部分艾滋病高发地区HIV感染妇女合并人乳头瘤病毒感染随访研究

【作者】 乔亚萍；

【导师】 王临虹； 方利文； 王爱玲；

【作者基本信息】 中国疾病预防控制中心 ， 儿少卫生与妇幼保健学， 2017， 博士

【摘要】 背景高危型人乳头瘤病毒(high-risk human papillomavirus,hrHPV)持续感染是宫颈癌发生的病因条件。艾滋病病毒(Human Immunodeficiency Virus,HIV)感染妇女是宫颈癌发生的高危人群。与未感染HIV的妇女相比,HIV感染妇女合并HPV感染率高,且消除缓慢、持续感染时间长,进展为宫颈癌前病变及癌的时间短,预后较差。云南、广西、新疆等地区是我国艾滋病流行较早、疫情较为严重的地区。估计我国目前有HIV感染女性16.5万,主要分布于上述地区。自2002年我国开始为HIV感染者提供免费的抗逆转录病毒治疗(antiretroviral therapy,ART)以来,HIV感染者死亡风险降低了 73%-82%,存活时间显著延长。国外研究显示,普遍开展抗病毒治疗后,如未接受宫颈癌筛查服务,HIV感染妇女的宫颈癌发生风险会额外增加。由于HIV感染妇女较为隐匿,担心感染状态暴露、遭受歧视,利用现有宫颈癌筛查服务存在障碍,较难及早发现宫颈癌前病变及癌。目前,我国针对HIV感染妇女开展的生殖健康服务主要集中在预防艾滋病母婴传播领域,针对HIV感染妇女开展的性传播感染,以及宫颈癌防治服务极为有限。虽然我国自2009年起开展农村妇女宫颈癌筛查项目,但筛查覆盖面及筛查率有限,而相较于普通妇女,HIV感染妇女能够获得的免费宫颈癌筛查服务的机会更少。我国HIV感染妇女宫颈癌防治服务需求尚未得到满足,亟需得到关注。目前,在我国开展的关于HIV感染妇女合并hrHPV感染状况、hrHPV持续感染及影响因素的研究极少,关于HIV感染妇女宫颈上皮内病变患病,以及宫颈癌及癌前病变的影响因素研究很少。特别是针对我国HIV感染妇女hrHPV新发感染、宫颈鳞状上皮内病变发生情况及影响因素的研究尚未见有文献报告。对我国HIV感染妇女合并hrHPV感染特点及影响因素;HIV感染妇女合并hrHPV感染的持续、消除以及新发感染的描述及影响因素;以及不同hrHPV感染状况对宫颈病变发生的影响,以及宫颈癌及癌前病变的影响因素等的了解均极为有限。因此有必要针对HIV感染妇女合并hrHPV感染持续、消除,和新发以及宫颈上皮内病变的变化过程开展相关研究,为在我国HIV感染妇女中如何更适宜地开展宫颈癌预防控制工作提供科学依据。目的1.研究部分HIV高流行地区HIV感染妇女hrHPV感染状况及影响因素;2.随访HIV感染妇女,研究hrHPV持续感染和转归,以及hrHPV新发感染情况,分析HIV感染相关因素等对HIV感染妇女hrHPV持续感染和hrHPV新发感染的影响;3.研究HIV感染妇女不同的hrHPV感染状况所致宫颈病变状况及其影响因素;随访HIV感染妇女,综合分析HIV感染妇女不同的hrHPV感染状况所致宫颈病变发生及其影响因素。方法本研究为前瞻性随访研究。于2015年5-8月在我国艾滋病高发的广西壮族自治区贺州市八步区,云南德宏州瑞丽市、陇川县,新疆维吾尔自治区伊犁州伊宁市和霍城县,以街道/乡镇为抽样单元,通过整群随机抽样方法,招募到18-49岁HIV感染妇女695例进行基线调查。通过问卷调查、查阅医疗记录、实验室检测和宫颈癌筛查收集研究对象信息。1.通过结构式问卷调查,收集了 HIV感染妇女的一般特征,包括社会人口学特征、相关行为特征及既往生育史;2.通过查阅医疗记录,收集HIV感染妇女抗逆转录病毒治疗情况、既往CD4+T淋巴细胞和HIV病毒载量检测情况;3.通过妇科检查,阴道分泌物检测、梅毒血清学检测、乙肝表面抗原检测、CD4+T淋巴细胞计数检测(流式细胞测定法)、HIV病毒载量检测(HIV-1核酸定量检测)、HPV检测(罗氏公司cobas4800)等实验室检测方法,收集了(1)HIV感染妇女宫颈炎、阴道炎等生殖道感染,梅毒、乙肝等性传播疾病患病情况;(2)HIV感染妇女CD4+T淋巴细胞计数和HIV病毒载量等;(3)HIV感染妇女hrHPV感染以及hrHPV型别分布情况。4.通过宫颈细胞学检查(薄层液基细胞学检测)、阴道镜检查(醋酸染色/碘染色)以及组织病理学检查,收集了 HIV感染妇女宫颈上皮内病变、宫颈癌及癌前病变等宫颈病变患病情况。基线调查后12-16个月,在2016年8-11月期间对前次接受基线调查的HIV感染妇女进行了随访调查。采用问卷调查和查阅医疗记录收集了 HIV感染妇女基本情况和接受抗逆转录病毒治疗、既往CD4+T淋巴细胞计数和HIV病毒载量检测情况。采用与基线调查相同的实验室检测方法收集了 HIV感染妇女生殖道感染和性传播疾病患病情况、CD4+T淋巴细胞计数和HIV病毒载量情况、合并hrHPV感染情况。应用宫颈细胞学检查、阴道镜检查、组织病理学检查,收集了 HIV感染妇女宫颈上皮内病变、宫颈癌及癌前病变患病情况。现场工作人员经过培训,统一调查方法。实验室标本采集、存储、运输和检测,以及宫颈癌筛查各环节均进行严格质控。使用Epidata3.0软件建立数据库,双人双录入后进行一致性检验和逻辑纠错。应用多因素分析控制混杂因素。数据分析采用率及百分比进行描述性分析,采用Personχ2检验(Fisher精确概率)、非条件logistic回归分析进行单因素和多因素分析。首先描述HIV高发地区HIV感染妇女合并hrHPV感染率及14种hrHPV型别分布,分析不同抗病毒用药状况、CD4+T淋巴细胞水平和HIV病毒载量水平等因素与hrHPV感染的相关性;2.描述随访期间HIV感染妇女hrHPV感染持续和感染消除的情况,综合分析基线调查和随访调查时不同抗病毒用药状况、CD4+T淋巴细胞水平、HIV病毒载量水平及其变化等HIV感染相关因素与hrHPV持续感染的关系;3.描述随访期间HIV感染妇女中新发hrHPV感染状况,综合分析基线调查和随访调查时HIV感染相关因素及其变化对hrHPV新发感染的影响;4.分别描述基线调查、随访调查时HIV感染妇女中宫颈上皮内病变及宫颈癌及癌前病变检出情况,分析不同hrHPV感染状况及感染不同hrHPV型别、HIV感染相关因素、性相关行为以及生殖道感染/性传播疾病患病与宫颈癌前病变的相关性;5.描述随访期间研究对象宫颈上皮内病变新发情况,综合分析不同hrHPV感染状态以及感染不同hrHPV型别及其他因素与宫颈上皮内病变发生的关系。主要结果基线调查了 695例HIV感染妇女,检出宫颈癌前病变(CIN2和CIN3)25例,继续追访其他670例HIV感染妇女。基线调查后12-16个月开展了随访调查,670例HIV感染妇女中108例失去联系、16例因病不能接受调查、5例死亡,最终541例HIV感染妇女接受了随访调查,随访率为80.75%。1.本研究中695例HIV感染妇女中,180例感染hrHPV,感染率为25.90%,最常见的前4位型别分别为:HPV16、58、52和51,感染率分别为6.76%、5.47%、5.04%和2.45%。接受抗病毒治疗妇女hrHPV感染率低于未接受抗病毒治疗妇女hrHPV感染率(χ2=7.256,P=0.007)。CD4+T淋巴细胞计数水平越高,hrHPV感染率越低(趋势χ2=9.883,P=0.002)。HIV病毒载量水平越低,hrHPV感染率越低(趋势χ2=17.547,P<0.001)。多因素分析结果显示,CD4+T淋巴细胞计数<350个/μl的妇女hrHPV感染风险高于CD4+T淋巴细胞计数≥500个/μl的妇女(aOR=2.07,95%CI:1.35-3.17,P=0.001),HIV病毒载量≥1000 copies/ml的妇女hrHPV感染风险高于HIV病毒载量<50 copies/ml 的妇女(aOR=2.09,95%CI:1.28-3.40,P=0.003)。