摘要目的 分析HIV阳性妇女子宫颈感染HPV状况.方法 选择2009年9月至2011年5月武汉大学中南医院艾滋病中心自愿接受宫颈癌筛查的HIV阳性妇女293例作为观察组,HIV阴性妇女200例作为对照组.采用标准问卷调查两组妇女的基本信息和HIV相关信息,Pap涂片进行宫颈细胞学检测,基因芯片技术检测23种HPV亚型.HPV阳性妇女每6个月随访1次,随访时间＞12个月.二分类logistic回归分析HPV持续感染的危险因素.结果 观察组和对照组的HPV感染率分别为44.4％( 130/293)和20.0％ (40/200),两组比较,差异有统计学意义(P＜0.05).HPV16型是最常见的亚型,观察组和对照组感染率分别为13.7％ (40/293)和7.0％ (14/200),其次是58、52、43和18型,两组感染率分别为9.2％( 27/293)和3.0％( 6/200),8.2％( 24/293)和2.5％(5/200),8.2％ (24/293)和1.5％ (3/200),6.8％ (20/293)和2.5％ (5/200).随访至12个月时,两组HPV持续感染率分别是47.5％(48/101)和21.1％ (8/38),两组比较,差异有统计学意义(P＜0.05).HPV持续感染有关的独立危险因素包括初次检查HPV多重感染(OR =6.4,95％ CI为1.6 ～25.6)、随访时患者的CD4 T淋巴细胞计数(CD4细胞计数)低(与CD4细胞计数＞3.5×108个/L比较,2.0×108个/L≤CD4细胞计数≤3.5×108个/L的OR值=8.1,95％CI为1.3 ～56.3,CD4细胞计数＜2.0×108个/L的OR值=9.1,95％CI为1.8 ～46.9),以及宫颈细胞学Pap涂片检查结果异常(OR=18.1,95％ CI 为4.5～76.9).结论 HIV阳性妇女的HPV感染率高,且易持续感染.减少多重HPV感染以及纠正异常的宫颈细胞可降低HIV阴性妇女的HPV持续感染.

abstractsObjective To investigate prevalence HPV infections in cervix among HIV-infected Chinese women.Methods From September 2009 to May 2011,293 women with positive HIV underwent cervical cancer screening as study group matched with 200 women with negative HIV as control group.Questionnaires including demographic information and HIV associated information were collected,Pap smear and 23 subtype of HPV were performed in those women.The women with positive HPV were followed up per 6 months,and the period of following up were more than 12 months.Binary logistic analysis was used for high risk factors of HPV persistent infection.Results Prevalent HPV infection was 44.4％ (130/293) in study group and 20.0％ (40/200) in control group,respectively,which reached statistical difference( P ＜0.05).The most common genotype of HPV was HPV 16,which prevalence was 13.7％ (40/293)in study group and 7.0％ (14/200) in control group.The other HPV subtype prevalence was HPV-58,HPV-52,HPV- 43 and HPV-18,which was 9.2％ (27/293),8.2％ (24/293),8.2％ (24/293),6.8％ (20/293) in study group and 3.0％ (6/200),2.5％ (5/200),1.5％ (3/200),2.5％ (5/200) in control group.At time point of 12 months following up,the persistent prevalence of HPV was 47.5％ (48/101) in study group and 21.1％ (8/38) in control group,which reached statistical difference (P＜0.05).Multiple HPV infections ( OR =6.4,95 ％ CI:1.6 - 25.6),abnormal cytology ( OR =18.1,95 ％ CI:4.5 - 76.9 ) and lower CD4 T cell count (compaed with CD4 ＞3.5 × 108/L,if 2.0 × 108 ≤CD4 ≤3.5 × 108,OR =8.1,95％ CI:1.3 -56.3 ; if CD ＜ 2.0 × 108/L,OR =9.1,95％ CI:1.8 - 46.9 ) were independently associated with HPV persistence among HIV-positive subjects.Conclusions Prevalence and persistence of HPV infections were more common among HIV-positive Chinese women than those in HIV-negative Chinese women.Improving immune function,decreasing multiple HPV infections,treating abnormal cervical cytology could decrease prevalence of HPV infection.