The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
AIDS. 2013 Jul 17;27(11):1753-62. doi: 10.1097/QAD.0b013e328360a509.
Men who have sex with men (MSM) are at elevated risk of having anal cancer. However, the prevalence and incidence among MSM of high-grade anal intraepithelial neoplasia (HGAIN), the putative precursor of anal cancer, is understudied, particularly in Asians.
A total of 123 HIV-positive and 123 HIV-negative MSM were enrolled at the Thai Red Cross AIDS Research Centre in Bangkok, Thailand, and followed for 12 months. Anal sample collection for human papillomavirus (HPV) genotyping and high-resolution anoscopy (HRA) with biopsies were performed at every visit.
Mean age at enrollment was 28.9 years. HIV-positive MSM were more commonly infected with high-risk HPV types in the anus than HIV-negative MSM (57.5 vs. 36.6%; P = 0.001). The prevalence of HGAIN was 18.9% in HIV-positive and 11.4% in HIV-negative MSM (P = 0.1). The incidence of HGAIN at 12 months was 29% in HIV-positive and 8% in HIV-negative MSM (P = 0.001). The hazard ratios for incident HGAIN in multivariate models were 5.16 [95% confidence interval (CI) 1.89-14.08, P < 0.001] in MSM with persistent HPV 16 and/or 18 infection and 2.62 (95% CI 1.04-6.61, P = 0.042) in HIV-positive MSM.
Approximately one-third of HIV-positive MSM developed incident HGAIN within 12 months. Given the relative increased prevalence of HIV among MSM worldwide, local HGAIN data are needed to guide practitioners, policy makers, and communities in planning for strategies to screen for and treat HGAIN in this population.
男男性行为者（MSM）发生肛门癌的风险较高。然而，MSM 中高级别肛门上皮内瘤变（HGAIN）的流行率和发病率较低，这是肛门癌的潜在前体，在亚洲人群中研究较少。
在泰国曼谷的泰国红十字会艾滋病研究中心共纳入了 123 例 HIV 阳性和 123 例 HIV 阴性 MSM，并随访了 12 个月。在每次就诊时，均采集肛门样本进行人乳头瘤病毒（HPV）基因分型和高分辨率肛门镜检查（HRA）及活检。
入组时的平均年龄为 28.9 岁。HIV 阳性 MSM 肛门感染高危型 HPV 的比例高于 HIV 阴性 MSM（57.5%比 36.6%；P=0.001）。HIV 阳性和 HIV 阴性 MSM 中 HGAIN 的患病率分别为 18.9%和 11.4%（P=0.1）。12 个月时 HGAIN 的发病率分别为 HIV 阳性者 29%和 HIV 阴性者 8%（P=0.001）。多变量模型中，HPV16 和/或 18 持续感染的 MSM 中发生 HGAIN 的风险比为 5.16（95%CI 1.89-14.08，P<0.001），HIV 阳性 MSM 为 2.62（95%CI 1.04-6.61，P=0.042）。
大约三分之一的 HIV 阳性 MSM 在 12 个月内发生了 HGAIN。鉴于全球 MSM 中 HIV 的相对流行率较高，需要当地的 HGAIN 数据来指导医生、政策制定者和社区规划针对该人群进行 HGAIN 筛查和治疗的策略。