接受抗病毒治疗的 HIV感染妇女hrHPV感染风险低于未接受抗病毒治疗的妇女(aOR=1.97,95%CI:0.96-4.07,P=0.066),具有边缘统计学意义。2.平均随访14个月后,121例HIV感染妇女hrHPV持续感染率为38.02%(46/121)。不同研究地区HIV感染妇女hrHPV持续感染率不同,广西调查现场和云南调查现场的HIV感染妇女合并hrHPV持续感染的风险高于新疆调查现场的HIV感染妇女(aOR=4.19,95%CI:1.48-11.82,P=0.007;aOR=4.35,95%CI:1.39-13.64,P=0.012)。3.在平均随访14个月后,420例HIV感染妇女hrHPV新发感染率为8.33%(35/420)。多因素分析结果显示:流动人口 HIV感染妇女hrHPV新发感染的风险是本地HIV感染妇女的4.86倍(95%CI:1.78-13.29,P=0.002)。同云南调查现场的HIV感染妇女相比,新疆调查现场的HIV感染妇女hrHPV新发感染风险是其的6.83倍(95%CI:2.51-18.58,P<0.001)。合并乙肝感染的妇女随访期间新发hrHPV感染风险高于未合并乙肝感染的妇女(aOR=4.14,95%CI:1.29-13.31,P=0.017)。4.基线调查和随访调查时,HIV感染妇女中宫颈细胞学异常检出率分别为12.66%和14.88%,宫颈癌前病变检出率分别为4.05%和0.43%。HIV感染妇女中hrHPV感染比例从宫颈细胞学结果未见异常时的19.24%增加至HSIL中的100.0%(趋势χ2=129.290,P<0.001),HIV感染妇女hrHPV感染比例从正常时的17.60%增加至CIN3的100.00%(趋势χ2=58.460,P<0.001)。hrHPV 感染(aOR=74.56,95%CI:14.44-385.13,P<0.001)、单一 hrHPV 感染(aOR=38.64,95%CI:8.35-178.89,P<0.001),HPV16/18 感染(aOR=169.06,95%CI:34.21-835.34,P<0.001)、其他 12 种 hrHPV 型别感染(aOR=18.31,95%CI:3.65-91.95,P<0.001)、初次性行为年龄小于 18 岁(aOR=3.32,95%CI:1.11-9.96,P=0.032)、梅毒感染(aOR=4.28,95%CI:0.99-18.59,P=0.023)是宫颈癌前病变的危险因素。5.平均随访14个月后,基线调查时479例宫颈细胞学检测结果未见异常或为ASC-US的HIV感染妇女中新发现18例SIL,发生率为3.76%。基线调查时多重hrHPV感染和单一hrHPV感染的妇女发生SIL的风险均高于未感染hrHPV的妇女(aOR=14.90,95%CI:3.83-57.95,P<0.001 和 aOR=3.41,95%CI:0.96-12.18,P=0.058)。感染 HPV16/18和感染其他12种hrHPV型的妇女发生SIL的风险是分别是未感染hrHPV妇女的7.81倍(95%CI:1.84-33.15,P=0.005)和 5.05 倍(95%CI:1.53-16.65,P=0.008)。维吾尔族妇女SIL发生风险是其他民族妇女的3.67倍(95%CI:1.19-11.35,P=0.024)。基线TCT结果为ASC-US的妇女发生SIL的风险是基线TCT结果正常妇女的11.43倍(95%CI:3.19-40.99,P<0.001)。结论1.研究地区HIV感染妇女合并hrHPV感染率高达25.9%。HIV感染妇女接受抗逆转录病毒治疗,机体免疫水平越高,HIV病毒载量越低,hrHPV感染风险越小。2.本研究中,平均随访14个月后,HIV感染妇女hrHPV持续感染为38.02%、hrHPV新发感染率为8.33%。不同调查现场的HIV感染妇女hrHPV持续感染和新发感染风险不同。流动人口、乙肝感染是HIV妇女新发hrHPV感染危险因素。3.HIV感染妇女是宫颈病变高发人群,宫颈癌前病变患病与hrHPV感染、初次性行为年龄早、梅毒感染相关。HIV感染妇女合并多重hrHPV感染、HPV16/18感染患宫颈癌前病变的风险更高。4.平均随访14个月后,HIV感染妇女细胞学检测结果SIL发生率为3.76%。合并hrHPV感染、基线TCT异常和梅毒感染是HIV感染妇女SIL发生的危险因素。HIV感染妇女合并多重hrHPV感染、HPV16/18型感染SIL发生风险更高。5.本研究随访时间有限,收集hrHPV持续感染和新发感染、SIL发生、宫颈癌及癌前病变等信息有限,需要继续追踪随访HIV感染妇女,长期观察hrHPV持续感染和新发感染、宫颈病变发生,分析其影响因素。在条件允许的情况下,设立HIV阴性妇女对照,深入探讨HIV感染妇女和HIV阴性妇女中hrHPV感染及转归,以及宫颈病变发生的差异。对HIV感染妇女生殖道感染和性传播疾病感染状况了解有限,建议开展进一步研究。更多还原

【Abstract】 BackgroundPersistent infection of high-risk human papillomavirus(hrHPV)is the necessary factor of cervical cancer.Human immunodeficiency virus(HIV)infected women is the high-risk group to having cervical cancer.Compared with HIV-negative women,the prevalence of HPV among HIV-positive women was higher;the process of elimination of HPV was slower;the persistence of HPV infection was longer,the process of developing to cervical cancer and precancerous lesions was faster and worse prognosis.The AIDS epidemic in Yunnan province,Guangxi Zhuang Autonomous Region and Xinjiang Uygur Autonomous Region emerged earlier and is more serious than other areas in China.It was estimated there were 165,000 HIV-infected women,who were mainly distributed in those 3 provinces.Free antiretroviral therapy(ART)were provided in China since 2002.It was reported that the death risk of people living with HIV reduced 73%-82%,and the life expectancy was longer.Research has showed that with the universal ART coverage,the risk of cervical cancer would