HIV 感染者和未感染者中高级别肛门鳞状上皮内病变的进展和自发消退。

Progression to and spontaneous regression of high-grade anal squamous intraepithelial lesions in HIV-infected and uninfected men.

机构信息

aCentre for Applied Medical Research, St Vincent's Hospital bThe Kirby Institute for Infection and Immunity in Society, University of New South Wales cWestern Sydney Sexual Health Centre, The University of Sydney & Westmead Hospital, Sydney, Australia. *Richard J. Hillman and Andrew Carr contributed equally to this article.

出版信息

AIDS. 2013 Sep 10;27(14):2233-43. doi: 10.1097/QAD.0b013e3283633111.

DOI:10.1097/QAD.0b013e3283633111

PMID:24157904

Abstract

OBJECTIVE

To quantify incidence of, and risk factors for, progression to and spontaneous regression of high-grade anal squamous intraepithelial lesions (ASILs).

DESIGN

Retrospective review of patients at St Vincent's Hospital Anal Cancer Screening Clinic during a period when high-grade ASILs were not routinely treated (2004-2011).

METHODS

All patients who had an anal Papanicolaou smear or high-resolution anoscopy were included, except for patients with previous anal cancer. High-grade anal intraepithelial neoplasia (HGAIN) was defined as a composite of histologically confirmed grade 2 or 3 anal intraepithelial neoplasia (AIN2/3) and/or high-grade squamous intraepithelial lesion on anal cytology. Analyses were repeated restricting to histologically confirmed AIN3.

RESULTS

There were 574 patients: median age 45 years (interquartile range, IQR 36-51), 99.3% male and 73.0% HIV-infected [median HIV duration was 13.8 years (IQR 6.4-19.8), median CD4+ T-lymphocyte count was 500 cells/μl (IQR 357-662), 83.5% had undetectable plasma HIV viral load]. Median follow-up was 1.1 years (IQR 0.26-2.76). Progression rate to HGAIN was 7.4/100 person-years (95% confidence interval, CI 4.73-11.63). No risk factor for progression to HGAIN was identified; progression to AIN3 was more likely with increasing age (Ptrend = 0.004) and in those who were HIV-infected [hazard ratio 2.8 (95% CI 1.18-6.68) versus HIV-uninfected; P = 0.019], particularly in those whose nadir CD4+ T-lymphocyte count was less than 200 cells/μl (Ptrend = 0.003). In 101 patients with HGAIN, 24 (23.8%) patients had spontaneous regression [rate 23.5/100 person-years (95% CI 15.73-35.02)], mostly to AIN1. Regression was less likely in older patients (Ptrend = 0.048). Two patients with HGAIN developed anal cancer.

CONCLUSION

High-grade ASILs frequently spontaneously regress. Longer-term, prospective studies are required to determine whether these regressions are sustained.

摘要

目的

量化高级别肛门上皮内瘤变（ASIL）进展、自然消退的发生率和相关风险因素。

设计

回顾性分析 St Vincent's 医院肛门癌筛查诊所期间未常规治疗高级别 ASIL 患者的病例（2004-2011 年）。

方法

纳入所有接受肛门巴氏涂片或高分辨率肛门镜检查的患者，除外有既往肛门癌的患者。高级别肛门上皮内瘤变（HGAIN）定义为组织学证实的 2 级或 3 级肛门上皮内瘤变（AIN2/3）和/或肛门细胞学检查高级别鳞状上皮内病变的复合病变。分析时还限制为组织学证实的 AIN3。

结果

共纳入 574 例患者：中位年龄 45 岁（四分位间距 IQR 36-51），99.3%为男性，73.0%为 HIV 感染者[中位 HIV 持续时间为 13.8 年（IQR 6.4-19.8），中位 CD4+T 淋巴细胞计数为 500 个/μl（IQR 357-662），83.5%患者的血浆 HIV 病毒载量不可检测]。中位随访时间为 1.1 年（IQR 0.26-2.76）。HGAIN 进展率为 7.4/100 人年（95%置信区间，CI 4.73-11.63）。未发现 HGAIN 进展的风险因素；进展为 AIN3 与年龄增加（趋势 P=0.004）和 HIV 感染（风险比 2.8[95%CI 1.18-6.68]vs. HIV 未感染；P=0.019）更相关，尤其是 CD4+T 淋巴细胞计数最低值＜200 个/μl 的患者（趋势 P=0.003）。在 101 例 HGAIN 患者中，24 例（23.8%）患者自发消退[消退率为 23.5/100 人年（95%CI 15.73-35.02）]，主要为 AIN1。年龄较大的患者消退的可能性较小（趋势 P=0.048）。2 例 HGAIN 患者发展为肛门癌。