中国北京男男性行为人群中 HIV 感染者和未感染者的人乳头瘤病毒肛门感染情况。
Anal human papillomavirus infection among HIV-infected and uninfected men who have sex with men in Beijing, China.
机构信息
State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention China CDC, Beijing, China.
出版信息
J Acquir Immune Defic Syndr. 2013 Sep 1;64(1):103-14. doi: 10.1097/QAI.0b013e31829b6298.
BACKGROUND
In light of China's unique ethnic and sociocultural context, and a marked rise in HIV prevalence among MSM, it is important to determine prevalence, genotypes and predictors of anal human papillomavirus (HPV) among HIV-infected and uninfected men who have sex with men (MSM) in Beijing, China.
METHODS
In 2010-2011, we recruited MSM (age range 18-61; median 28 years) through peer volunteers, and collected demographic/behavioral information via interviewer-administrated questionnaires. Trained health workers collected anal swabs for HPV genotyping by PCR and blood samples for HIV/syphilis serologies.
RESULTS
We obtained anal specimens from 212 HIV-infected and 459 HIV-uninfected participants. Among HIV-infected MSM, 82.1% were HPV-infected vs. 57.5% in HIV-uninfected (p<0.01). HIV-infected men had the greatest likelihood of multiple types: 17.9% uninfected; 36.3% with one type; 36.8% with 2-3; 9.0% with ≥4. Oncogenic HPV prevalence was higher among HIV- infected (61.3%) than uninfected participants (39.7%; p<0.01). HIV-uninfected MSM reporting always using condoms during insertive anal intercourse (past 6 months) were less likely to be HPV-infected (OR=0.49, 95%CI: 0.31-0.77). Among HIV-uninfected MSM, HPV infection was associated with unprotected receptive anal intercourse (past 6 months; OR=1.92, 95%CI: 1.19-3.11) and being forced to have sex (previous year; OR=3.32, 95%CI: 1.10-10.0). Multivariable logistic analysis among HIV infected MSM suggested that unprotected oral intercourse (past 6 months) was associated with HPV (adjusted OR=2.12, 95%CI: 1.00-4.48). Syphilis occurred in 55.8% of HIV-infected/HPV-infected, 50.0% of HIV-infected/HPV-uninfected, 19.6% of HIV-uninfected/HPV-infected, and 13.0% of HIV-uninfected/HPV-uninfected MSM.
CONCLUSIONS
HPV anal infections were more common among HIV-infected than uninfected MSM in China, including oncogenic and multiple types. Unprotected oral and receptive anal sex were was independently associated with HPV infection. Promotion of safer sex and HPV vaccination is strongly recommended among MSM.
背景
鉴于中国独特的民族和社会文化背景，以及男男性行为者（MSM）中 HIV 感染率的显著上升，有必要确定中国北京 HIV 感染者和未感染者中肛门人乳头瘤病毒（HPV）的流行率、基因型和预测因素。
方法
2010-2011 年，我们通过同伴志愿者招募 MSM（年龄 18-61 岁；中位数 28 岁），并通过访谈者管理的问卷收集人口统计学/行为信息。经过培训的卫生工作者通过聚合酶链反应（PCR）采集肛门拭子进行 HPV 基因分型，并采集血液样本进行 HIV/梅毒血清学检测。
结果
我们从 212 名 HIV 感染者和 459 名 HIV 未感染者中获得了肛门标本。在 HIV 感染者中，82.1%的人感染了 HPV，而在 HIV 未感染者中，这一比例为 57.5%（p<0.01）。HIV 感染者最有可能感染多种类型：17.9%未感染者；36.3%感染一种类型；36.8%感染 2-3 种类型；9.0%感染≥4 种类型。感染 HPV 的 HIV 感染者（61.3%）比未感染者（39.7%）的比例更高（p<0.01）。在 HIV 未感染者中，报告在过去 6 个月中始终使用安全套进行插入性肛交的 MSM 感染 HPV 的可能性较低（OR=0.49，95%CI：0.31-0.77）。在 HIV 未感染者中，HPV 感染与无保护的接受性肛交（过去 6 个月；OR=1.92，95%CI：1.19-3.11）和被迫发生性行为（过去一年；OR=3.32，95%CI：1.10-10.0）有关。在 HIV 感染者的多变量 logistic 分析中，过去 6 个月无保护的口交与 HPV 有关（调整后的 OR=2.12，95%CI：1.00-4.48）。梅毒发生在 55.8%的 HIV 感染者/HPV 感染者、50.0%的 HIV 感染者/HPV 未感染者、19.6%的 HIV 未感染者/HPV 感染者和 13.0%的 HIV 未感染者/HPV 未感染者中。
结论
在中国，HIV 感染者中 HPV 肛门感染比未感染者更常见，包括致癌和多种类型。无保护的口交和接受性肛交与 HPV 感染独立相关。强烈建议 MSM 推广安全性行为和 HPV 疫苗接种。
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