Background HIV-associated cellular immune dysfunction has been linked to higher risk of cervical dysplasia and cancer in HIV infected women. We sought to understand the relationship between HIV and development of epithelial cell abnormalities (ECA) at follow-up in women with prior normal cervical cytology (NCC). Methods Retrospective cohort analysis of women who received a Pap test at the Operation Stop Cervical Cancer Unit in Jos, Nigeria over a 10-year period (2006–2016). We analyzed the data of women with NCC at first Pap who had at least one follow-up cytology result for time-to-detection of ECA. We determined follow-up time in years from date of first NCC to date of first ECA report or date of last NCC follow up report with censoring at last follow-up date or December 31st, 2016 whichever came first. The primary outcome was development of any ECA as defined by the Bethesda 2001 reporting system. We identified demographic and clinical factors associated with incident ECA using multivariable Cox regression. Results A total of 1599 women were eligible for this analysis. Overall, 3.7% (57/1556) of women reported being HIV infected. The median age at first Pap was 39 years (IQR; 33–45). The HIV infected women were younger (36.3 ± 8.1) compared to those uninfected (39.3 ± 6.6), p = 0.005. After an accrued follow-up time of 3809 person-years (PYs), 243 women (15%) had an ECA with an event rate of 6.38 per 100 PYs. Women ≥35 years at first Pap were more likely to have an ECA compared to those < 35 years (7.5 per 100 PYs vs 3.8 per 100 PYs, HR = 1.96; 95% CI: 1.4, 2.8). HIV status was not significantly associated with developing ECA in either unadjusted (7.4 per 100 PYs vs 6.4 per 100 PYs, HR = 1.17; 95% CI: 0.53, 2.3) or adjusted analyses (aHR = 1.78; 95% CI: 0.87, 3.65). Conclusion Women living with HIV and on successful antiretroviral treatment may not have a differential hazard in the development of ECA during follow up after a prior normal Pap. Offering a repeat CCS to women who are 35 years or older irrespective of HIV status is likely an effective strategy in resource limited settings.

中文翻译：

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尼日利亚宫颈细胞学检查正常女性的 HIV 和上皮细胞异常的发展

背景 HIV 相关的细胞免疫功能障碍与 HIV 感染妇女的宫颈发育不良和癌症风险较高有关。我们试图了解 HIV 与宫颈细胞学检查 (NCC) 正常的女性在随访时发生上皮细胞异常 (ECA) 之间的关系。方法 回顾性队列分析在 10 年期间（2006-2016 年）在尼日利亚 Jos 的 Operation Stop 宫颈癌科接受巴氏试验的女性。我们分析了首次 Pap 时患有 NCC 的女性的数据，这些女性至少有一个随访细胞学结果用于检测 ECA 的时间。我们确定了从第一个 NCC 日期到第一个 ECA 报告日期或最后一个 NCC 随访报告日期的随访时间，并在最后一个随访日期或 2016 年 12 月 31 日进行审查，以先到者为准。主要结果是根据 Bethesda 2001 报告系统定义的任何 ECA 的发展。我们使用多变量 Cox 回归确定了与 ECA 事件相关的人口统计学和临床​​因素。结果共有 1599 名女性符合该分析的条件。总体而言，3.7% (57/1556) 的女性报告感染了 HIV。首次 Pap 的中位年龄为 39 岁（IQR；33-45）。与未感染的女性 (39.3 ± 6.6) 相比，感染 HIV 的女性更年轻 (36.3 ± 8.1)，p = 0.005。在 3809 人年 (PY) 的累积随访时间后，243 名女性 (15%) 发生 ECA，事件率为 6.38/100 PY。与小于 35 岁的女性相比，首次 Pap ≥ 35 岁的女性更有可能发生 ECA（7.5/100 PYs 对 3.8/100 PYs，HR = 1.96；95% CI：1.4, 2.8）。在未经调整（每 100 年 7.4 对 6.4 每 100 年，HR = 1.17；95% CI：0.53, 2.3）或调整分析（aHR = 1.78；95% CI：0.87, 3.65）中，HIV 状态与发展 ECA 没有显着相关性）。结论 感染 HIV 并成功接受抗逆转录病毒治疗的女性在先前正常 Pap 后的随访期间可能不会对 ECA 的发展产生不同的危害。在资源有限的环境中，为 35 岁或以上的女性提供重复 CCS 可能是一种有效的策略，无论 HIV 感染状况如何。