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

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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

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lul:.:narurnar::ri'il:strinri ? rn:ryvirGetutfi au nmiltn uas:c6ir

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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$t2td1? rfiqqr rYauf;ndiqlry, qnio GariorirwJ, niqdnr ug+,6, oinf,ur nrfio. aiqnr ndaunor I Q$

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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 ,:

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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

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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

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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

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ilaQn (Papanicolaou smear : PAP smear)d.^Alts^d

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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

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a dr.,r fi ria dr 6'runr.:4fi 6 (P-value < o.o5) (1 s'1 6)

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ilrnrunan ludFrsyr0{nrta HIV tu:uutmuunuq

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ilrnrnnn [udn-Yranrto HIVq

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(Retrospective cohort study) Inunr::ru:rtJ

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tynAilFt?Udnn Exact probability test,

I

Wilcoxon's ranksum test uaseLn:rvfi'nrrru' l9

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Ltn n Fi1\11 a{ Ltu? Luil n'l:?lu n?lil rJ au fl n n1 il

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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)

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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;

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HSIL) Saerns 5.8 (8:1u) tLasiJstS.:ilrnrunan

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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)

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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

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n:?at'{un?1ufi nrjn61fint:uriarq ot tlqufitd.rdlarA

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iaaac 66.7 LLav 'dr.:ars ar 6.: so fl SocrasJaolu,^Aa:

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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

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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 ,

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d, s d6l?:?nilTgt15nUL?td1l' tfiqryr fiorufindfiqlq, qnfru riori'uroinsd, aiq{or uslrr6, sindur nrfia, aiqar nciaunar 'l 'l p

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( P <0. oo 1 ) d a n n fr a.: ri'tt :'t u.,t 1 uyY{'Lu Lta v!oa

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q

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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.,:

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fi nrrrusna.:n'iranifihifi nrd'a Htv urf,rq{

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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 ,-

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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)