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"This book is meant to provide a complete overview of the research of HPV and its connection to cervical cancer."

"ABSTRAKPenyebab utama kanker serviks adalah infeksi virus yang di kenal dengan Human papillomaviruses HPV. Salah satu upaya pencegahan kanker serviks di Indonesia dilakukan dengan imunisasi HPV sejak dini. Imunisasi HPV untuk anak dilakukan sejak tahun 2016. Hasil menunjukan terdapat pro dan kontra dari orangtua siswi dalam pelaksanaan perdananya. Penelitian ini bertujuan untuk mengetahui adakah hubungan antara faktor pengetahuan orangtua terkait kanker serviks dengan motivasi situasional orangtua terhadap imunisasi HPV tersebut. Desain penelitian yang digunakan adalah potong lintang. Sampel penelitian ini adalah orangtua siswi. Sebanyak 238 responden dipillih menggunakan consecutive sampling. Hasil analisis penelitian menunjukan terdapat hubungan antara tingkat pengetahuan terkait kanker serviks dengan motivasi situasional orangtua terhadap imunisasi HPV anak p=0,046; ?=0,05. Berdasarkan hasil penelitian diperlukan suatu upaya peningkatan pengetahuan tentang kanker serviks sehingga dapat meningkatkan motivasi orangtua terhadap imunisasi HPV.

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ABSTRACTThe main cause of cervical cancer is a viral infection that is known as Human papillomaviruses HPV . One of the solution to prevent cervical cancer in Indonesia is done by immunization of HPV. HPV immunization for children has been done since 2016. The results show there are pros and cons from parents in fields. This research aims to determine whether there is a correlation between knowledge factors of parents related to cervical cancer with situational motivation of parents to HPV immunization. The research design used is cross sectional. The sample of this research are parents of girls. A total of 238 respondents were selected using consecutive sampling. The result of the research analysis showed that there was a correlation between cervical cancer knowledge level with parental situational motivation toward childhood HPV immunization p 0,046 0,05. The result of this study suggest the need for increase parents knowledge about cervical cancer that can affects parent 39s motivation for HPV immunization. "

"ABSTRAKLatar Belakang: Persistensi infeksi HPV onkogenik merupakan penyebab kanker serviks. Retinol sebagai mikronutrien antioksidan memiliki peran esensial dalam sistem imun mencegah persistensi. Retinol memodulasi sel T CD4+/CD8+ serta produksi sitokin. Tumor Necrosis Factor-Alpha (TNF-) adalah sitokin pro-inflamasi yang mampu mengendalikan HPV, namun pada infeksi persisten TNF- justru memicu karsinogenesis. Rasio sel T CD4+:CD8+ dan TNF- yang adekuat di awal infeksi HPV merupakan titik kunci klirens. Penelitian ini bertujuan untuk mengetahui tingkat kecukupan deposit retinol, ekspresi TNF-, dan rasio sel T CD4+:CD8+ pada kelompok serviks normal, infeksi subklinis HPV klirens, persisten, dan kanker serviks.Metode: Tingkat kecukupan deposit retinol diketahui berdasarkan pemeriksaan darah perifer dengan metode ELISA. Stimulasi spesifik epitop E6 HPV tipe 16 dilakukan pada sel sekret servikovaginal yang telah diinkubasi 24 jam, diamati ekspresi TNF- secara semikuantitatif dengan metode ELISpot. Pemeriksaan sel T CD4+ dan CD8+ dari sekret servikovaginal secara kuantitatif dengan metode flowsitometri.Hasil: Deposit retinol yang cukup pada kelompok serviks normal, infeksi subklinis HPV klirens, persisten, dan kanker serviks berturut-turut adalah 85%, 75% (OR 1,89), 33,3% (OR 11,33), dan 75% (OR 1,89). Ekspresi TNF- pada kelompok serviks normal adalah 10%, sedangkan kanker serviks 75% (OR 27,00; p<0,001). Tidak tampak ekspresi TNF- pada kelompok infeksi subklinis HPV klirens dan persisten. Rasio sel T CD4+:CD8+ yang tinggi pada kelompok serviks normal adalah 10% dan kanker serviks 25% (OR 0,33). Tidak terdapat rasio sel T CD4+:CD8+ yang tinggi pada kelompok infeksi subklinis HPV klirens (OR 1,22) dan persisten (OR 0,95). Tidak terdapat hubungan bermakna antara tingkat kecukupan deposit retinol dengan ekspresi TNF- (p=0,147), tingkat kecukupan deposit retinol dengan rasio sel T CD4+:CD8+ (p=0,726), dan rasio sel T CD4+:CD8+ dengan ekspresi TNF- (p=0,690).Kesimpulan: Penelitian ini mampu membuktikan bahwa tingkat kecukupan deposit retinol tertinggi dijumpai pada kelompok serviks normal dan ekspresi TNF- tertinggi pada kelompok kanker serviks (OR 27,00; p<0,001). Tingkat kecukupan deposit retinol terendah bukan pada kelompok kanker serviks, melainkan pada infeksi subklinis HPV persisten (OR 11,33). Tidak terdapat perbedaan bermakna pada tingkat kecukupan deposit retinol dan rasio sel T CD4+:CD8+. Terdapat perbedaan bermakna pada ekspresi TNF- antara kelompok kanker serviks dengan serviks normal (p<0,001), kanker serviks dengan infeksi HPV subklinis klirens (p=0,024), dan klirens dengan persisten (p=0,007). Tidak terdapat perbedaan bermakna ekspresi TNF- antara kelompok kanker serviks dengan infeksi HPV subklinis persisten (p=0,058). Tidak bermaknanya beberapa hasil terkait imunitas masih mungkin dikarenakan tingkat kecukupan deposit retinol kelompok kanker serviks pada penelitian ini sangat baik dimana bertentangan dengan kepustakaan.