increase if HIV-infected women didn’t receive cervical cancer screening.HIV-infected women were tended to conceal their HIV-infected status,and were afraid of disclosing their HIV-infected status to others due to stigma and discrimination.Hence,there were barriers to utilize cervical cancer screening service for HIV-positive women.Currently,the reproductive health services aimed at HIV-positive women mainly focuses on prevention mother-to-child transmission of HIV.Services on prevention of sexual transmitted diseases and cervical cancer are limited.The coverage and screening rate of the national program on cervical cancer screening for rural women is still limited and relatively low.Compared with other women,HIV-infected women were more likely to have less chance to obtain the free cervical cancer screening.The needs of cervical cancer prevention and control among HIV-positive women have not been met and need to be concerned about.Currently,there are few studies on hrHPV infection status and persistence of hrHPV infection and their influencing factors among HIV-infected women.There is rare research on cervical squamous intraepithelial lesion(SIL),cervical cancer and precancerous lesions among HIV-infected women in China.Especially,there is no reported on the incidence of hrHPV infection and SIL and their influencing factors among HIV-infected women in China.There is little known on the status of hrHPV infection and the influencing factors,the persistence,elimination,and incidence of hrHPV infection and their influencing factors.There is also little known on the relations between different hrHPV infectious status and SIL,cervical cancer and precancerous lesions,and their influencing factors.Hence,it is necessary to carry out research on the persistence,elimination of hrHPV infection,the incidence of hrHPV infection and SIL,and the influencing factors on cervical cancer and precancerous lesions among HIV-positive women,in order to provide evidence to carry out appropriated cervical cancer screening services to HIV-positive women in China in the future.Objective1.To study the infection status of hrHPV and influencing factors among HIV-positive women.2.To follow up the HIV-positive women and observe the persistence,elimination,and incidence of hrHPV infection,and to analyze the relation between HIV-infection related factors and other factors and the persistence of hrHPV infection and the incidence of hrHPV infection.3.To study the status of cervical lesions caused by different hrHPV infection status in HIV-infected women and its influencing factors.And to analyze the incidence of cervical lesions caused by different status of hrHPV infection and its influencing factors among HIV-positive women.MethodsThis study was a prospective follow-up study.The study sites were Babu district of Hezhou city from Guangxi Zhuang Autonomous Region,Ruili city and Longchuan county from Yunnan province,Yining city and Huocheng county from Xinjiang Uygur Autonomous Region.In the study sites,the cluster random sampling method was applied.During May to August in 2015,695 HIV-infected women aged 18-49 years old were recruited and participated the baseline survey.The information was collected through questionnaire,medical