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TRANSCRIPT
A dtt a,ulIUfigluflUU Original Article
,{anr:er:? ousrEsilrnilne nlil osr6d6 orfi orot'loi
I:sns ru rao: t :rf rJ :strYndpap smear in women Infected with HIV in sawanpracharak HospitaL
v -Joufiryqr frnufrn6fiqlry rrr.u.
nnffu rto.rfft rdfl.rd aYr.u.
,fO*|rl rtaeufi ?il.u.
nisrfiur nrfin rn.u.
aiqor ndorutnar ?m.u.laaa
nciil{ ru ilu"tfi ?lltl 1Rlu?R1n
Ir'.r,n'tr,u sa : :r{rj :vrrYnduvdo.ifi?nunlfl?::n
aa::rfil:vtrYndtatat:
fld o qfiuii z r{qgnrnil-?silrnu zbbz voto No.2 Mty-Aog,
Chaninya PatanasakPinYo M.D.
Suphachai Roungchaisareepong B.Sc
Saranta Sangmanee B.Sc
Nuttina Kongnil B.Sc
Srisuda Klomklao B.Sc
Anatomical PathologY DePartment
Sawanpracharak HosPital
Nakhon Sawan
Sawanpracharak Medical ]ournal
vluYtftouo
Tnailtvoqriq
Aa: LTt a fl fl U1 n?1iltnto.t n?1 il fi nil n fi za.: ttaairEiaq fi rrJr n ru orq n'[uant
d a o d', H t V u-liinu Lfi uu n1u a n3dhi fi n rd'a H lv dtfi ;u n1:nr? ae fi a du99
fi'ls pRp smear LLasnl:Ft:?q?urfrailrnilnqni4 l:.:naturadx::d'il:s{linriflEnuYtflflHl :
gr.luuunrt?ffuatddYY.: Fnutt7",:til5uutnuuLtuuuaumn{
n{ufraodr{ :t a a aAa , .,,.,.F-.^.
nailflnu1 na an:nfizunn:?a Htv tiluurn fiilrn:rq PAP smear
v" t4 a a o
ri.:rrsir6au iln:1nil 2549 fitthautruuril:u 2552 a1u?u 139 T1u
n{rr rGuu rfi Eu rfl uanidt*i a^rd', H rv dfr ar q rviT fiu fi 4fi rir rur uav
{ururn:ro1nfrr6a.:riu siluru 139 :1El
TGnr:frnul : rffu{aqazuan:?a PAP smear LLasrJan:?a7utu010.:dFlr11tfl1tJ1n:?a
lul:.:narurnar::ri'il:strinri ? rn:ryvirGetutfi au nmiltn uas:c6ir
Fr?ltJ1uLL:{ao.::aul:n orrrun{ruorq fi:sd'urrru rdariu Soelas gs
ruanr:finu1 : ao,tfifiorr#a Htv '139 11u nunmufinrjnfitatrdaqfifiJrnloqn
iouas z+.s siTtriuarrifl*aou{a HIV dfirua PAP smear firrrlnfirfin.l
d, u 6d?:Tnil:et1in$t2td1? rfiqqr rYauf;ndiqlry, qnio GariorirwJ, niqdnr ug+,6, oinf,ur nrfio. aiqnr ndaunor I Q$
iasac s.o mta6.:r{lu +.9 rvir adr.:firiaeir6'rpnr.:46fi (p.o.oot){€ta,aula9a
LUUFI?'ltlrJFlUnnIn:sFlUn?13J?Utt:':tO.l:AEJ[:FlnOn.]UFl Atypia AUfl\:!q
sJ v r5{ il1 n N n a n uri d Ftidk a o, rd'a H I v r{l u n ar ru fi n il n 6 rfi u.::sriu{Atypia rvitiu d,,:finrtrrrornrir.,:ri'uoeir.,:firiarirrirymfidfifi (P=0.041)
L[n e fl-',] v{ u n ? r ru fi nnl n fi '[u a nid fi rr rfla n t v 1 fi m&.: u ri r-a ro^: ru vriu rio u fi ,:
- A d a , a aA?u6h101Ei d{3J n?1ilun?0{n?1il,.1 ail nnn1il{?{a1sLLF|fl Fr1{a1ndfl:Yl
{qqq
hj 6 or rda H tV a dr.: fi riarir a"rynr.:afi 6 1e=0.00 1 ) dru zua fl 1:nr?a3&.x-AaeaavvtUtU0Ulf'ltJnAn LilUnnnl{nUm\: [UFllUi{Afl1T?UOQEI :snun?1il:ULt:d
a a.,:Ta BI: n rra, uurhiru nr : ril d au ruil a.,: nr ardr.,: ar uq
aJo & Yev v a6Ft:?lFrnt{a HIV n?:Ln:un1:a:?a PAP smear num L[aBn?:n:?a
. a I V ro v I Ail a s n'i1 nurl n fi lor slil,ir nlnrir.:ar q rfi a n:?ailu Fr?1 il fi nil n 6 nr:
r , e t y v a -X ! A a u a ellTvtilu:afl [:anoFl?Etfl1:d0\]naa{ilufl uasrlnuutuotll0uuEJu ft.:LttJ
d,.adud
asLiluFr?1u9JnunFttilu\:TvFru Atypia nn1il!e
nr:finrtfia HlV, rust5.:il1nilnnfl, PAP smear, Biopsy, n?1iJ{n
Abstract
Obiective
Ada?at:guttagd:lJI
ccvnrfltnfl,q
Design
Subjects
Method
Results
The purpose of this study was to determine the prevalence of cervical
epithelial abnormality in HIV infected women compared with
non - HIV infected women.
