Recorrência de neoplasia intra-epitelial cervical graus 2 ou 3 em mulheres infectadas pelo HIV tratadas pela exérese da zona de transformação por alça diatérmica (EZTAD)
Palavras-chave:
Neoplasia intra-epitelial cervical, Prognóstico, Soropositividade para HIV, Recidiva, EletrocirurgiaResumo
CONTEXTO E OBJETIVO: Mulheres infectadas pelo HIV têm maior probabilidade de apresentar câncer cervical e seus precursores. O tratamento dessas lesões pode prevenir a neoplasia. O objetivo deste estudo foi verificar a probabilidade de recorrência de neoplasia intra-epitelial cervical graus 2 ou 3 (NIC 2-3) em mulheres infectadas pelo HIV (HIV+), comparando-a com a de mulheres soronegativas (HIV-) tratadas pela exérese da zona de transformação por alça diatérmica (EZTAD). TIPO DE ESTUDO E LOCAL: Estudo de coorte conduzido no Instituto Fernandes Figueira — Fundação Oswaldo Cruz (IFF-Fiocruz), Rio de Janeiro, Brazil. MÉTODO: 55 HIV+ e 212 HIV- foram acompanhadas após tratamento de NIC 2-3 pela EZTAD (faixa: 6-133 meses). RESULTADOS: A incidência de NIC 2-3 recorrente foi de 30,06/10.000 mulheres-mês no grupo HIV+ e 4,88/10.000 mulheres-mês no grupo HIV- (risco relativo, RR = 6,16; intervalo de confiança, IC 95%: 2,07- 18,34). A probabilidade de recorrência alcançou 26% aos 62 meses de acompanhamento em mulheres HIV+, e manteve-se estável em cerca de 0,6% no 93o mês de acompanhamento em mulheres HIV-. Não pudemos demonstrar outros fatores prognósticos relacionados à recorrência de NIC, mas o uso de terapia antiretroviral potente (highly active antiretroviral therapy - HAART) pode reduzir o risco dessa ocorrência em pacientes HIV+. CONCLUSÕES: Mulheres HIV+ têm maior risco de recorrência de NIC 2-3 após EZTAD comparadas a mulheres HIV-. Esse maior risco não foi influenciado pelo status da margem ou grau de doença tratada. O uso de HAART pode reduzir o risco desta ocorrência em mulheres HIV+.
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UNAIDS. AIDS epidemic update: special report on HIV/AIDS. Geneva: Joint United Nations Programme on HIV/AIDS (UN- AIDS) and World Health Organization (WHO); 2006. p. 1-96.
Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced hu- man immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853-60.
Brito AM, Castilho EA, Szwarcwald CL. Regionalpatternsofthetempo- ral evolution of the AIDS epidemic in Brazil following the introduction of antiretroviral therapy. Braz J Infec Dist. 2005;9(1):9-19.
Massad LS, Ahdieh L, Benning L, et al. Evolution of cervical abnormalities among women with HIV-1: evidence from surveillance cytology in the women’s interagency HIV study. J Acquir Immune Defic Syndr. 2001;27(5):432-42.
Grinsztejn B. Prevalência de infecções sexualmente transmissíveis e estudo dos fatores de risco para infecção pelo HPV numa coorte de mulheres infectadas pelo HIV no Rio de Janeiro. [thesis]. Rio de Janeiro: Faculdade de Medicina da Universidade Federal do Rio de Janeiro; 2001.
Russomano F, Bastos FI, Camargo MJ, et al. High prevalence of genital intra-epithelial neoplasia in a cohort of HIV infected women in Rio de Janeiro (RJ), Brazil. In: XIV International AIDS Conference. July 7-12, 2002 (abstract no ThPeC7549). Available from: http://gateway.nlm.nih.gov/MeetingAb- stracts/102256183.html. Accessed in 2007 (Nov 9).
Suárez Rincón AE, Vázquez Valls E, Ramírez Rodríguez M, Mon- toya Fuentes H, Covarrubias Rodríguez M de L, Sánchez Corona.
J. Lesiones escamosas intraepiteliaes en pacientes VIH seropositivas. Su frecuencia y asociación con factores de riesgo para neoplasia cervical. [Squamous intra-epithelial lesions in HIV seropositive females. Their frequency and association with cervical neoplasia risk factors]. Ginecol Obstet Mex. 2003;71:32-43.
Hluangdansakul W, Phinchantra P, Bowonwatanuwong C. Prevalence of SIL and SCCA in human immunodeficiency virus-seropositive women at anonymous clinic in Chonburi Hospital. J Med Assoc Thai. 2006;89(3):289-93.
Petry KU, Scheffel D, Bode U, et al. Cellular immunodeficiency enhances the progression of human papillomavirus-associated cervical lesions. Int J Cancer. 1994;57(6):836-40.