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ABSTRACT

Background: Persistency of oncogenic-HPV infection is the cause of cervical cancer. Retinol is one of antioxidant micronutrients that plays essential roles in immune system to prevent the persistency by modulating CD4+ and CD8+T cells and cytokines production. Tumor Necrosis Factor-Alpha (TNF-) is an acute pro-inflammatory cytokine which has many crucial roles in controlling HPV. In contrast, when persistent infection occurs, TNF- induces carcinogenesis. Ratio of CD4+:CD8+ T cells and adequate TNF- production in acute HPV infection are keypoints for clearance. The aim of this research is to analyze sufficency level of retinol deposit, expression of TNF-, and ratio of CD4+:CD8+ T cells in normal cervix, clearance and persistent HPV subclinical infection, and cervical cancer group.

Methods : Sufficiency level of retinol deposit was analyzed from peripheral blood by ELISA method. The cervicovaginal secretions which had 24 hours incubated were stimulated specifically by E6 epitope HPV type-16, measuring TNF- expression semiquantitatively by ELISpot method and CD4+/CD8+ T cells quantitatively by flowcytometry method.

Results: Sufficient level of retinol deposit in normal cervix, clearance HPV subclinical infection, persistent, and cervical cancer group was 85%, 75% (OR 1.89), 33.3% (OR 11.33), and 75% (OR 1.89), respectively. The expression of TNF- in normal cervix group was 10%, while in cervical cancer was 75% (OR 27.00; p<0.001). There were no expression in clearance and persistent HPV subclinical infection groups. High ratio of CD4+:CD8+ T cells in normal cervix and cervical cancer group was 10% and 25% (OR 0.33). There were no high ratio of CD4+:CD8+ T cells in clearance (OR 1,22) and persistent (OR 0.95) HPV subclinical infection groups. There was no significant correlation between sufficiency level of retinol deposit and TNF- expression (p=0.147), sufficiency level of retinol deposit and ratio of CD4+:CD8+ T cells (p=0.726), ratio of CD4+:CD8+ T cells and TNF- expression (p=0.690).

