RESUMEN
With heterosexual transmission of HIV becoming the primary mode of transmission to women in the USA, and a high rate of human papillomavirus (HPV) and cervical neoplasia in HIV-infected women, obstetrician-gynecologists have become primary care providers for HIV-infected women. Reports of a high rate of recurrence and progression of cervical neoplasia in this population suggest that gynecologists must strive to identify those women with cervical neoplasia who are HIV infected. Alterations in local immune response of the genital tract caused by HIV infection may be responsible for higher prevalence, recurrence rates, and progression rates of cervical neoplasms in these women. Since cervical cancer may have a more fulminant course in HIV-infected women and has become an AIDS-defining illness, the surveillance and treatment of cervical neoplasia may need to be more aggressive.
Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , VIH-1 , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Infecciones Tumorales por Virus/complicaciones , Infecciones Tumorales por Virus/diagnóstico , Enfermedades del Cuello del Útero/complicaciones , Enfermedades del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/complicaciones , Displasia del Cuello del Útero/diagnóstico , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/diagnóstico , Antivirales/uso terapéutico , Colposcopía , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/terapia , Infecciones por VIH/transmisión , Humanos , Tolerancia Inmunológica , Tamizaje Masivo/métodos , Papillomaviridae/clasificación , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/terapia , Recurrencia , Factores de Riesgo , Sensibilidad y Especificidad , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/terapia , Enfermedades del Cuello del Útero/epidemiología , Enfermedades del Cuello del Útero/terapia , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/terapia , Frotis Vaginal , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/terapiaRESUMEN
A Connecticut insurance company adopted a policy prohibiting smoking in all work areas. Three months later, the authors assessed smoking behavior changes and attitudes of a sample of 1,210 employees, 56.6 percent of the total. The survey showed that the policy of no smoking in the work areas did not markedly affect smoking cessation, that it reduced cigarette consumption for those who continued to smoke, that those who previously smoked most were most likely to reduce consumption, and that despite negative feelings about the policy by smokers, only 29 percent of smokers and 4 percent of nonsmokers wanted a worksite smoking policy eliminated. During the 1-year prepolicy period, smoking prevalence decreased from 25.2 percent to 23.6 percent of the sample. During the 3-month postpolicy period, smoking prevalence decreased to 22.0 percent. During the prepolicy period, consumption did not change significantly (from 0.99 to 0.95 packs per day) and few smokers increased (11 percent) or decreased (13 percent) consumption. During the postpolicy period, consumption decreased by 32 percent to 0.67 packs per day, and 12 times as many smokers decreased (44 percent) as increased (3.5 percent) consumption. Of those who smoked at least two packs per day, 93 percent smoked less after the policy. Among nonsmokers, 70 percent thought the policy had a positive overall effect on the work environment, compared with 19 percent of smokers.