records,laboratory tests and cervical cancer screening.1.The information of basic characteristics of HIV-positive women was collected through structured questionnaire.The information included social demographic characteristics,behavior characteristics,fertility history.2.From the medical records,the information on the use of ART,previous CD4+T lymphocytes count testing and HIV viral load detection testing was collected.3.Applying gynecological examination,vaginal secretions detection,syphilis serological tests,hepatitis B surface antigen detection,HIV viral load detection(HIV-1 nucleic acid quantitative detection),CD4+T lymphocyte count detection(flow cytometry),and HPV testing(Roche cobas 4800),we collected:1)infectious status of reproductive tract infection and sexual transmitted infections,including cervicitis,vaginitis,Hepatitis B virus infection,and syphilis infection;2)CD4+T lymphocytes count and HIV viral load,3)hrHPV infectious status and type distribution.4.through the cervical cytology(Thin layer liquid-based cytology),colposcopy and histopathological examination,we collected cervical intraepithelial lesions,cervical cancer and precancerous lesions among HIV-positive women.The HIV-positive women,who participated the baseline survey,were followed up and received the follow-up survey between August and November in 2016.The general information and status of ART,pervious CD4+T lymphocytes count test and HIV viral load test.By applying the same laboratory tests as the baseline survey,the information on infectious status of RTIs and STDs,CD4+T lymphocytes counts and HIV viral loads,and the infectious status of hrHPV among HIV-positive women was collected.By applying the cervical cytology,colposcopy and histopathological examination,the occurrence of cervical intraepithelial lesions,cervical cancer and precancerous lesions in HIV-positive women was collected.The field staff were trained to unified the methods.The blood samples,cervical exfoliative cells,cervical pathology samples were collected,preserved,transported and tested according to relative standards and operation guideline.Every step of cervical cancer screening was under the quality control.Epidata 3.0 software was applied to set up the database.The information was double entered by two persons followed by the consistency test and logic error correction.Multivariate analysis was used to control the confounding factors.The rate or percentage were used for descriptive analysis.Univariate and multivariate analysis were performed using Personχ2(Fisher exact probability)and unconditional logisitic regression analysis.Frist,described the prevalence of hrHPV and distribution of 14 genotypes of hrHPV,analyzed the relationship between hrHPV infection and the different status of ART,CD4+T lymphocyties counts,HIV viral loads,and other factors.Second,described the persistence and elimination of hrHPV infection of HIV-positive women during the follow-up period.Analyzed the relationship between hrHPV persistence infection and ART status,level of CD4+T lymphocyties counts and HIV viral loads at baseline survey and follow-up survey and their changes and other factors.Third,described the occurrence of hrHPV infection during the follow-up period,and analyzed