Conclusions: This study was able to prove that normal cervix group has the highest retinol deposit sufficiency level and cervical cancer group has the highest TNF- expression (OR 27,00; p<0,001). The lowest of retinol deposit sufficiency level was not in cervical cancer, but in persistent HPV subclinical infection group (OR 11.33). There was no significant correlation in sufficiency level of retinol deposit and ratio of CD4+:CD8+ T cells. There was significant correlation in TNF- expression between cervical cancer and normal cervix (p<0.001), cervical cancer and clearance subclinical HPV infection (p=0.024), and between clearance and persistent group (p=0.007). There was no significant correlation in TNF- expression between cervical cancer and persistent subclinical HPV infection group (p=0.058). Not significant some results related immunity that might be due to retinol deposit sufficiency level in cervical cancer group in this study was very good, which conflicted with literatures."

"Kanker serviks adalah salah satu jenis kanker pada wanita yang paling umum di seluruh dunia. Human papillomavirus (HPV) merupakan salah satu jenis virus yang menjadi penyebab utama kanker serviks dengan jumlah setidaknya 70% dari seluruh kasus yang ada dan didominasi oleh serotipe 16 dan 18. Protein E6 adalah sebuah protein pada HPV yang dapat menyebabkan degradasi p53 akibat proses ubiquitinisasi yang diaktifkan dari pembentukkan sebuah trimetrik kompleks protein E6, p53 dan E6AP sehingga menghasilkan sebuah sel kanker. Inhibisi protein E6 dapat dilakukan untuk pencegahan kanker serviks. Dalam penelitian ini, senyawa SSYA10- 001 yang telah terbukti secara in vitro dapat menginhibisi protein E6 dilakukan modifikasi menggunakan organoboron dengan menggunakan metode in silico. Pada tahapan molecular docking, digunakan aplikasi MOE 2014.09 untuk mendapatkan informasi mengenai interaksi antara protein-ligan. Setelah dilakukan analisis energi pengikatan dan uji farmakologi serta dibandingkan dengan sebelum modifikasi, diperoleh 4 ligan modifikasi terbaik untuk masing-masing serotipe. Untuk serotipe 16, diperoleh mseq 82, 68, 76, dan 49 dengan energi ikatan masing-masing -7,3892 kkal/mol, -7,3456 kkal/mol, -7,3122 kkal/mol, dan -7,2373 kkal/mol. Sedangkan untuk serotipe 18, diperoleh mseq 95, 69, 76, dan 68 dengan energi ikatan masing-masing - 6,2324 kkal/mol, -6,1602 kkal/mol, -6,0606 kkal/mol, dan -6,0266 kkal/mol. Hal ini menunjukkan peningkatan yang signifikan dalam energi ikatan dan jumlah interaksi yang lebih tinggi dibandingkan sebelum modifikasi, dengan nilai energi ikatan sebelumnya -5,6250 kkal/mol untuk serotipe 16 dan -4,6169 kkal/mol untuk serotipe 18.

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Cervical cancer is one of the most common types of cancer in women worldwide. Human papillomavirus (HPV) is a virus that primarily responsible for at least 70% of all cases, with serotypes 16 and 18 being the dominant ones. The E6 protein, found in HPV, can induce the degradation of p53 protein through the ubiquitination process, which is activated by forming a trimetric complex involving E6 protein, p53, and E6AP, resulting in the formation of cancer cells. Inhibiting the E6 protein can be done for cervical cancer prevention. In this study, the compound SSYA10-001, which has been proven to inhibit the E6 protein in vitro was modified using boron compound through in silico methods. The molecular docking stage utilized the MOE 2014.09 application to obtain information regarding the interaction between the protein and ligands. After analyzing the binding energy and conducting pharmacological tests, the top four modified ligands were obtained for each serotype. For serotype 16, the mseq 82, 68, 76, and 49 were obtained with energy binding values of -7.3892 kcal/mol, -7.3456 kcal/mol, -7.3122 kcal/mol, and -7.2373 kcal/mol, respectively. Meanwhile, for serotype 18, the mseq 95, 69, 76, and 68 were obtained with energy binding values of -6.2324 kcal/mol, -6.1602 kcal/mol, -6.0606 kcal/mol, and -6.0266 kcal/mol, respectively. This indicates a significant improvement in energy binding and a higher number of interactions compared to before modification, where the energy binding values were -5.6250 kcal/mol for serotype 16 and -4.6169 kcal/mol for serotype 18."

