Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA.
Clin Infect Dis. 2012 Apr;54(7):1026-34. doi: 10.1093/cid/cir1012. Epub 2012 Jan 30.
Anal cancer is one of the most common cancers affecting individuals infected with human immunodeficiency virus (HIV), although few have evaluated rates separately for men who have sex with men (MSM), other men, and women. There are also conflicting data regarding calendar trends.
In a study involving 13 cohorts from North America with follow-up between 1996 and 2007, we compared anal cancer incidence rates among 34 189 HIV-infected (55% MSM, 19% other men, 26% women) and 114 260 HIV-uninfected individuals (90% men).
Among men, the unadjusted anal cancer incidence rates per 100 000 person-years were 131 for HIV-infected MSM, 46 for other HIV-infected men, and 2 for HIV-uninfected men, corresponding to demographically adjusted rate ratios (RRs) of 80.3 (95% confidence interval [CI], 42.7-151.1) for HIV-infected MSM and 26.7 (95% CI, 11.5-61.7) for other HIV-infected men compared with HIV-uninfected men. HIV-infected women had an anal cancer rate of 30/100 000 person-years, and no cases were observed for HIV-uninfected women. In a multivariable Poisson regression model, among HIV-infected individuals, the risk was higher for MSM compared with other men (RR, 3.3; 95% CI, 1.8-6.0), but no difference was observed comparing women with other men (RR, 1.0; 95% CI, 0.5-2.2). In comparison with the period 2000-2003, HIV-infected individuals had an adjusted RR of 0.5 (95% CI, .3-.9) in 1996-1999 and 0.9 (95% CI, .6-1.2) in 2004-2007.
Anal cancer rates were substantially higher for HIV-infected MSM, other men, and women compared with HIV-uninfected individuals, suggesting a need for universal prevention efforts. Rates increased after the early antiretroviral therapy era and then plateaued.
肛门癌是感染人类免疫缺陷病毒（HIV）的个体中最常见的癌症之一，尽管很少有研究分别评估男男性行为者（MSM）、其他男性和女性的发病率。关于日历趋势也存在相互矛盾的数据。
在一项涉及北美 13 个队列的研究中，参与者的随访时间为 1996 年至 2007 年，我们比较了 34189 名 HIV 感染者（55%为 MSM、19%为其他男性、26%为女性）和 114260 名 HIV 未感染者的肛门癌发病率。
在男性中，未经调整的每 10 万人年肛门癌发病率为 HIV 感染的 MSM 为 131 例，其他 HIV 感染的男性为 46 例，HIV 未感染的男性为 2 例，相应的人口统计学调整后的发病率比（RR）分别为 80.3（95%置信区间 [CI]，42.7-151.1）和 26.7（95% CI，11.5-61.7），与 HIV 未感染的男性相比，HIV 感染的 MSM 和其他男性的发病率更高。HIV 感染的女性肛门癌发病率为 30/100000 人年，HIV 未感染的女性未观察到病例。在多变量泊松回归模型中，与其他男性相比，HIV 感染的 MSM 的风险更高（RR，3.3；95%CI，1.8-6.0），但与其他男性相比，女性的风险没有差异（RR，1.0；95%CI，0.5-2.2）。与 2000-2003 年相比，1996-1999 年 HIV 感染者的调整后 RR 为 0.5（95%CI，0.3-0.9），2004-2007 年为 0.9（95%CI，0.6-1.2）。
与 HIV 未感染者相比，HIV 感染的 MSM、其他男性和女性的肛门癌发病率要高得多，这表明需要采取普遍的预防措施。发病率在早期抗逆转录病毒治疗时代后增加，然后趋于平稳。