Retrospective cohort study
The study group were 139 HIV infected women who undenvent pap
smear from January 2006 to April 2009. The comparative group were
non - HIV infected women with same age, area and the date that
collected pap smear.
The data was collected from medical records and analyzed by statistic
descriptive and statistic correlation.
24.50/" of HIV infected women had abnormal pap smears which is 4.9
time (5%) higher than non - infected HIV women (P<0.001). Severity
of abnormal pap smears show ASC-US to cervical cancer. But
non - HIV infected women show only ASC-US and AGN - endocervix
fl anr:n:?nusli {ilrnloq nluan5fi n'nrdotal'!oi l:lnaruaa.l::rirJ:;trYnifld o oriud 2 x.A.-d.a. 2ss2Smffi in Women Infected with Hrv in
Conclusion
Key words
umdro3n1:nnrto rotlat (Human
lmmunodeficiency Virus : Hl$ r{lurftymr
61 f,''rrruq?d eir rirytr atla n uafl atil:31il FIlil u
r1og-iur.J:rrn rrtn uru' {fi nr{a H tv 330,740 11 u
rfl urnrtufr.l 1 01,698 T'tu(1) :1tl.l1un,t:dnu1
rirr 1 rtrlnnv{u'ildrlidfirtd'a ntv fidn:T
n 1 : r fi or il c t5.rfi n il n Q
n q.,: n'j'r n uil n fi ('')
LLa s
n:?av{ura aI:nnr alurEioU firrlrnilnA n
lfiennn'irartfit*iarud'u nrv 6..: +.s rir(95% Cl, 3.0-8.21tsr uuno.nrfufi',:vrunr:da'vd'aJo4ria nr:inr*r eJstr',:il1 n il na n?a{dqt:il n n t?,8)
Htv il1nn'j1nuilnfi (6) tufl zsgo rJ:vrvrnnuiS
anrin'r6.rrirnuprlfiilcri.,:ilrnHorqn (lnvasive
(P=0.04'l). ln HIV infected women, abnormal pap smears were found
in every age group. ln non - HIV infected women, abnormal pap
smears were found only in elderly women (P=0.001). Histologic
abnormality of uterine cervix in HIV infected women were not statistically
different from non - HIV infected women in severity and chronological
changes
: HIV - infected women in Sawanpracharak Hospital had a high
prevalence of abnormal pap smear and had a tendency to develop
moderate or higher grade of cervical dysplasia. lt was recommended
that HIV infected women should undergo more frequent cytologic
evaluation than that of non - HIV infected women. When abnormal
pap smears were found, colposcopic evaluation should be inmediately
performed and histologic studies should be confirmed for severity of
the disease.
: HIV infection, Cervical cancer, Pap smear, Biopsy, Prevalence
cervical cancer) t{luarnr:utclohlfla{[and uat
q'n nm il fi nil n fi ta.::o ul:nfl o.,:il1 n il a Q
ndfi Fl
Cervical intraepithelial neoplasia (ClN) afl1u
category e tufl rd ur fl-ufl TvTt:?.1fi'lfir:suqt
lfflfrfi urru roorfLmriln a rfiuI:nructi,tilr n
ru or q n rdrhJ 6t fl o n1:m:?a FiFr mot tleL5til1 n
ilaQn (Papanicolaou smear : PAP smear)d.^Alts^d
tilu [n nil nn 61 el1 la{? EJ a n ou n n1Til? a{
ucri.,:il1niloranlfi anidfinr{a HtV'luriT .:
rl:crnFt fir,u" PAP smear fiorjnfiSasac
1 8.5-49.9ta'sr deuaotidfi orrda Hrv turjatilFilmu
v'runfl ilfi nrlnfiSoBav 8.8-59.6(10-'a) uanqln
riutr-tfl u nmru fi sril nfi tad PAP smear tuan6