"ABSTRAKLatar belakang: Human papillomavirus (HPV) merupakan etiologi kanker serviks dan kanker oral. Berbeda dengan kanker serviks, data infeksi HPV oral di Indonesia belum diketahui. Prevalensi infeksi HPV oral yang pernah diteliti pada populasi normal sebesar 1,3−9,2% dan meningkat pada pasien dengan infeksi HPV serviks (18,1%). Tujuan: Mengetahui prevalensi infeksi HPV oral pada pasien kanker serviks dan distribusi tipe HPV, serta mengevaluasi faktor yang berperan dalam terjadinya infeksi. Metode: Penelitian desain potong lintang pada 30 subjek penelitian kanker serviks. Dilakukan pengambilan sampel dari rongga mulut dan orofaring dengan menggunakan brushing untuk mendeteksi DNA HPV dengan nested-PCR elektroforesis dilanjutkan pemeriksaan genotyping HPV metode hibridisasi. Hasil: Prevalensi infeksi HPV oral pada pasien kanker serviks 56,7% dengan tipe HPV risiko tinggi ditemukan 43,3%. HPV tipe 51, 16, dan 18 merupakan tipe HPV risiko tinggi yang paling sering ditemukan di mukosa oral. Tidak didapatkan lesi oral pada seluruh subjek penelitian. Terdapat 1 subjek yang mempunyai tipe HPV yang sesuai antara oral dan serviks (11,1%). Simpulan: Hasil prevalensi infeksi HPV oral yang tinggi menunjukkan perlunya deteksi infeksi HPV oral dan mengetahui faktor risiko yang berhubungan dengan infeksi, serta perkembangannya dalam proses keganasan.

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ABSTRACTBackground: Human papillomavirus (HPV) is an etiologic agent for both oropharyngeal and cervical cancers. In contrast to cervical cancer, the data of oral HPV infection in Indonesia is not yet known. The prevalence of oral HPV infection in normal population is about 1,3−9,2% and increase in patients with cervical infection (18,1%). Objective: To evaluate the prevalence and type distributions of oral HPV infections in patients with cervical cancer, and evaluate the risk factor which contribute to its occurrence. Methods: Cross-sectional study on 30 subjects, previously diagnosed with cervical carcinoma. Oral mucosal cells were collected by brushing from their oropharyngeal area. HPV DNA detection was caried out using nested-PCR and the HPV Genotyping (HPV genoflow array test). Results: The prevalence of oral HPV infection of patients with cervical cancer is 56,7%, the high-risk HPV type prevalence is 43,3%. The HPV high risk 51, 16 and 18 were most found in oral mucosa. Clinically healthy oral mucosa without any lession was observed in all cases. Only one subject has same HPV type in oral and cervical mucosa (11,1%). Conclusion: Results show a high prevalence of oral HPV infection. It is important to detect HPV in oral and the risk factors associated with infection and progression to malignancy."

"[ABSTRAKHuman Papilloma Virus (HPV) merupakan penyebab infeksi menular seksual yang paling sering di dunia. HPV genital berdasarkan potensi onkogeniknya terdiri dari low risk HPV (lr-HPV) dan high risk HPV (hr-HPV). Kondiloma akuminata merupakan penyakit menular seksual yang disebabkan oleh HPV dan memiliki angka morbiditas paling tinggi di seluruh dunia termasuk di RS Cipto Mangunkusumo. Sebagian besar kondiloma akuminata disebabkan oleh lr- HPV, tetapi dewasa ini diketahui terdapat proporsi infeksi hr-HPV yang cukup besar pada kondiloma akuminata. Infeksi hr-HPV pada kondiloma akuminata merupakan salah satu faktor risiko terjadinya keganasan anogenital. Penelitian ini bertujuan untuk mendapatkan proporsi hr- HPV serta HPV 16 dan 18 pada lesi kondiloma akuminata atipikal regio anogenital di RS dr. Cipto Mangunkusumo dengan metoda Real Time Polymerase Chain Reaction (PCR). Dilakukan pemeriksaan PCR terhadap 21 lesi kondiloma akuminata atipikal dari 20 subyek penelitian. Hasil pemeriksaan mendapatkan proporsi hr-HPV sebesar 42,9% (9 dari 21 lesi) serta proporsi HPV 16 dan 18 sebesar 23,8% (5 dari 21 lesi).

