乎可以防止进展。我们的发现表明，子宫颈筛查间隔应小于10年-与CD4细胞计数低于500细胞/ mul的女性年龄无关。

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