dau,d'o nv fraruriafln'ifluamtdtilfinr{a nrv narffimenrntfinrnl:.:nmuraar::ri'rl::nrrinri
a dr.,r fi ria dr 6'runr.:4fi 6 (P-value < o.o5) (1 s'1 6)
o aa - &y ,a du1 9JA n1:1UAfl UTI LFr tJ1 [1]:UU tTl UU Ft?1ilqn
aann?1il fi nil n 6to.: ttaaird au fi erh nil na nqqoaf
Q1 LLUnFllil:eflUn21ilTUtL:\:fl A{TAU L:n Ltnt
turJqqfunr:oruafrdrafi nrd'a Hrv 6du riT'lfr9t, d A !frrh afia'r a Eusrrfiu ttavn'Ianran:?av'tu
e A a , r,t v & t a d t
n?1il,JnilnFl?a{r{anH0ur-tx1_hnilnanLnrnmu n1ilflail01u ?Ln:1sfin']1&lLtrlfln1{:vt1?1',1qsqqa Xa- , s A a
n1: Enu'] U rJ? n qU:sd{ n tv{ o FInul
n?1 iltnz 0.1 n?1 il fi nil n fi za.: rqadr6au fi rqa. d ai^ X td d u
ilrnrunan ludFrsyr0{nrta HIV tu:uutmuunuq
6n6dtil a n rd'o H rv dtdfu nr:n:?aifi aq:'u drn:&
PAP smear ttaunlTFl:?a{utuail1nilaan{Adaada,al rn:rvtrau trt n1:6un?1il r',lnU n rt rtl SJtsFtu
q
n?1 ilJ5U Lr:{?A{TA EJIIn t[AuFl1 il n ri el ar aqqq
urii a'lfi u{l ufr o il n"[u n1:n ua tlasfl 4.,: fiutrr5.:s{. o aio A
ilrnrnnn [udn-Yranrto HIVq
444?tflt:flnHlaa,dAvvFINUl t{.1 LU:UU tfl UU LtUU U AU?14{
(Retrospective cohort study) Inunr::ru:rtJ
{arun rua n:ae PAP smear ?a.ldrt3fi fi ,inn:?aq
H I v yntfr a.:ilfr ffi nr:4 fi {a.r n--ui n ar u{l uur n
fi rdr rur m:ra'[ul:.ltt arur aar::d'il:ctrindU 'a a arl{Lrrlrriau iln:1nil 2549 n{Lotoulill*1uU
tynAilFt?Udnn Exact probability test,
I
Wilcoxon's ranksum test uaseLn:rvfi'nrrru' l9
^ | 6
Ltn n Fi1\11 a{ Ltu? Luil n'l:?lu n?lil rJ au fl n n1 il
ar q fir u nr:i m:1s?in1Tn n fl ou t3',: L#u (Linear) - J Ly
regression) Yl?snun?1ilI{A}JU:AUAs 95
4flaRltflnut
| @ , aJo XnailFl?afl1{dFl:mnn[ta Hlv [taE
ffnidtilAnr{o ntv fiqirurunrisJnu 1s9 r'ta
firunn:ro PAP smear mn:1fl unvfiruanr:q
9U A,n:?aEuruoilrnruoan 28 tLne 10 :1ElFl']il{o v V , a & r drd
AIFlU ?l.ldo.lnailti01UFl{LtFl 18-60 U ilA1Elqqq
^ol d ao ,o u uroafl 39.4 9.2 tLnvelflila1tu1aEiIUA{il?O
duFr:d?:lFr
a)9.lnn1ln:?a PAP smear ?o.:6Fl:11
^A^.1MNTTIA HIV flUN?1'J'JFIUfl 'I?4.:1fl
AU'.,I']
ilrnrunqn foaas 24.5 (g4 r'lEl) LLAvfllsJl:n
d, v dd?TTdil:UtfindUftflfl w-qqr rYorufi'niifiqlq, qniu Eariarntnrd, aiqdnr ua'ru6. cioBur nrfio. niqor n,iuu,n", 1 1 0
{{
2s52 druru 139 :lu rardilrdanriaadr.:fr 1{un?1a.lfinrln61finn:snTurY.:rrri Atypia nufitqq
hifinrd'o Htv rLuurflrrirdourruan:?q PAPg
smear fitfrrrurm:ra PAP smear 'lu{urfiuruAOrdufdnufi5a3.r1 trl:?a Lut?{L?n1 tFt u?flu Ln fl SJTcUs
virtfiutrirfiu 1 6au fiarurvirriu finfiritur9{
16srfium':olnf,rdsraniidanrd'o Htv ttas
fi,iruruuriT n-uda 1g9 T1s fiudumrrunnr:J & a, v
Fl:?fl fl UtUAUl n lJ OA nil{ fl AU Lnsfi A.l nlTn:?a
pAP smear In crnr:f,uduqrnda ultJdna uae
fi ilt 1 fl r a fl il : y o"r rr-r dl:.,l ?l g 1 u 1 a a a n'[ fr t a.r
r.rEri.,ril'rnil nQn n?1il fi orr-l nfi :vriu Atypia
nr?qv{u;aflav 31.8 (20 :'ttj) lfiuri ntypicat
squamous ceil undetermined significance
(ASCUS);ouas 10.8(15 :19) Atypical
glandular cell-Endocervical (AGC-EndoceMcal)
taflns 2.2 (g:1u) Lmv Atypical squamous