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ABSTRACTHuman papillomavirus (HPV) is the most common cause of sexually transmitted disease in the world. In accordance to its oncogenic property, genital HPV is known to be low risk HPV (lr-HPV) and high risk HPV (hr-HPV). Condyloma acuminata is a sexually transmitted disease caused by HPV and has a high morbidity worldwide including in Cipto Mangunkusumo National Hospital. Most of condyloma acuminata caused by lr-HPV, although recently findings revealed a high proportion of hr-HPV in condyloma acuminata. Infection of hr-HPV in condyloma acuminata is one of risk factor for anogenital malignancy. This study aimed to obtain the proportion of hr-HPV in atypical lesion of condyloma acuminata in anogenital region at Cipto Mangunkusumo National Hospital with Real Time Polymerase Chain Reaction (PCR). Real Time PCR was conducted on 21 atypical lesion from 20 subject. The proportion of hr-HPV from those lesions was 42,9% and HPV 16/18 was 23,8%. ;Human papillomavirus (HPV) is the most common cause of sexually transmitted disease in the world. In accordance to its oncogenic property, genital HPV is known to be low risk HPV (lr-HPV) and high risk HPV (hr-HPV). Condyloma acuminata is a sexually transmitted disease caused by HPV and has a high morbidity worldwide including in Cipto Mangunkusumo National Hospital. Most of condyloma acuminata caused by lr-HPV, although recently findings revealed a high proportion of hr-HPV in condyloma acuminata. Infection of hr-HPV in condyloma acuminata is one of risk factor for anogenital malignancy. This study aimed to obtain the proportion of hr-HPV in atypical lesion of condyloma acuminata in anogenital region at Cipto Mangunkusumo National Hospital with Real Time Polymerase Chain Reaction (PCR). Real Time PCR was conducted on 21 atypical lesion from 20 subject. The proportion of hr-HPV from those lesions was 42,9% and HPV 16/18 was 23,8%. , Human papillomavirus (HPV) is the most common cause of sexually transmitted disease in the world. In accordance to its oncogenic property, genital HPV is known to be low risk HPV (lr-HPV) and high risk HPV (hr-HPV). Condyloma acuminata is a sexually transmitted disease caused by HPV and has a high morbidity worldwide including in Cipto Mangunkusumo National Hospital. Most of condyloma acuminata caused by lr-HPV, although recently findings revealed a high proportion of hr-HPV in condyloma acuminata. Infection of hr-HPV in condyloma acuminata is one of risk factor for anogenital malignancy. This study aimed to obtain the proportion of hr-HPV in atypical lesion of condyloma acuminata in anogenital region at Cipto Mangunkusumo National Hospital with Real Time Polymerase Chain Reaction (PCR). Real Time PCR was conducted on 21 atypical lesion from 20 subject. The proportion of hr-HPV from those lesions was 42,9% and HPV 16/18 was 23,8%. ]"

"Infeksi Human Papillomavirus (HPV) adalah infeksi menular seksual yang sering terjadi pada perempuan yang aktif secara seksual yang dapat menyebabkan kanker serviks. Tujuan penelitian ini untuk mengidentifikasi hubungan antara pengetahuan, keyakinan, dan perilaku seksual perempuan dengan pencegahan penularan HPV. Penelitian cross-sectional ini menggunakan teknik convenience sampling dengan 649 responden perempuan usia reproduktif yang menikah atau pernah menikah. Hasil penelitian menunjukkan bahwa hubungan antara pengetahuan, keyakinan, dan perilaku seksual dengan pencegahan penularan HPV mempunyai hubungan yang signifikan secara statistik. Pengetahuan merupakan variabel paling dominan mempengaruhi pencegahan penularan HPV (r = 0,174) dengan nilai p value < 0,001, semakin tinggi pengetahuan maka semakin tinggi pula melakukan pencegahan. Keyakinan terhadap penularan HPV, perilaku seksual yang sehat, dan pengetahuan tentang pencegahannya dapat mengurangi prevalensi penularan HPV sehingga meningkatkan kesehatan perempuan secara umum, selain itu dengan memberikan pendidikan/edukasi serta menghindari faktor resiko, deteksi dini, dan melakukan pemeriksaan organ reproduksi secara berkala merupakan faktor kunci untuk mencegah penularan HPV

