肛门内尖锐湿疣、细胞学异常与人类乳头瘤病毒感染在 HIV 感染男性中的情况。

Condylomata, cytological abnormalities and human papillomavirus infection in the anal canal in HIV-infected men.

机构信息

Retrovirology Laboratory IrsiCaixa Foundation, Barcelona, Spain.

出版信息

HIV Med. 2012 Oct;13(9):549-57. doi: 10.1111/j.1468-1293.2012.01013.x. Epub 2012 Mar 21.

DOI:10.1111/j.1468-1293.2012.01013.x

PMID:22435501

Abstract

BACKGROUND

Genital infections with low-risk (LR) and high-risk (HR) human papillomavirus (HPV) genotypes are associated with ano-genital condylomata and anal squamous cell cancer. HPV-related pathologies in HIV-infected men are a serious concern. In this study, the prevalence of anal condylomata and their association with cytological abnormalities and HPV infection in the anal canal in HIV-infected men [men who have sex with men (MSM) and heterosexuals] were estimated.

METHODS

This was a cross-sectional study based on the first visits of patients in the Can Ruti HIV-positive Men (CARH·MEN) cohort. Anal condylomata were assessed by clinical and proctological examination. Samples from the anal canal were collected for HPV genotyping and cytological diagnoses.

RESULTS

A total of 640 HIV-infected men (473 MSM and 167 heterosexuals) were included in the study. The overall prevalence of anal condylomata was 25% [157 of 640; 95% confidence interval (CI) 21-28%]; in MSM it was 28% and in heterosexuals it was 15% [odds ratio (OR) 2.2; 95% CI 1.4-3.5]. In patients with anal condylomata, HPV infection in the anal canal was more prevalent (92% vs. 67% in those without anal condylomata; OR 8.5; 95% CI 3.2-22). This higher HPV prevalence involved at least two HPV genotypes (OR 4.0; 95% CI 2.2-7.1), mainly HR genotypes (OR 3.3; 95% CI 1.7-6.4). Similarly, the cumulative prevalence of HPV-6 and HPV-11 was higher in patients with anal condylomata (63% vs. 19% in those without anal condylomata). Having anal condylomata was associated with higher prevalences of cytological abnormalities (83% vs. 32% in those without anal condylomata; OR 6.9; 95% CI 3.8-12.7) and high-grade squamous intraepithelial lesions (HSILs) (9% vs. 3% in those without anal condylomata; OR 9.0; 95% CI 2.9-28.4) in the anal canal.

CONCLUSIONS

HIV-infected men with anal condylomata were at risk of presenting HSILs and harbouring multiple HR HPV infections in the anal canal. Although MSM presented the highest prevalence of anal condylomata, heterosexual men also had a clinically important prevalence. Our findings emphasize the importance of screening and follow-up for condylomata in the anal canal in HIV-infected men.

摘要

背景

与低危（LR）和高危（HR）人乳头瘤病毒（HPV）基因型相关的生殖器感染与肛门生殖器湿疣和肛门鳞状细胞癌有关。HIV 感染者的 HPV 相关病变令人严重关切。在这项研究中，我们评估了 HIV 感染者（男男性行为者和异性恋者）肛门湿疣的流行率及其与肛门管细胞学异常和 HPV 感染的关系。

方法

这是基于 Can Ruti HIV 阳性男性（CARH·MEN）队列中患者首次就诊的一项横断面研究。通过临床和直肠检查评估肛门湿疣。采集肛门管样本进行 HPV 基因分型和细胞学诊断。

结果

共纳入 640 名 HIV 感染者（473 名男男性行为者和 167 名异性恋者）。肛门湿疣的总体患病率为 25%[640 例中的 157 例；95%置信区间（CI）为 21-28%]；男男性行为者中的患病率为 28%，异性恋者中的患病率为 15%[比值比（OR）为 2.2；95%CI 为 1.4-3.5]。在患有肛门湿疣的患者中，肛门管内 HPV 感染更为常见（92%比无肛门湿疣的患者为 67%；OR 8.5；95%CI 3.2-22）。这种更高的 HPV 流行率涉及至少两种 HPV 基因型（OR 4.0；95%CI 2.2-7.1），主要是 HR 基因型（OR 3.3；95%CI 1.7-6.4）。同样，在患有肛门湿疣的患者中，HPV-6 和 HPV-11 的累积患病率更高（63%比无肛门湿疣的患者为 19%）。患有肛门湿疣与较高的细胞学异常（83%比无肛门湿疣的患者为 32%；OR 6.9；95%CI 3.8-12.7）和高级别鳞状上皮内病变（HSIL）（9%比无肛门湿疣的患者为 3%；OR 9.0；95%CI 2.9-28.4）在肛门管中发生的风险增加有关。