cell cannot exclude high grade squamous
intraepitrelial lesion (ASC-H) iauac 1.4 (2 Tltl)
dru nm u fi nr.l n fi :vriu dudr^rulfi rtri :o sl:prt v rr o c u A r---.--^-?--..^^^v- c& i
nail6l,lafl1{zu1uLU:un:ild1r:aTu?o{nnil{1u :ueruruour.nilrnrunantfindtm?fdtflaa?urirq -ql----'-c q {
a d-i- i " -ilan1r615'rtu3li.tiltnuoan tildntT9l6ll0tou l01 l:.lTlu lljlad255flu:gx l:nu
111 Pap Smen in Women Inftrted with HIv in Sawmprachuak Hospital. fld o au"ud 2 $.a.-d.A. 2ss2
(Low grade squamous intraepithelial lesion;
LSIL) Sasac 3.6 (5 :'tu) :aul:n:vriuj ^ u e&
tE a ! il ? il't n lJ n a ntU Fl d ttFl? Ll d t"lfa afl u q{
lHigh graOe .OrJror. intraepithelial lesion;
HSIL) Saerns 5.8 (8:1u) tLasiJstS.:ilrnrunan
zfin Squamous cell carcinoma (SCCA) iaanv
0.7 (1 :1u) druanidtrifiorrd'a Hlv fi,ra PAP,dy
smear ilnilnF iagav 5.o (7 :'tu) ?{un?1il
jm.ldfln (P=0.001) (n1fl',:Yl 2)
3A,aJtJaf]1:rn?atuLuaul nilnQn?I0{dn:m
xfiorrfia Htv f iuFrr1Nfirrrlnfi Sounc o4.B (18 ?'tu)
druaorflrifirrd'r Hrv ilu SaEras 4o.o (4:1s)
d.:ki unnrir.:riu 1e=0. t oel vY.:aa.:ndrun:ra
il u n ? 1 il fi n il n fi t o,: :s rriu n ? 1 il lu Ltr.,: ?l 0.i I a fl
I:rrifirf.:rrri HSIL, Squamous cell carcinoma
in situ (ClS) qudtn:tav{x'i1L{lurustitdrn
uAn?EJ(n1:1.171 1)
9r0tta
nn{?.,:
,JnnlTn:?a PAP smear fla.:flnifi
Hlv d11J1:0Fr:?Qvrunfl rufi oriln61fi
aTadarY.,:ruriarErrirn'ir eo tloufi.,: oo flqq
AAFIO HSIL :O.OA{8J1FIA CIS LLAY SCCA M1il
rir d'u d.,::rriu n?1ilTu tt:.,:?a{Ta uI:Fl
vry.:aa.: n fl rutri rror n rirt,Y, (p=o.oo+) Inr El
: ,aor{u n?1il r,tFlufl a rudn3darrd', Htv 1fr54fl av
39.3, 14.3 uns rO.Z drutuanidtrifinrda
HIV llu5otlav 20.0, 10.0 uas 10.0 n1Nj
alnu (Fl1r1.111 3):!,aa
t{A n1:FlT?AtU tUAil1 n il AA nI O',ldFl:Yl
6Brrd'a Htv uar6{niflriao,rd'a Htv d1tJ1:n
n:?at'{un?1ufi nrjn61fint:uriarq ot tlqufitd.rdlarA
60 il LtUtnU'tnu LFrElv'tuFt?'ltJzununflla.l
s1-60 il iotlac as.z rimara st fi{ +o tl
iaaac 66.7 LLav 'dr.:ars ar 6.: so fl SocrasJaolu,^Aa:
53.3 ?rusmdnslrLeJFtFlrta Hlv ilzunnr?azu!^adt
rilarJnilnFlt?{a1fl 31 n\: 40 U tLAv t?{o'lElqq
s1-60 tl flufauas t00.0 rrirniu uav dmaruaArvAc/r
41 6{ 50 n ll'{U:aunz 25.0 11{6{Ftd?U?A{
ar a fi n rl n 6ki fi uurLiru d'fi'or ra u yle{ d a { n ri ru ua sq
xraaALil uor n rtr.:num1.:dn n (P=0.841 XFt1:'1.:?1 4)
201:Ol
q
tasav so.o d?{a1fl 31 6.r +o tl iaerav
24.5 uac?ir{a1rl 41 6.: so i) iauav zz.q
drucrridkifinr{a Htv orGrun:?av{un?'uJ
fi nrlnfilfirituriara sr fldulil fnar,{unrltJ
finrrlnfiluti?.,:o1q +t fit so fl iaaav 1o.Z
rir.,:orq st fi.r oo fl Sauas 0.7 Ltacv'{u'[u
rir.:arq gt 6.r ao fl taaav z.o d,l#ndru
za.:nmru fi nrln fiza.:anidfin rd'o u tv fi uurhiruA X o I aJr,^ 3
aaa.tLilaa1uil1nfl u lull tusTl6Fl:m Lilnnltaq
drea,^JJH I V r,l Lru? Lu ilfl a { d n d? u Fl? 1 tJ r,t n U n n tv'l tJ ?u
fiorrlnfirfis.,::rriu Rtypia Mtiu nmufinr.lnfid ;Jaqntfin sccA nmrufirrilnfidvlururnidqnq
uulfiuri ASCUSSaunv 4.3 (6 :'tu) uar
