分析 HIV 感染的男男性行为者和异性恋男性的肛门细胞学和组织学标本中人类乳头瘤病毒基因型的分布。

Distribution of human papillomavirus genotypes in anal cytological and histological specimens from HIV-infected men who have sex with men and men who have sex with women.

机构信息

Lluita Contra La SIDA Foundation, Badalona, Spain.

出版信息

Dis Colon Rectum. 2013 Sep;56(9):1043-52. doi: 10.1097/DCR.0b013e31829c654f.

DOI:10.1097/DCR.0b013e31829c654f

PMID:23929013

Abstract

BACKGROUND

Anal cancer is caused by human papillomavirus (HPV). Moreover, human immunodeficiency virus (HIV) is an additional risk factor for anal cancer. Therefore, when designing preventive protocols for HIV-infected men, it is important to detect high-risk (HR) oncogenic HPV genotypes present in their anal canals. However, most studies have focused only on men who have sex with men (MSM).

OBJECTIVE

To estimate the prevalence of HPV and describe its genotype distribution using anal cytology and histology specimens from HIV-infected populations of MSM and men who have sex with women (MSW).

DESIGN

Crosssectional study of the CARH·MEN cohort.

SETTING

Single-center prospective cohort of HIV-infected men attending the Outpatient HIV Clinic of Hospital Germans Trias i Pujol (Spain), where they undergo annual screening for HPV infection of the anus, penis and mouth.

PATIENTS

Four hundred eighty-three HIV-infected men (341 MSM, 142 MSW) with no current or previous history of anal condylomata.

MAIN OUTCOME MEASURES

HPV genotypes detected (multiplex-PCR), cytology results (Papanicolaou test) and histology results (biopsy-based).

RESULTS

Cytological abnormalities were detected in 40% of MSM (129/321; 95%CI, 35-46) and 20% of MSW (26/131; 95%CI, 13-28) (OR=2.7; 95%CI, 1.7-4.4). All high-grade squamous intraepithelial lesions (HSIL) were positive for HR-HPV in both groups. High-resolution anoscopy was performed in 146 patients (120 MSM, 26 MSW) with abnormal cytological diagnoses. Lesions were visualized in 80 MSM (67%) and 14 MSW (54%) (OR=1.7 [95%CI, 0.7-4.0]). Histological diagnosis was anal intraepithelial neoplasia (AIN)-1 in 51 MSM (64%) and 6 MSW (43%), AIN-2 in 9 MSM (11%) and 3 MSW (21%), AIN-3 in 7 MSM (9%) and 1 MSW (7%), and normal in 13 MSM (16%) and 4 MSW (29%). HPV16 was the most prevalent HR genotype.

LIMITATIONS

Study limitations include its crosssectional design.

CONCLUSIONS

Anal cancer screening should be offered to all HIV-infected men, regardless of their sexual orientation.

摘要

背景

肛门癌由人乳头瘤病毒（HPV）引起。此外，人类免疫缺陷病毒（HIV）是肛门癌的另一个危险因素。因此，在为感染 HIV 的男性设计预防方案时，检测其肛门内存在的高危（HR）致癌 HPV 基因型非常重要。然而，大多数研究仅关注男男性行为者（MSM）。

目的

通过对 MSM 和男男性行为者（MSW）中 HIV 感染人群的肛门细胞学和组织学标本进行分析，估计 HPV 的流行率并描述其基因型分布。

设计

CARH·MEN 队列的横断面研究。

地点

西班牙 Germans Trias i Pujol 医院门诊艾滋病毒诊所，这里为感染 HIV 的男性提供年度肛门、阴茎和口腔 HPV 感染筛查。

患者

483 名 HIV 感染男性（341 名 MSM，142 名 MSW），均无当前或既往肛门湿疣病史。

主要观察指标

多重聚合酶链反应（PCR）检测到的 HPV 基因型、细胞学结果（巴氏试验）和组织学结果（活检）。

结果

MSM 中有 40%（129/321；95%CI，35-46）和 MSW 中有 20%（26/131；95%CI，13-28）的患者（OR=2.7；95%CI，1.7-4.4）出现细胞学异常。两组中的所有高级别鳞状上皮内病变（HSIL）均为 HR-HPV 阳性。对 146 例细胞学异常诊断患者（120 名 MSM，26 名 MSW）进行高分辨率肛门镜检查。80 例 MSM（67%）和 14 例 MSW（54%）（OR=1.7[95%CI，0.7-4.0]）中可见病变。51 例 MSM（64%）和 6 例 MSW（43%）为肛门上皮内瘤变（AIN）-1，9 例 MSM（11%）和 3 例 MSW（21%）为 AIN-2，7 例 MSM（9%）和 1 例 MSW（7%）为 AIN-3，13 例 MSM（16%）和 4 例 MSW（29%）为正常。HPV16 是最常见的 HR 基因型。