Factors associated with recurrence of cervical intraepithelial neoplasia after conization in HIV-infected and noninfected women.

摘要

PURPOSE: To identify risk factors associated with recurrence of cervical intraepithelial neoplasia (CIN) following loop electrosurgical excision procedures in women with and without human immunodeficiency virus (HIV). METHODS: A total of 33 patients with recurrent CIN and 105 without recurrence were contrasted using a nested case-control design. The patients were enrolled between 1999 and 2004. Recurrence diagnosis was established after conization, and tissues were fixed in formalin and embedded in paraffin. Polymerase chain reaction was used to detect the human papillomavirus genome (HPV DNA) types 6, 11, 16, 18, 31, 33, and 35. Statistical analysis was performed using chi(2) test with Yates correction and the Fisher's exact test for comparison of categorical variables. Multivariate analysis was carried out using logistic regression models. RESULTS: Human immunodeficiency virus infection (p = 0.001), glandular involvement (p = 0.000), and compromised margins (p = 0.02) were significantly associated with CIN recurrence. HPV DNA was positive in 57.6% of patients with CIN recurrence. High-risk HPV subtypes were detected in most cases but were not associated with recurrence (p = 0.27). In multivariate analysis, HIV infection and glandular involvement were independently associated with CIN recurrence. CONCLUSIONS: Human immunodeficiency virus infection and glandular involvement are associated with CIN recurrence.