the relationship between cervical cancer and precancerous lesion and the different hrHPV infectious status and genotypes,factors associated with HIV infection,sexual behaviors,and RTIs/STDs.Main resultsAmong 695 HIV-positive women participated the baseline survey,25 women were detected with precancerous lesions(CIN2 and CIN3),and other 670 were followed up continuously.The follow-up survey was conducted 12-16 months later after the baseline survey.Among 670 women were followed-up,108 women were lost contact,16 women could not receive the investigation due to health problems,and 5 were died.Finally,541 HIV-positive women participated the follow-up survey.The follow-up rate was 80.75%(541/670).1.In the research,among 695 HIV-positive women,180 were infected with hrHPV and the prevalence of hrHPV in HIV-positive women was 25.90%.The most common types of hrHPV was HPV16,52,58 and 51,and the prevaleneces were 6.76%,5.47%,5.04%,and 2.45%respectively.The hrHPV prevalence among HIV-positive women who were receiving ART was lower than those who didn’t have ART(x2=7.256,P=0.007).The higher the CD4+T lymphocytes counts were,the lower prevalence of hrHPV was(trendx2=9.883,P=0.002).The lower the level of HIV viral loads,the higher prevalence of hrHPV was(trendχ2=17.547,P<0.001).Multivariate analysis showed that the women with CD4+T lymphocytes counts<350 cell/μl were more likely to be infected with hrHPV than those with CD4+T lymphocytes counts≥500cell/μl(aOR=2.07,95%CI:1.35-3.17,P=0.001).The women with HIV Ⅵ≥1000 copies/mlw were more likely to be infected with hrHPV than those with HIV VL<50 copies/ml(aOR=2.09,95%CI:1.28-3.40,P=0.003).2.After an average of 14 months follow up,the persistence rate of hrHPV infection among HIV-positive women with hrHPV infection at baseline survey was 38.02%(46/121).The persistence rates of hrHPV infection were different in different research sites.HIV-positive women from research sites in Guangxi and Yunnan had more risk to have persistant hrHPV infection than those in Xinjiang(aOR=4.19,95%CI:1.48-11.82,P=0.007;aOR=4.35,95%CI:1.39-13.64,P=0.012).3.After an average of 14 months follow up,the incidence of hrHPV infection among HIV-psotive women was 8.33%(35/420).The multivariate analysis showed that the risk of newly infecting hrHPV among floating women was 4.86 times that of local women(95%CI:1.78-13.29,P=0.002).The risk of newly infecting hrHPV among HIV-positive women from Xinjiang sites was 6.83 times that of HIV-positive women from Yunnan sites(95%CI:2.51-18.58,P<0.001).The HIV-positive women with HBV infection had higher risk to be infected with hrHPV than those without HBV infection(aOR=3.67,95%CI:1.17-11.51,P=0.026).4.The detection rates of cytology abnormalities in HIV-positive women at baseline survey and follow-up survey were 12.66%and 14.88%respectively.And the detection rates of precancerous lesions were 4.05%and 0.43%.The percentages of infected with hrHPV increased from 19.24%of normal cytology to 100%of HSIL(trend χ2=129.290,P<0.001).The percentages of infected with hrHPV increased from 17.60%of normal to 100.00%of CIN3(trend χ2=58.460,P<0.001).Multivariate analysis showed that the risk factors of precancerous lesions included multiple hrHPV