Quality of life in women with HPV and accurary of direct visual anal inspection with acetic acid and lugol compared to high-resolution anoscopy to diagnose intraepithelial anal lesion

Abstract Objectives: to describe life quality of women with HPV and analyze the accuracy of anal visual inspection with acetic acid and lugol compared to high-resolution anoscopy in the detection of anal intraepithelial lesions. Methods: diagnostic evaluation study conducted with adult solid-organ transplant recipients and/or diagnosed with HIV and/or with a history of anogenital neoplasia, attended at the High Resolution Anoscopy outpatient clinic between April and December 2018. To calculate the accuracy parameters, 87 women participated: 44 with lesions and 43 without them. The 44 women with lesions were also subjected to a descriptive study to assess their life quality using the SF-36 questionnaire. Results: it was observed that almost half of the women in the study practiced vaginal, anal and oral intercourse without condom. History of HPV infection and anogenital neoplasia were the most prevailing with percentages of 81% and 72.7%, respectively. In five out of the eight domains of SF-36 they did not perform well in regard to life quality. Visual inspection with acetic acid and lugol presented sensitivity of 22.7% and specificity of 100%. Conclusion: unsatisfactory life quality was evidenced. Direct visual inspection with acetic acid and lugol should not be used in trials to spot intraepithelial HPV lesions, for it presents low sensitivity.

摘要 研究目的：描述人乳头瘤病毒（Human Papillomavirus, HPV）感染女性的生活质量，并对比分析醋酸卢戈液肛门视诊（visual inspection with acetic acid and lugol）与高分辨率肛门镜检查（high-resolution anoscopy）在肛门上皮内病变（anal intraepithelial lesions）检测中的诊断准确度。方法：本研究为诊断性评估研究，研究对象为2018年4月至12月于高分辨率肛门镜检查门诊就诊的成年实体器官移植受者、人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）感染者以及有肛门生殖器肿瘤病史的女性。为计算诊断准确度参数，最终纳入87名女性受试者，其中44名确诊肛门上皮内病变，43名未患该病变。此外，针对44名确诊病变的女性，采用SF-36量表开展生活质量描述性研究。结果：研究观察到，近半数受试女性在进行阴道、肛门及口腔性行为时未采取安全套防护措施。HPV感染史与肛门生殖器肿瘤病史为受试者中最普遍的既往病史，检出率分别为81%与72.7%。在SF-36量表的8个维度中，有5个维度的生活质量评分表现不佳。醋酸卢戈液肛门视诊的诊断敏感度为22.7%，特异度为100%。结论：本研究证实受试女性的生活质量欠佳。醋酸卢戈液肛门视诊诊断敏感度较低，因此不应将其用于肛门上皮内HPV相关病变的筛查试验。