Franceschi Silvia, De Vuyst Hugo
International Agency for Research on Cancer, Lyon, France.
Curr Opin HIV AIDS. 2009 Jan;4(1):57-63. doi: 10.1097/COH.0b013e32831b9c81.
To explore the possible role of current prophylactic vaccines against human papillomavirus (HPV) in the prevention of anal intraepithelial neoplasia and squamous cell carcinoma of the anus (SCCA).
SCCA incidence is increasing in several developed countries, particularly in HIV-positive men who have sex with men (MSM). Antiretroviral treatments against HIV do not seem to decrease SCCA risk. A meta-analysis of 955 SCCA showed that HPV prevalence was 85%, i.e., similar to that in cervical carcinoma, with an even stronger predominance of HPV16. In addition, more than 90% prevalence of HPV was found in anal intraepithelial neoplasia. Trials of the bivalent and quadrivalent vaccines against HPV16/18 have shown nearly 100% efficacy against high-grade lesions of the cervix, vulva and vagina in uninfected women under 26 years of age. The quadrivalent vaccine that includes HPV6/11/16/18 has also shown high efficacy against anogenital warts.
Currently available HPV vaccines could potentially prevent the vast majority of SCCA, but only if administered before the onset of sexual activity. Answers to some still open questions, notably vaccine efficacy in men and HIV-infected individuals and willingness to expand vaccination programmes to both sexes, are essential to predict the ultimate impact of HPV vaccines on the prevention of cancerous and precancerous anal lesions.
探讨当前人乳头瘤病毒（HPV）预防性疫苗在预防肛门上皮内瘤变和肛门鳞状细胞癌（SCCA）中的可能作用。
在一些发达国家，SCCA的发病率正在上升，尤其是在男男性行为者（MSM）中的HIV阳性者。抗HIV的抗逆转录病毒治疗似乎并未降低SCCA风险。一项对955例SCCA的荟萃分析显示，HPV感染率为85%，即与宫颈癌相似，其中HPV16的优势更为明显。此外，在肛门上皮内瘤变中发现HPV感染率超过90%。针对HPV16/18的二价和四价疫苗试验表明，在26岁以下未感染的女性中，对宫颈、外阴和阴道的高级别病变的疗效接近100%。包含HPV6/11/16/18的四价疫苗对肛门生殖器疣也显示出高效。
目前可用的HPV疫苗有可能预防绝大多数SCCA，但前提是在性活动开始前接种。回答一些仍未解决的问题，特别是疫苗在男性和HIV感染者中的疗效以及将疫苗接种计划扩大到男女两性的意愿，对于预测HPV疫苗对预防肛门癌前病变和癌性病变的最终影响至关重要。
