Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, USA.
Dis Colon Rectum. 2011 Apr;54(4):433-41. doi: 10.1007/DCR.0b013e318207039a.
Prevalence of high-grade anal intraepithelial neoplasia, the human papillomavirus-associated putative anal cancer precursor, is high in HIV-infected men who have sex with men, but less is known about its prevalence in other HIV-infected subgroups. Similarly, the prevalence of abnormal cytology, used as a screen, is not well-defined in these subgroups.
This study aimed to estimate the prevalence of abnormal cytology and anal intraepithelial neoplasia in a primary care HIV-infected population.
This investigation was designed as a cross-sectional study.
This study took place at a Ryan White-funded clinic.
Included in the study were all (n = 779) HIV-infected patients receiving primary care services between March 2006 and March 2008.
The main outcome measures were anal cytology and high-resolution anoscopy results.
The prevalence of abnormal cytology was 43%: 62% in men who reported receptive anal intercourse, 39% in women who reported receptive anal intercourse, and 25% in all others (P trend <.0001). High-grade anal intraepithelial neoplasia prevalence was 27%: 44% in men who reported receptive anal intercourse, 26% in women who reported receptive anal intercourse, and 10% in all others (P trend <.0001). Two patients had squamous-cell cancer. Independent predictors of dysplasia were CD4 at screening, receptive anal intercourse, sexual orientation, and history of human papillomavirus disease. Anal cytology and histology findings were not well correlated.
The study population may not be representative of the general HIV-infected population, there were differences between screened and unscreened patients and between patients with abnormal cytology who had high-resolution anoscopy and those who did not, only patients with abnormal cytology had high-resolution anoscopy, and there were possible misclassification errors and uncontrolled possible confounders.
High-grade anal intraepithelial neoplasia is relatively common in HIV-infected patients regardless of sexual practice. Although risk increases with receptive anal intercourse, patient-provided information on this sexual practice should not be used as a determining factor for screening. Strategies to prevent anal cancer are necessary for all HIV-infected patients.
在男男性行为者（MSM）艾滋病毒感染者中，高级别肛门上皮内瘤变（HPV 相关的潜在肛门癌前病变）的流行率较高，但在其他 HIV 感染者亚组中，其流行率知之甚少。同样，作为筛查手段的异常细胞学的流行率在这些亚组中也没有很好地定义。
本研究旨在评估初级保健 HIV 感染者人群中异常细胞学和肛门上皮内瘤变的流行率。
本研究设计为横断面研究。
本研究在一个 Ryan White 资助的诊所进行。
纳入研究的是 2006 年 3 月至 2008 年 3 月期间接受初级保健服务的所有（n = 779）HIV 感染者。
主要观察指标为肛门细胞学和高分辨率肛门镜检查结果。
异常细胞学的流行率为 43%：有肛交史的男性为 62%，有肛交史的女性为 39%，其他所有人为 25%（趋势 P <.0001）。高级别肛门上皮内瘤变的流行率为 27%：有肛交史的男性为 44%，有肛交史的女性为 26%，其他所有人为 10%（趋势 P <.0001）。两名患者患有鳞状细胞癌。异常增生的独立预测因子包括筛查时的 CD4、肛交、性取向和人乳头瘤病毒疾病史。肛门细胞学和组织学检查结果相关性不佳。
研究人群可能不能代表一般的 HIV 感染者人群，筛查患者和未筛查患者之间以及细胞学异常患者中接受高分辨率肛门镜检查和未接受高分辨率肛门镜检查的患者之间存在差异，仅细胞学异常的患者接受了高分辨率肛门镜检查，可能存在错误分类和未控制的混杂因素。
高级别肛门上皮内瘤变在 HIV 感染者中较为常见，与性行为方式无关。尽管肛交的风险增加，但不应将患者提供的关于这种性行为的信息作为筛查的决定因素。所有 HIV 感染者都需要采取预防肛门癌的策略。
