1Department of Dermatology, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain 2Department of Colorectal Surgery, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain 3Department of Internal Medicine (HIV section), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain 4Department of Pathology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
Dis Colon Rectum. 2014 Apr;57(4):475-81. doi: 10.1097/DCR.0000000000000095.
The incidence of anal cancer among HIV-infected patients is higher than that in other populations. Anal high-grade squamous intraepithelial lesions are considered precursors to invasive squamous-cell carcinomas and are strongly associated to high-risk human papillomavirus infection.
The aim of this study is to determine the prevalence of anal high-grade squamous intraepithelial lesions through screening based on cytology and high-resolution anoscopy with biopsy in a cohort of HIV-infected men who have sex with men.
This investigation is an observational cross-sectional cohort study.
The study was conducted in the HIV unit of a tertiary hospital in Spain.
Three hundred HIV-infected men who have sex with men participated. Physical examination led to a diagnosis of perianal squamous-cell carcinoma and high-grade squamous intraepithelial lesions in 2 patients who were then excluded.
Anal liquid cytology was performed. Patients with cytological abnormalities underwent high-resolution anoscopy and biopsy.
The primary outcome measured was biopsy-proven high-grade squamous intraepithelial lesions.
The median age was 41 ± 10.5 years. The mean and nadir CD4 cell counts were 651 ± 205 cells/mm(3) (interquartile range, 438-800) and 273 ± 205 cells/mm(3) (interquartile range, 131-362). High-risk human papillomavirus was detected in 80.9% of patients, and human papillomavirus 16 was detected in 35.9% of patients. The mean number of human papillomavirus genotypes was 4.6 ± 2.9 (CI, 2-6). Anal cytology was abnormal in 40.9% of patients (n = 122/298; interquartile range, 35.4%-46.6%). High-resolution anoscopy and biopsies were performed in 119 patients. The results of histological analyses were as follows: normal, 7.7% (n = 23); condyloma, 4.3% (n = 13); anal intraepithelial neoplasia 1, 5.7% (n = 17); anal intraepithelial neoplasia 2, 14% (n = 42); and anal intraepithelial neoplasia 3, 8% (n = 24). The overall prevalence of high-grade squamous intraepithelial lesions among patients with abnormal cytology was 54% (95% CI, 45.1%-62.8%). A diagnosis of high-grade squamous intraepithelial lesions was associated with human papillomavirus 16 and human papillomavirus 51 infection, and with detection of a higher number of human papillomavirus genotypes.
High-resolution anoscopy was only performed in patients with abnormal cytology.
The prevalence of high-risk human papillomavirus infection and high-grade squamous intraepithelial lesions is high in our cohort. Physical examination enabled straightforward diagnosis of perianal high-grade squamous intraepithelial lesions and squamous-cell carcinoma in 2 patients.
HIV 感染者中肛门癌的发病率高于其他人群。高级别肛门鳞状上皮内病变被认为是侵袭性鳞状细胞癌的前体，与高危型人乳头瘤病毒感染密切相关。
本研究旨在通过对一组男男性接触 HIV 感染者进行细胞学和高分辨率肛门镜检查及活检筛查，确定高级别肛门鳞状上皮内病变的流行率。
这是一项观察性的横断面队列研究。
研究在西班牙一家三级医院的 HIV 病房进行。
300 名男男性接触 HIV 感染者参与了研究。2 名患者因肛门鳞状细胞癌和高级别鳞状上皮内病变而接受了诊断性检查，并被排除在外。
进行肛门液基细胞学检查。细胞学异常的患者进行高分辨率肛门镜检查和活检。
活检证实的高级别鳞状上皮内病变为主要观察终点。
中位年龄为 41±10.5 岁。平均和最低 CD4 细胞计数分别为 651±205 个/mm³（四分位距，438-800）和 273±205 个/mm³（四分位距，131-362）。80.9%的患者检测到高危型人乳头瘤病毒，35.9%的患者检测到人乳头瘤病毒 16 型。平均人乳头瘤病毒基因型数量为 4.6±2.9（CI，2-6）。40.9%的患者（n=122/298；四分位距，35.4%-46.6%）的肛门细胞学检查异常。119 名患者进行了高分辨率肛门镜检查和活检。组织学分析结果如下：正常 7.7%（n=23）；湿疣 4.3%（n=13）；肛门上皮内瘤变 1 级 5.7%（n=17）；肛门上皮内瘤变 2 级 14%（n=42）；肛门上皮内瘤变 3 级 8%（n=24）。细胞学异常患者中高级别鳞状上皮内病变的总患病率为 54%（95%CI，45.1%-62.8%）。高级别鳞状上皮内病变与 HPV16 和 HPV51 感染以及检测到更多的人乳头瘤病毒基因型相关。
仅对细胞学异常的患者进行了高分辨率肛门镜检查。
本队列中高危型人乳头瘤病毒感染和高级别鳞状上皮内病变的流行率较高。体检使我们能够在 2 名患者中直接诊断出肛周高级别鳞状上皮内病变和鳞状细胞癌。
