Gaisa Michael, Sigel Keith, Hand Jonathan, Goldstone Stephen
aDivision of Infectious Diseases bDivision of General Internal Medicine cDepartment of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
AIDS. 2014 Jan 14;28(2):215-22. doi: 10.1097/QAD.0000000000000062.
To determine rates of anal dysplasia in a cohort of HIV-infected men who have sex with men (MSM), women, and heterosexual men with abnormal anal cytology.
DESIGN/METHODS: We evaluated histologic findings in 728 HIV-infected MSM, women, and heterosexual men referred for high-resolution anoscopy (HRA) after abnormal anal cytology in a single-center cohort study. Using multivariable logistic regression, we evaluated predictors of high-grade squamous intraepithelial lesion (HSIL) histology or invasive carcinoma including age, sexual behavior, receptive anal intercourse (RAI), anogenital warts, smoking status, antiretroviral therapy, CD4 T-cell count, and HIV-1 plasma viral load.
A total of 2075 HIV-positive patients were screened with anal cytology and 62% of MSM, 42% of women, and 29% of heterosexual men had abnormal findings (P <0.001). Of the 728 HIV-infected patients with abnormal anal cytology who underwent HRA, 71% were MSM, 23% women, and 6% heterosexual men. HSIL/cancer was found in 32% of MSM, 26% of women, and 23% of heterosexual men (P = 0.3). There were five cases of anal squamous cell carcinoma (0.7%), four in MSM and one in a heterosexual man. In a multivariable adjusted analysis, biopsy-proven HSIL/cancer was associated with RAI [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.3-3.7]. CD4 T-cell counts more than 500/μl conferred a lower risk of HSIL/cancer (OR 0.5; 95% CI 0.3-0.9).
Rates of anal HSIL histology are high in HIV-infected patients of all sexual risk groups with abnormal anal cytology. Consequently, all HIV-infected patients may warrant anal cancer screening.
确定一组感染人类免疫缺陷病毒（HIV）的男男性行为者（MSM）、女性以及肛门细胞学检查异常的异性恋男性中肛门发育异常的发生率。
设计/方法：在一项单中心队列研究中，我们评估了728名因肛门细胞学检查异常而接受高分辨率肛门镜检查（HRA）的感染HIV的MSM、女性和异性恋男性的组织学检查结果。使用多变量逻辑回归分析，我们评估了高级别鳞状上皮内病变（HSIL）组织学或浸润性癌的预测因素，包括年龄、性行为、接受性肛交（RAI）、肛门生殖器疣、吸烟状况、抗逆转录病毒治疗、CD4 T细胞计数以及HIV-1血浆病毒载量。
共有2075名HIV阳性患者接受了肛门细胞学筛查，其中62%的MSM、42%的女性和29%的异性恋男性有异常发现（P<0.001）。在728名因肛门细胞学检查异常而接受HRA的感染HIV患者中，71%为MSM，23%为女性，6%为异性恋男性。HSIL/癌症在32%的MSM、26%的女性和23%的异性恋男性中被发现（P=0.3）。共有5例肛门鳞状细胞癌（0.7%），其中4例在MSM中，1例在异性恋男性中。在多变量调整分析中，活检证实的HSIL/癌症与RAI相关[比值比（OR）2.2；95%置信区间（CI）1.3 - 3.7]。CD4 T细胞计数超过500/μl可降低HSIL/癌症的风险（OR 0.5；95% CI 0.3 - 0.9）。
在所有性风险组中，肛门细胞学检查异常的感染HIV患者中肛门HSIL组织学的发生率较高。因此，所有感染HIV的患者都可能需要进行肛门癌筛查。