Olaitan A, Mocroft A, McCarthy K, Phillips A, Reid W, John- son M. Cervical abnormality and sexually transmitted disease screening in human immunodeficiency virus-positive women. Obstet Gynecol. 1997;89(1):71-5.
Wright TC Jr, Koulos J, Schnoll F, et al. Cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus: outcome after loop electrosurgical excision. Gynecol Oncol. 1994;55(2):253-8.
Fruchter RG, Maiman M, Sedlis A, Bartley L, Camilien L, Arrastia CD. Multiple recurrences of cervical intraepithelial neoplasia in women with the human immunodeficiency virus. Obstet Gynecol. 1996;87(3):338-44.
Robinson WR, Hamilton CA, Michaels SH, Kissinger P. Effect of excisional therapy and highly active antiretroviral therapy on cervical intraepithelial neoplasia in women infected with human immuno- deficiency virus. Am J Obstet Gynecol. 2001;184(4):538-43.
Chirenje ZM, Rusakaniko S, Akino V, Munjoma M, Mlingo
M. Effect of HIV Disease in Treatment Outcome of Cervical Squamous Intraepithelial Lesions Among Zimbabwean Women. J Low Genit Tract Dis. 2003;7(1):16-21.
Tebeu PM, Major AL, Mhawech P, Rapiti E. The recur- rence of cervical intraepithelial neoplasia in HIV-positive women: a review of the literature. Int J STD AIDS. 2006;17(8):507-11.
Massad LS, Fazzari MJ, Anastos K, et al. Outcomes after treat- ment of cervical intraepithelial neoplasia among women with HIV. J Low Genit Tract Dis. 2007;11(2):90-7.
Schwartz LB, Carcangiu ML, Bradham L, Schwartz PE. Rapidly progressive squamous cell carcinoma of the cervix coexisting with human immunodeficiency virus infection: clinical opinion. Gynecol Oncol. 1991;41(3):255-8.
Del Priore G, Lee MJ, Barnes M, Garcia P, Till M. The inad- equacy of standard treatment of dysplasias in a woman with acquired immune deficiency syndrome. Int J Gynaecol Obstet. 1994;47(3):273-4.
Stratton P, Ciacco KH. Cervical neoplasia in the patient with HIV infection. Curr Opin Obstet Gynecol. 1994;6(1): 86-91.
Holcomb K, Matthews RP, Chapman JE, et al. The efficacy of cervical conization in the treatment of cervical intraepi- thelial neoplasia in HIV-positive women. Gynecol Oncol. 1999;74(3):428-31.
Kuhn L, Sun XW, Wright TC Jr. Human immunodeficiency virus infection and female lower genital tract malignancy. Curr Opin Obstet Gynecol. 1999;11(1):35-9.
Robinson W 3rd. Invasive and preinvasive cervical neoplasia in human immunodeficiency virus-infected women. Semin Oncol. 2000;27(4):463-70.
Tate DR, Anderson RJ. Recrudescence of cervical dysplasia among women who are infected with the human immunodeficiency virus: a case-control analysis. Am J Obstet Gynecol. 2002;186(5):880-2.
Gilles C, Manigart Y, Konopnicki D, Barlow P, Rozenberg S. Management and outcome of cervical intraepithelial neoplasia lesions: a study of matched cases according to HIV status. Gynecol Oncol. 2005;96(1):112-8.
Heard I, Potard V, Foulot H, Chapron C, Costagliola D, Kazatchkine MD. High rate of recurrence of cervical intraepi- thelial neoplasia after surgery in HIV-positive women. J Acquir Immune Defic Syndr. 2005;39(4):412-8.
Heard I, Tassie JM, Kazatchkine MD, Orth G. Highly ac- tive antiretroviral therapy enhances regression of cervical intraepithelial neoplasia in HIV-seropositive women. AIDS. 2002;16(13):1799-802.
Maiman M, Fruchter RG, Serur E, Levine PA, Arrastia CD, Sedlis A. Recurrent cervical intraepithelial neoplasia in human immunodeficiency virus-seropositive women. Obstet Gynecol. 1993;82(2):170-4.
Frega A, Biamonti A, Maranghi L, et al. Follow-up of high-grade squamous intra-epithelial lesions (H-SIls) in human immu- nodeficiency virus (HIV)-positive and human papillomavirus (HPV)-positive women. analysis of risk factors. Anticancer Res. 2006;26(4B):3167-70.
Prendiville W. Large loop excision of the transformation zone. In: Prendiville W, editor. Large loop excision of the transformation zone. A practical guide to LLETZ. London: Chapman & Hall Medical; 1993. p. 36-58.
Kleinbaum DG, Kupper LL, Morgerstern H. Confounding. In: Kleinbaum DG, Kupper LL, Morgerstern H, editors. Epidemiologic research: Principles and quantitative methods. New York: John Wiley & Sons; 1982. p. 242-65.
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