AGC-Endocervical iaflac 0.7 (1 :ra) d'':
^i o aio XFll1il rJAil n6fr n:rQvlu [udn511nn tdo HIV
, aolv,o X dvd{n?ldnTmLeJnatua HIV 4.9 trir adr.:fiua
,iryl''rg r. .: a fi fi 1 e.o. oo t ; u, n.. n rf, s-.: t'i u'j't
:snu n?1[,rruLL:.:ra{ rJnfi orrl n6 rrnnrir.,:tiu, dv: - - -- . d
a drrfi riaeir a runr.:aff ff 1R=0.041 ) 6 n
a . ao aJa 3 ,
nunmrufi nrjnfi'luan5fi fi ararirn'ir zo fl: Jo alo X
,JAnlTn:?AUUtUA [UdFliYlFl FItUA H lV t?.]41fl
A N V , .i.c. r arfiaarerurnfiu vr'.r z nd:rfi#ordruntiuttot
aaio{!ft1:dnuldn:nFlor{0 Hlv flmrl:lq
rln6n.runriuarerLrnnFir.:n-ua?.j1{firigdr6'ru rinn:atusl5.:ilrnuor4ndrsi6 PAP smear-qquql
d, s d6l?:?nilTgt15nUL?td1l' tfiqryr fiorufindfiqlq, qnfru riori'uroinsd, aiq{or uslrr6, sindur nrfia, aiqar nciaunar 'l 'l p
'[uI:.:fl ur!1 a dx?rri'il:vzrinrifi nr1 iJtfl 'u a.]q
avAtvd,J A n T? A'J n 1_l n A d.l n.t:A U Az, 24.5 {{ n1{ n U d Ft:{d, rA A t d u o u AAYlLlJFlntta HIV AU1\:lJUfl 611nfUTl1{dnn
( P <0. oo 1 ) d a n n fr a.: ri'tt :'t u.,t 1 uyY{'Lu Lta v!oa
rir.,:rhs rn nfi t'{ lJ ouG n1:ni5a a as B. B-sg. o( 1 o- 1 4)
q
Lrav 1 8.5-49.0(8-e) nmrufi orilnfidn:rovluf.,:dv a-lc ,^ & atl dFld?Ud.ln?1 dnTn L:J Fl Fl L?,4 H lV 6.l.: 4.9 tn'lq
d.: rvir niu nT : 6 n r*'r'[u ri,,:il :v tn A(5) 6 n r{.: Eft
611 il 1 : n 1t u n ? 1 3J fi n rJ n 61fi1u yr n :v aiu* Y . -"
n?1 illlJ tLT.,lfl An:A fl hn n': IFi:vFrU Atypiaq
ad,ia.h,o&aun.,rilrL5{1-h nilna n ?rueltdnTn uJ Frnrza Hlv
oto vilun'11ilfi nrlnfirfi at:roiu Rtypia tviruu, Xau a ,
r-i.: fr"tri ui u'i 1 u a fl e 1 n q vv{ u n ? 1 il fi n rl n fi t 4.,:
:agl:nlurfi aufirilrnrrnanffi{dnifi fi nrfo nrvqq
fi nrrrusna.:n'iranifihifi nrd'a Htv urf,rq{
-^!Fr ? 1 :J fi n il n fi fi r,i I g".: n :sa 1 fl a u'[u n n :s d'u I a.]
{qr r aAa
n?1 8J:U LtT{?4.::0 U t:n il1 fl n?1 d ATmil zu A F|:?A
Htv rlnfi adr.:frriadrn,ryr1{dfi A (P=0.041 ), 6\vA ,-
Ltas6lltJlTn n:?Av.l! n?1 il al ou n n Ln n{ [LFl? flA u ( A v , aA
roi ru vrlu do u fi .,: i s a.,: a r u u n n Fi'r.,: a 1 n d n5fro$qu ,a & i:trifi orufia utv fi GurrTre?\un?1ilfi orrlnfilfi
,&v€aua E Fl{ ttFrilnl u? u taTq}'{uf,aun{? u nn1{pru(' u)
rrdor.:'lfr rriu'ir an6ii A o, rd'a H tv fr[a nr a
nr?avrr Fr?1 ru fi orrl n fi t0.,: rda rdarlr n il na nlfi{y, , uy ^i d
a.:n'.:uriarsal.:rioaurinrrrufi otrlnfi fi nufi rrurLiu6,i3aiaA,^&
a na{ lufl aila1 u?]il1n?u Lu?ilvndn:r LtJornruaqq
H tV ?\u rruahjru nrrru fi nrl n fi ufi r.rdurdoar q& t au
ll1 fl TlUtln fl n1.l nUO U'l{ilU El d1 n qm1{6{fl Fl
(P=0.001 ) d0a nfia.ofiu nr:finurtuanruiu.J.J
U1T'l FIU:1 Fl: YITI|U n?1il rJ AU nnfl A.: tfl AU tJ?$l. 6 aio & \ e o u
ulnilaanLudn:mFlnrta Hlv LnrJlntu?u{v€ra,aJa
ta:fl Trufi rrFrilu n?1ri tJ nu n na na{ tiloilo't goq
urndu(18) fl1arfluila?ra.onr:ffnr{a Hlv ii
oou d) d ,AvirLfi rta n rE a! fr ?il1 n il n a n fr n1:ril 6 nu url a.:q{
rir n'j'nI n fi un Ev{ u n1 : ril 6 fl u uil nllfi of.,: uri ar q
El-{ fi a EJ
( 1 5' 1 6) il :s n a u riu nr 1 il t n fl a { a ni fi n rdaq