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Infection of Human Papillomavirus (HPV) is a sexually transmitted disease that often occurs in sexually active women that can cause cervical cancer. The objective of this research was to identify the relationships of knowledge, belief, and sexual behavior of women with HPV infection prevention.This cross-sectional study used convenience sampling to recruit 649 women in reproductive age who are married or have ever been married. The results showed statistically significant relationship between knowledge, belief, and sexual behavior and HPV infection prevention. Knowledge was found to be the most dominant variable affecting the prevention of transmission of HPV (r = 0.174) with p value < 0,001. The higher the level of knowledge, the higher the prevention effort. The belief of HPV, healthy sexual behavior, and knowledge about its prevention are likely to reduce the prevalence of HPV infection and thus improving women's health in general. In addition, improving health education as well as avoiding the risk factors, early detection, and routine examination of the reproductive organs are the key factors to prevent the transmission of HPV."

"Salah satu jenis kanker yang paling umum diderita perempuan di Indonesia adalah kanker serviks dan dapat dicegah melalui vaksin HPV.  Pengetahuan tentang vaksin HPV yang rendah dan keyakinan yang keliru tentang kanker serviks dapat menurunkan tingkat vaksinasi HPV. Penelitian kuantitatif deskriptif ini bertujuan untuk mengidentifkasi gambaran pengetahuan dan keyakinan kesehatan terkait kanker serviks, HPV, dan vaksin HPV pada mahasiswa dengan melibatkan 210 responden yang dipilih dengan teknik quota sampling. Instrumen penelitian ini termasuk kuesioner data demografi, dan terjemahan dari Health Belief Model Scale for Human Papilloma Virus and Its Vaccination. Hasil penelitian ini menunjukkan 91,4% responden belum divaksin HPV, 74,8% mempunyai pengetahuan yang baik terhadap kanker serviks, HPV, dan vaksin HPV. Mayoritas responden mempunyai pemahaman yang baik terhadap kanker serviks, HPV, dan vaksin HPV, tetapi masih banyak responden yang meragukan kemanan dan efektivitas dari vaksin HPV. Promosi dan sosialisasi terkait fakta-fakta dan ketersediaan vaksin HPV diperlukan untuk meningkatkan kesadaran dan vaksinasi HPV guna mencegah terjadinya kanker serviks.

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One of the most common cancers among women in Indonesia is cervical cancer, which can be prevented through the HPV vaccine.  Low knowledge about the HPV vaccine and false beliefs about cervical cancer can reduce HPV vaccination rates. This descriptive quantitative study aimed to identify the picture of knowledge and health beliefs related to cervical cancer, HPV, and HPV vaccine in university students by involving 210 respondents selected by quota sampling technique. The research instruments included a demographic data questionnaire, and a translation of the Health Belief Model Scale for Human Papilloma Virus and Its Vaccination. The results showed 91.4% of respondents had not been vaccinated against HPV, and 74.8% had good knowledge of cervical cancer, HPV, and the HPV vaccine. The majority of respondents have a good understanding of cervical cancer, HPV, and the HPV vaccine, but there are still many respondents who doubt the safety and effectiveness of the HPV vaccine. Promotion and socialization of the facts and availability of the HPV vaccine are needed to increase awareness and HPV vaccination to prevent cervical cancer."

