Project 2-Understanding CIN2+ among HIV infected women after LEEP: An epidemiological and immunohistochemical study

项目 2 - 了解 LEEP 后 HIV 感染女性中的 CIN2：流行病学和免疫组织化学研究

• 批准号: 10256043
• 负责人: SUSAN CU-UVIN
• 金额: $ 12.8万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-07 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10256043
• 关键词: AIDS/HIV problem; Acetic Acids; Address; Adopted; Africa; Age-Years; Appearance; Back; Biopsy; Cancer Etiology; Cervical; Cervical Intraepithelial Neoplasia; Cervix Uteri; Cessation of life; Characteristics; Cold Therapy; Colposcopy; Country; Development; Diagnosis; Disease; Enrollment; Epidemiology; Excision; General Population; HIV; HIV Seropositivity; HPV-High Risk; High Prevalence; Histocompatibility Testing; Human Papillomavirus; Human papilloma virus infection; Human papillomavirus 16; Immune; Incidence; Intercellular Junctions; International Agency for Research on Cancer; Kenya; Lesion; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Natural History; Recommendation; Recurrence; Resources; Risk; Risk Factors; Science; Specimen; Tissues; Uganda; Visit; Visual; Woman; base; cancer invasiveness; healing; high risk; loop electrosurgical excision procedure; novel strategies; prevent; screening; standard of care

Abstract Current estimates indicate that every year 5,250 women (crude rate 20.5) are diagnosed with cervical cancer in Kenya and 3,286 (crude rate 12.8) die from the disease. Cervical cancer ranks as the 2nd most frequent cancer among women in Kenya and the 1st most frequent cancer among women between 15-44 years of age. About 9.1% of women in the general population are estimated to harbor human papillomavirus (HPV) 16/18 and 63.1% of invasive cervical cancers are attributed to HPV 16/18. In Uganda, cervical cancer is the number one cause of cancer related death in women. 6,413 Ugandan women (crude rate 28.8) are diagnosed with cervical cancer and 4,301(crude rate 19.3) die from the disease. About 3.6% of the general population harbor HPV 16/18 and 57% of invasive cancer is attributable to HPV 16/18. HIV-infected women have higher prevalence, incidence, and persistence of HPV infections, more so in women with severe immune compromise. HIV has been shown to increase the risk of the development, progression and recurrence of cervical intraepithelial neoplasia. Several studies have consistently shown that HIV-infected women present higher risk of CIN persistence or recurrence after standard therapy . Both Kenya and Uganda have high prevalence for HIV/AIDS at 7% and 12.9%, respectively. In settings where loop electrosurgical excision procedure (LEEP) is available, accessible and appropriate, treatment with LEEP is recommended by the WHO. However, there is a paucity of studies assessing the efficacy of LEEP among HIV-infected women and the characteristics of CIN2/3 lesions after LEEP. The core objective of this application is to understand the natural history of recurrent CIN2/3 lesions among HIV-infected women after LEEP. To help guide management based on HIV/HPV science, we propose an epidemiologic and immunohistochemical study of the cervix following LEEP to address the value of destruction of the cervical transformation zone to prevent cancer. We propose to enroll 300 HIV-infected women with CIN2/3 undergoing LEEP and follow them every 6 months for 2 years with colposcopy and biopsy when appropriate. We will do a repeat LEEP for recurrent CIN2/3 lesions. The Specific Aims for this proposed study are: 1. To assess the incidence and risk factors for “recurrent” CIN2/3 after LEEP among HIV- infected women. 2. To determine baseline HR-HPV types (in tissue) among HIV-infected women with CIN2/3 undergoing LEEP compared to the HR-HPV types with “recurrent” cervical lesions after a second LEEP. 3. To determine the immunohistochemical differences between the initial and repeat LEEP specimens among HIV-infected women with “recurrent” CIN2/3

抽象的 目前的估计表明，每年有5,250名女性（原油20.5）被诊断出患有宫颈癌 肯尼亚和3,286（粗率12.8）死于疾病。宫颈癌排名为第二大癌症 在肯尼亚的妇女中，在15-44岁之间的女性中，第一次是最常见的癌症。关于 据估计，有9.1％的妇女估计有人乳头瘤病毒（HPV）16/18和63.1％ 浸润性宫颈癌的归因于HPV 16/18。在乌干达，宫颈癌是 女性与癌症有关的死亡。 6,413名乌干达妇女（粗率28.8）被诊断为宫颈癌 和4,301（粗率19.3）死于该疾病。大约3.6％的一般人口HPV 16/18和 57％的侵入性癌症可归因于HPV 16/18。感染HIV的妇女的患病率更高，发病率 HPV感染的持久性，在患有严重免疫功能低下的女性中更是如此。艾滋病毒已显示 增加宫颈上皮内肿瘤的发育，进展和复发的风险。 研究一直表明，感染HIV的妇女表现出更高的CIN持久性或复发风险 标准疗法后。肯尼亚和乌干达的艾滋病毒/艾滋病的患病率高为7％和12.9％， 在循环电外科惊喜程序（LEEP）的设置中，可访问和 WHO建议适当的LEEP治疗。但是，评估的研究很少 LEEP在HIV感染的妇女中的效率以及LEEP后CIN2/3病变的特征。核心 该应用的目的是了解HIV感染的CIN2/3病变的自然史 leep之后的女人。为了帮助基于HIV/HPV科学的指导管理，我们提出了一个流行病学和 LEEP后子宫颈的免疫组织化学研究解决了宫颈破坏的价值 改造区以预防癌症。我们建议注册300名患有CIN2/3的HIV感染妇女 LEEP并在适当的情况下进行一次阴道镜检查和活检每6个月每6个月关注它们。我们会做 重复复发CIN2/3病变的LEEP。 这项拟议研究的具体目的是： 1。评估HIV感染妇女LEEP之后“经常性” CIN2/3的事件和危险因素。 2。确定HIV感染的CIN2/3的妇女中的基线HR-HPV类型（在组织中） 与第二次LEEP后具有“经常性”宫颈病变的HR-HPV类型相比。 3。确定初始和重复LEEP标本之间的免疫组织化学差异 艾滋病毒感染的妇女具有“经常性” CIN2/3