&OvavdtuotvHlv ?\u6{{?uil1n [u?ura:fuv{uD T?ilnuuoaErquA uv ' t q r 66ulduui fl 1?ilu n?1rJqnaa.:hidrioruvr5.:ilrn
ilaQn Human papilloma virus (HPV)'[uarl5i^ & vv , a.Ir,^ &fifiorrfia urv lda.:n'jTanffirifiorrfia Htv (1s-21)
q
Lras Ei.ln:?qv\uhiarfl ndtfiat6.:5a uav Boqo-!^X)outd,'Luarr5fifinrfra Htv fifiarqriaern'il so fl dru
aJ^AAa,d.dFtryrFtnrua Hlv flila1t]il1nfl?1 30 uv'rx
^8dnlTfinLfia HPV rfi u.,riaua& s(20'21) 6.,:silriluvda.J-r{,r
F| A.l lJ n 1 : Fi n U1 ty'{ iJ L Fl tl Fl A LU t n U t A y{ 1 s n ? 1 &l
vv6ta&vdtJ?{U0:sfi?1\:fll:Flrltt0 HPV nUn'l'ltjiltn
't- o J o, o ai^ &?la\naU t:n LutUAUi.l?1-J1fl il nA n tUdFl:nFlnLUAqa
Htv u.l3aurfi uunrilnriilalElqqa
n''r :Fln u't r,r a 9J Flu fl nfl a{ fl 1:n:2 auu
rdoilrnuornn?a{dmifi Aorrda ntv uasdni0
Jq ,^ & , , , d dvfileifi nrrfi a H tv la.irrrl'irfi nmru#ruri'uifnu
( P = 0. 1 68 ) uiu r fi u r d'r n ,: rl.t #ru niu ii't 4.,: :s rr"'u
n?1 ill?u rL:.,:?o{:a ul:n (P=0.664) Lmeuudfi eJq
#ndruza.:nmrufi nilnfi n1il?i?.ro'r El (P=0.841 )t d&
' d, t dv
:sfi ?'t{ dFtril{ do{ n n il n LSJv'ru?1 ilu fl d1 n6uJ ' u , i"
7t't.0dn n a1aLua.0ilr1Q1fl nail n?aEJ1{11u1tJ1
fi nur fi siru?ulia u dru:vfiu nr1 ilru Lrrn?a\:+ J a& t a d
TauL:nmilusJor.run HSIL, CIS ou6.:ruvti.:
ilrnr nantfl n sccA unlilvru amru fi nrjn6"[u{teFl-u Atypia [tas LSIL rafl [fia{a1nn1:ar?a
?o{n1:do.,tnfia.o (Colposcopy) [4ufl1:m:?8Aa ^Y , u
PAP smear fi r.rnmruzunilnhntun:voru HSIL
ovr s v a A ' O
uas [?,:? il nu n15Tnu1 ilJB[:.] dt d fl?u 114 fuavn1
{uhl drunrTrufinilnfi:ud'u Atypia uae LSIL
,{antn:?!xrtirilrnrn gnluadEfi fi nrdoros'loi l:uuuraar::drJ:arind113 Smm in Women Inferted with HIV in Sawanprrcharak Hospial
oJlfrnr:n:ro PAP smear'lunlrn:?afinot'llJ ?{01fla
fld o ofud 2n.A.-d.A.2ss2
q
aalR919tRttilillun1fl
?a?ounil :4.:61dnfl or:ti nantnaiI
de u ( t qulurrv{Yrg :o8tan{flun:0: u4uluuYl ua&
:o.r F[1dn:14'l:Eiz1ilil: niurri d rrutri'rtuYata
nfl?tuFlaufl 0.,1n1?Flnu1 ulutlflnutanilq
fradasilu firirurunr:f:.:t{ urula tLat$
nf urn:leJn1:r[2u't.,:ruio-al:',:usrulad?:Td'. u c) u ae X
il:str:nr*Ttduudqunl:?as uafl a.l nu
fi a.,:trosau n ru.,t1uQ fi {el riuim ur n 4 il',11uaa e4 tenciild'tut?zn::ild.:niJllfl1fr??lfl1naun Ltr
q
I:.,:r'r Elr u r a d? :: d'il :vur in r$d dr u? fl n ?1 il
dvon n uav'lfr rir rrurrjr lu nr::ru:? il{a il a
UAEJAnI::flU1t{nil
A v, a a Y r y v dHSI L n.,:IHJX1n1:Flnl*1uQvLililU n?1il6ltJvluf,vtut&,dta4^
nuga'*:nAru n?A El1{l]il6O{ tLnnilU?1dFl:m0lO! a ' ^dJr?ia Hlv f,1ilJ1:fl Fr:?qr{u n?1il9,1F|ufl Fl?lttl0
fi 'lrlr nrJ na nq.:n'i1 dn':dtri6 n t{a H lv
il:vrurru 1.0 tYil
,fl:UI
oJo A ...- t{an3fifinr7a HIV fi nmrutnn?1iliipttA.J
rln6za.ouEoufi :ilrnruorand{ v{un'rrLildttutlila',:q{{
za.,: rdau fi rilr nru ora nlfijr t.rn'jr ?uul{n'j1
ruasrirnirantdhi#Ld'a nrv antdfi ond, nrv
6.,:nr:n:eo PAP smear vTufi Ltflsn?:rt:?or ad a f l,o u
ilaan'irnuilnnhann 4-6 tnau lnulilq1naq
9Atonfrltolilo.t
2.