infection(aOR=74.56,95%CI:14.44-385.13,P<0.001),single hrHPV infection(aOR=38.64,95%CI:8.35-178.89,P<0.001),infection with HPV16/18(aOR=169.06,95%CI:34.21-835.34,P<0.001),infection with other 12 types hrHPV(aOR=18.31,95%CI:3.65-91.95,P<0.001),early age at sexual exposure(less than 18 years old)(aOR=3.32,95%CI:1.11-9.96,P=0.032),infected with syphilis(aOR=4.28,95%CI:0.99-18.59,P=0.023).5.In this study,among 479 HIV-positive women with normal or ASC-US of cytology at the baseline survey,after an average of 14-month follow-up,18 women developed SIL.The incidence of SIL was 3.76%.The HIV-positive women with multiple hrHPV infection or single hrHPV infection were more likely to develop SIL than women without hrHPV infection(aOR=14.90,95%CI:3.83-57.95,P<0.001 and aOR=3.41,95%CI:0.96-12.18,P=0.058).The risk of developing SIL in women who were infected with HPV16/18 or other type of hrHPV was associated with 7.81 times(95%CI:1.84-33.15,P=0.005)and 5.05 times(95%CI:1.53-16.65,P=0.008)respectively,for women who were not infected with hrHPV.Compared with other ethnic women,Uygur women had higher risk to develop SIL(aOR=3.67,95%CI:1.19-11.35,P=0.024).ASC-US at baseline survey was also associated with risk of SIL(aOR=11.43,95%CI:3.19-40.99,P<0.001).Conclusion1.Among HIV-positive women in research sites,the hrHPV prevalence was 25.90%.With ART,the suppression of HIV and improving immunization level,the risk of being infected with hrHPV will be reduced.2.After an average of 14 months follow up,the persistence rate and the incidence of hrHPV infection among HIV-psotive women was 38.02%and 8.33%respectively.The persistent rates and incidence of hrHPV infection were various from different research sites.HIV-positive women who were floating population,infected with HBV were more likely to be newly infected with hrHPV during the period of follow-up.3.HIV-positive women were high risk group to cervical lesions.Infected with hrHPV,sexual onset less than 18 years old,infected with syphilis was the risk factors to have cervical lesion.Women with multiple hrHPV infection or infected with HPV16/18 were at the greater risk to have cervical precancerous lesions.4.The incidence of SIL(TCT)among HIV-positive women was 3.76%after an average of 14-month follow-up.Infected with hrHPV,with abnormal result of TCT at the baseline,and infected with syphilis were the risk factor of developing SIL.Women with multiple hrHPV infection and HPV16/18 infection had more risk to develop SIL during the follow-up.5.Due to the limited time of follow-up in this research,the information on persistence and incidence of hrHPV infection,the incidence of SIL was limited.It is necessary to follow up HIV-positive women continuously in order to investigate persistence and incidence of hrHPV infection,the incidence of precancerous lesions,and their impact factors.With the time and resource permitted,it needs to establish the control of HIV negative women to in-depth study the differences on the prevalence,persistent infection and incidence of hrHPV infection between HIV-positive women and HIV-negative women.Currently,there is little known about RTIs and STDs among HIV-positive women in China.It necessary to conduct study on RTIs/STDs among HIV-positive women in the future.更多还原