"Pendahuluan: Penelitian ini bertujuan untuk mengetahui hubungan antara jumlah CD4, infeksi HPV, faktor risiko, dan terjadinya lesi prakanker pada pasien terinfeksi HIV.Metode: Studi potong-lintang ini dilakukan di Rumah Sakit Umum Dr. Cipto Mangunkusumo, Indonesia. 80 subjek penelitian dikumpulkan dari bulan Juli-Oktober 2021. Data subjek penelitian dikumpulkan menggunakan kuesioner terstruktur, meliputi usia, pendidikan, paritas, inisiasi seksual dini, jumlah pasangan seksual, riwayat merokok, riwayat kontrasepsi oral, riwayat penyakit menular seksual, dan jumlah CD4 terendah. Pemeriksaan sitologi, kolposkopi, dan tes HPV-DNA dilakukan pada seluruh subjek penelitian, dan 11 subjek melakukan pemeriksaan lanjutan histopatologi karena ditemukan abnormalitas pada pemeriksaan awal. Penginputan dan analisis data dilakukan dengan menggunakan IBM SPSS versi 25. Analisis bivariat, perhitungan odd ratio dan p value dilakukan untuk mengidentifikasi jumlah CD4, HPV-DNA, dan faktor risiko yang terkait dengan lesi prankanker serviks.Hasil: Dari data penelitian didapatkan bahwa 81,2% memiliki jumlah CD4 yang baik, dengan rata-rata jumlah CD4 sebesar 437,05 sel/mm3. Sebagian besar subjek memiliki HPV-negatif; namun, terdapat 22,2% subjek yang diketahui HPV-positif, memiliki lesi prakanker. Penelitian kami juga menemukan bahwa jumlah CD4 (p=0,01, OR 7,625; CI 95% 1,744-33,331) dan HPV-DNA (p<0,01, OR 12,286; CI 95% 1,456–103,65) secara signifikan berhubungan dengan lesi prakanker serviks. Kami juga menemukan korelasi antara inisiasi seksual dini dan hasil sitologi (p=0,05, OR 6,4; CI 95% 1,1306–36,2292).Kesimpulan: Jumlah CD4 yang rendah dan HPV-DNA positif berhubungan dengan perkembangan lesi prakanker. Pasien terinfeksi HIV dengan jumlah CD4 rendah juga dikaitkan dengan hasil HPV-DNA positif. Inisiasi seksual dini, sebagai faktor risiko kanker serviks, diketahui meningkatkan hasil skrining yang tidak normal. Oleh karena itu, metode skrining co-testing direkomendasikan sebagai strategi untuk mencegah kanker serviks pada semua pasien terinfeksi HIV.

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Introduction: This study aimed to determine the association between CD4 count, human papillomavirus (HPV) infection, risk factors, and the occurrence of precancerous lesions among HIV-infected patients.

Methods: This cross-sectional study was conducted at the Dr. Cipto Mangunkusumo General Hospital, Indonesia. All samples were collected between July and October 2021, and 80 HIV-infected subjects were included in the study. All participant data were collected using a structured questionnaire, including age, education, parity, early sexual initiation, number of sexual partners, history of smoking, history of oral contraception, history of sexually transmitted diseases, and the lowest CD4 count. Cytological examination, Colposcopy, and HPV DNA tests were performed on all participants, and 11 subjects underwent biopsy due to abnormalities. Data entry and analysis were performed using IBM SPSS 25th version. Bivariate analysis was performed, and odds ratios and p-values were computed to identify the CD4 count, HPV DNA, and risk factors associated with histopathology results.

Results: Among the participants, 81.2% had a good CD4 count, with a mean CD4 count of 437.05 cells/mm3. Most of the subjects were HPV-negative; however, 22.2% of HPV-positive subjects had precancerous lesions based on histopathologic results. Our study found that CD4 count was correlated with precancerous lesions (p=0.01, OR 7.625; CI 95% 1.744-33.331) and HPV DNA was significantly associated with cervical precancerous lesions (p<0.01, OR 12.286; CI 95% 1.456–103.65). Another finding was the correlation between early sexual initiation and cytology results (p = 0.05, OR 6.4; CI 95% 1.1306–36.2292).

Conclusion: Low CD4 counts and HPV DNA positivity are associated with the development of precancerous lesions. HIV-infected patients with low CD4 counts were also associated with positive HPV DNA results. Early sexual initiation, as a risk factor for cervical cancer, was found to increase abnormal screening results. Therefore, co-testing screening methods are recommended as a strategy to prevent cervical cancer in all HIV-infected patients."