1. eitin:yurorinsr n:run?UnruIin. d?1h1u.l1unrtrflr:i.:I:n 2550. uufluj: fl:Yrl:?{
d1f,1:6usq?; 2550. fiflr Og-2.
Maiman M, Fruchter RG, serhe E. Human immunodeficiency virus infection and
cervical neoplasia. Gynecol Oncol 1990; 38: 377-82.
Spitz M, Brennessel D, Seltzer VL. ls human papilloma virus-related disease an
independent risk factor human immunodeficiency virus?.Gynecol Oncol 1993; 49:
243-6.
Wright TC, Ellerbrock TV, Chiasson MA. Cervical intraepithelial neoplasia in
women infected with human immunodeficiency virus : prevalence, risk factor and
validity of Papanicolaou smear : New York Cervical Disease study. Obstet 1994;
84: 591-7.
Mandelblatt JS, Fahs M, Garibaldi K, Senie Rt, Peterson HB. Association between
HIV infection and cervical neoplasia : implications for clinical care of women at risk
for both conditions. AIDS 1992; 6: 173-8-
4.
5.
d,u6:d??:4il:g'd15nUt2fl6'lT rfirgqr fioruf,'ndiqlq, qniu 6ariurdr.rd. eYqdor uscr6. sinBur n.rfio, niqor nciaunar I 'l {
o. nrir.:'ru:vurn?nu{:nranrd. fiureJfidral:nranduncfifior{afifiaT nr:ff[fflunr:rflr
:c{.:Irn. :1 er.:1u n1:rfl r:vr-rl:nrl:cri'r fil nrri zsgo; 2a (2s) : 1 -39.
7. Drogoul V, Marimoutou C, Schlupp R. Determinants and evolution of squamous
intraepithelial lesions in H|V-infected women, 1991-2004. AIDS Care 2OO7; 19:
1052-7.
L Drapkin AL, Livingston EG, Dodge R. Cervical intraepithelial neoplasia in H|V-infected
women in a southeastern US population. South Med J 1997; 90(9):893-6.
9. fi6u-uyi tnsnir.,:d'. rusr5.:ilrnrunan: fl'r:rr:?arinnro.,rrusr5tilrnruoqn'Lur{.ofifior& dt dlfral6tlai. ?1:d1:I:nrond 25so; 19 (s): i6s-73.
10. 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.
^€d1 1 . Rtu ?r rJu:srd:fina. n?1ilfinilnfira.,:nr:rt:?ailsLi.:il1nilnan'[uantfifinr{araord
lu anr r-iurjmr rir:r eF. ?1:d1:I:n fi n ri a zs47 ; oo (a) : ssz -ie.12. f,ruFt rFtrusy{.or1'?fi2. nflrufiortlnfiza.:rtadrEiaqfiT]rnilnQnalnnlrnr?a Pap smear
a alo x v d r d t
o s
LudnSTtF|nLtatatLarta.r[T']vru']u1ad:sll:. '11:6{1:?{1n1:d'1fi't:fud?t 2550; 16(6):
943-50.
13. Sirimal K, Sutchritpongsa P, Chaisilwattana P. Relationship between human papilloma
virus infection and abnormal pap smear in H|V-seropositive women at Siriraj
hospital. J Med Assoc Thai 2003; 86: 897-902.
14.Maiman M, Fruchter RG, Seror E. Prevalence of human immunodeficiency virus in
a colposcopy clinic. J Am Med Assoc 1988; 260: 2214-5.
l5.Deerasamee S, Martin N, Sontipong S.Cancer in Thailand 1992-1994, IARC
Technical Report No.34. Lyon: IARC; 1999. p. 56-9.
t 6. ilur::ru firurTryqrrfirr. rJqq-uiifrnmrufrufiuifniunr:ul6uuriln{ro.:runrdaufirq
.oda8vaJvor.l,nrunariluanSfinrfiarazloi fianrriudr:rrtu:rq:. ?T6n:n?unilI:n 2s49;32 1G9.
