与美国大量 HIV 感染成年人群中普遍存在异常肛门细胞学相关的因素。

Factors associated with prevalent abnormal anal cytology in a large cohort of HIV-infected adults in the United States.

机构信息

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

出版信息

J Infect Dis. 2010 Nov 15;202(10):1567-76. doi: 10.1086/656775. Epub 2010 Oct 6.

DOI:10.1086/656775

PMID:20925532

Abstract

BACKGROUND

The prevalence of and risk factors for abnormal anal cytology among men and women with human immunodeficiency virus (HIV) infection have not been extensively investigated.

METHODS

The Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN study) is a prospective cohort study of HIV-infected patients in 4 US cities. Baseline questionnaires were administered and anal samples for cytology and human papillomavirus (HPV) detection and genotyping were collected.

RESULTS

Among 471 men and 150 women (median age, 41 years), 78% of participants were receiving combination antiretroviral therapy, 41% had a CD4(+) cell count of ≥500 cells/μL, and 71% had an HIV RNA viral load of <400 copies/mL. The anal cytology results were as follows: 336 participants (54%) had negative results, 96 participants (15%) had atypical squamous cells, 149 participants (24%) had low-grade squamous intraepithelial lesions, and 40 participants (6%) had high-grade squamous intraepithelial lesions. In a multivariate analysis, abnormal anal cytology was associated with number of high-risk and low-risk HPV types (adjusted odds ratio [AOR] for both, 1.28; P < .001), nadir CD4(+) cell count of <50 cells/μL (AOR, 2.38; P = .001), baseline CD4(+) cell count of <500 cells/μL (AOR, 1.75; P = .004), and ever having receptive anal intercourse (AOR, 2.51; P < .001).

CONCLUSION

HIV-infected persons with multiple anal HPV types or a nadir CD4(+) cell count of <50 cells/μL have an increased risk for abnormal anal cytology.

摘要

背景

人类免疫缺陷病毒（HIV）感染者的肛门细胞学异常的流行情况和危险因素尚未得到广泛研究。

方法

理解 HIV 和艾滋病在有效治疗时代的自然史研究（SUN 研究）是一项在美国 4 个城市进行的 HIV 感染者前瞻性队列研究。进行了基线问卷调查，并采集了肛门样本进行细胞学和人乳头瘤病毒（HPV）检测和基因分型。

结果

在 471 名男性和 150 名女性参与者中（中位年龄 41 岁），78%的参与者正在接受联合抗逆转录病毒治疗，41%的参与者 CD4（+）细胞计数≥500 个/μL，71%的参与者 HIV RNA 病毒载量<400 拷贝/ml。肛门细胞学结果如下：336 名参与者（54%）结果为阴性，96 名参与者（15%）为非典型鳞状细胞，149 名参与者（24%）为低级别鳞状上皮内病变，40 名参与者（6%）为高级别鳞状上皮内病变。多变量分析显示，异常肛门细胞学与高危型和低危型 HPV 类型的数量有关（两者的调整比值比 [AOR]，1.28；P<0.001），CD4（+）细胞计数最低<50 个/μL（AOR，2.38；P=0.001），基线 CD4（+）细胞计数<500 个/μL（AOR，1.75；P=0.004），以及曾经有过接受性肛门性交（AOR，2.51；P<0.001）。