RESUMO
To determine factors that influence excision treatment outcome and recurrence of cervical squamous intraepithelial lesions (SIL) in women living with HIV infection, we analysed 1848 women who underwent excision treatment of cervical SIL at Tygerberg Hospital, Cape Town, South Africa. We compared treatment failure defined as presence of cervical intraepithelial neoplasia (CIN) I (presence of CIN I or higher at first follow-up after excision treatment) and post-excision recurrence of lesions (at one year or later) between women of HIV-positive, -negative or unknown status and examined factors associated with excision treatment outcome and recurrence. HIV-infected women experienced higher treatment failure than uninfected women (53.8% versus 26.9%, P < 0.001). At treatment failure, more HIV-infected women had low-grade squamous intraepithelial lesion (LSIL) compared with uninfected women (64.9% versus 37.3%, P < 0.001). Treatment failure did not differ with the type of excision used in HIV-infected women. HIV-infected women were more likely to experience recurrence of lesions after excision treatment than uninfected women (hazard ratio 1.95, 95% confidence interval [CI] 1.59-2.39; P < 0.001). Antiretroviral therapy (ART) initiated before excision biopsy had a strong protective effect against recurrence (hazard ratio 0.70, 95% CI 0.55-0.89; P = 0.006). Our data suggest that women with cervical SIL initiated on ART earlier may be expected to have better long-term excision treatment outcome. Close follow-up should be maintained after cervical excision treatment, especially in a setting of high HIV prevalence.
Assuntos
Antirretrovirais/administração & dosagem , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Displasia do Colo do Útero/complicações , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/virologia , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Recidiva , Estudos Retrospectivos , África do Sul/epidemiologia , Estatísticas não Paramétricas , Resultado do Tratamento , Neoplasias do Colo do Útero/epidemiologia , Displasia do Colo do Útero/epidemiologiaAssuntos
Sorodiagnóstico da AIDS/legislação & jurisprudência , Direitos Civis/legislação & jurisprudência , Emprego/legislação & jurisprudência , Saúde Ocupacional/legislação & jurisprudência , Comitês Consultivos , Infecções por HIV/prevenção & controle , Humanos , Programas de Rastreamento/legislação & jurisprudência , África do SulRESUMO
A cross-sectional survey was carried out in order to study the relationship between Kashin-Beck disease and drinking water. The average volume of the water containers was larger in families unaffected by the disease. Organic material was measured by ultraviolet (UV) spectroscopy. The UV absorbency was significantly lower in drinking water of unaffected families. Thus, the organic material in drinking water may play a role in the pathogenesis of Kashin-Beck disease.
Assuntos
Osteoartrite/epidemiologia , Abastecimento de Água , Estudos Transversais , Humanos , Fatores de Risco , Tibet/epidemiologiaAssuntos
Sorodiagnóstico da AIDS/legislação & jurisprudência , Emprego/legislação & jurisprudência , Pessoal de Saúde/legislação & jurisprudência , Programas de Rastreamento/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Sociedades Médicas , África do SulRESUMO
Bedletters of 100 diagnosed cases of tuberculosis from Kalafong Hospital, Pretoria, were reviewed retrospectively. All patients were followed up to evaluate treatment and notification. An overall treatment failure rate of 13% was recorded, mainly due to non-compliance by patients referred to clinics. There was an undernotification rate of at least 48%.