17.Massad LS, Ahdieh L, Benning L, Minkoff H, Greenblatt RM, Watts H, et al.
Evolution of cervical abnormalities among women with HIV-1: evidence from
surveillance cytology in the women's interagency HIV study. J Acquir lmmune
Defic Syndr 2001; 27: 432-42.
lS.Palefsky JM, Minkoff H, Kalish LA, Levine A, Sacks HS, Gracia P, et al.
fi anrsnsin!sti,rilrnln gnluanSfi fi nrdotodoi'l:lnallrana::rirJ:;lrYnifld e au"ud 2 il.n.-d.Fr. 2b52Smffi in women lnfected with HIV in
Cervicovaginal human papillomavirus infection in human immunodeficiency virus-1
(HlV)-positive and high risk HlV-negative women. J Natl Cancer lnsdt 1999; 91:
226-36.
r s. d.rurrX rntufifi:4a. nlrrfinraul:nnrulurdaqilrnuorqnravsJsLS.:rJrnruoqn'[u
6n1un1:nififinr:uni:ru1nfla.:L{arattai. rriuniunit?{d1: 2548i 20(1): 48-53.
20. Moscicki AB, Shiboski S, Broering J, Powell K, Clayton L, Jay N, et al. The natural
histology of human papillomavirus infection as measured by repeated DNA testing
in adolescent and young women. J Pediatr 1998; 132: 277-84'
21.Ho GY, Bierman R, Beardsley L, Chang CJ, Bush RD. Natural histology of
ceruico-vaginal papillomavirus infection in yong women.N Eng J Med 1998; 338: 423-8.
n1fl.:d 1 9Jan1:61:?A PAP smear LLAs:v61:Un?1il?Utt:.:?lo{Tagl:Fl
oJo S6{Fl:llFrFrtto Hlv
a-fu ,o Adgr:nLilFrntza Hlv
aflufus P value.ituru15aaavl 'irurulSaetav;
9{an:?a PAP smear
ruailnfi
r.rafionlnfi
Fl?'l u?U LLT{? O\::A UITn
AGC-Endocervical
ASCUS
ASC-H
LSIL
HSIL
SCCA
105(75.5)
34(24.5)
3(2.2\
15(10.8)
2(1.4)
5(3.6)
8(5.8)
1(0.7)
132(95.0)
7(5.0)
1(0.7)
6(4.3)
0(0)
0(0)
0(0)
0(0)
<0.001
0.041
c,v(d?TTnilTgtlin$t?Ud1t dqqr rinufrndfiqlq, qnfra riorfrarrinsd, aYqdnr uE.rud, oin6ur nrfia, niqar nrioarnor 'l 'l $
J.Fl1T',r\:fi 2
',JAfllTn:?A PAP smear Q1$Unn1ilnnilO1Uqq
aJ^ AdFl:ilolFtr?fa Hlv
a-h ,^ A619l:11tilnFtrflO Hlv
o1q(fl) r.rafinrlnfi ruar.lnfi r.rafiorlnfi aiailnfi P value
iiruruliaanry,irurultoana; drurulfaunr; riruruliaanr;
(zo 1(50.0) 1(s0.0) 0(0) 2(100.0) 0.001
21-30 8(33.3) 16(66.7) 0(0) 24(100.0) (resression)
31-40 12(24.5) 37(75.5) 1 (2.0) 48(e8.0)
41-50 11(22.4) 38(77.6) 5(10.2) 44(8e.8)
51-60 2('13.3) 13(86.7) 1 (6.7) 14(e3.3)
!{X,vr-m1T1{n 3 r.ran1TF|T?SUULUAU1nNnAn UAs :tALn21ilTU[LT{?A{TAflL:n
aJ^ A aok,^ X
d.nuruy flfl5frnnlza Hlv dnJylLil0i.ryda Hlv p vatuea1u?u(Tounv) a1u?lr(:oflas)
^A,{anT?a?Iutu0!1nilnnn
ruarjnfi 10(35.7) 6(60.0) 0.168
atafinrlnfi 18(64.3) 4(40.0)
n?1il:UL[:{?4.::OflITn
HS|L 11(39.3) 2(20.0) 0.664
crs 4(14.3) 1(10.0)
sccA 3(10.7) 1 (10.0)
n1:1.rfi 4 ara n1:Fr:aodurdarlr n il na nd1 LLun n1il nai ilo1 ?l{qq
aorififinr{a urv aorSfikifiorr{a utv
a1q(fl) runfiorrlnfi ruailnfi arnfiprrlnfi ruarlnfi P value
drurul5aaa:;,i'rurulSouar; a:ru:u1iaua11 .iTurulioan;1
31-40 4(66.7) 2(33.3) 1 (100.0) 0(0) 0.841
41-50 8(53.3) 7(46.7) 2(25.0) 6(75.0) (resression)
51-60 6(85.7) 1 (14.3) 1 (100.0) 0(0)