Sadlier C, Rowley D, Morley D, Surah S, O'Dea S, Delamere S, O'Leary J, Smyth P, Clarke S, Sheils O, Bergin C
Department of GU Medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland.
HIV Med. 2014 Sep;15(8):499-504. doi: 10.1111/hiv.12150. Epub 2014 Mar 24.
The incidence of human papillomavirus (HPV)-associated anal cancer is increasing. Men who have sex with men (MSM), particularly those coinfected with HIV, are disproportionately affected. Documenting the molecular epidemiology of HPV infection is important in guiding policy makers in formulating universal and/or targeted vaccine guidelines.
A prospective cohort study was conducted. HIV-positive and HIV-negative MSM > 18 years old were invited to participate. Provider-performed anal swabs were collected and anal HPV infection was detected using consensus primer solution phase polymerase chain reaction (PCR) followed by type-specific PCR for high-risk (HR)-HPV types 16, 18 and 31. Between-group differences were analysed using χ(2) tests and Wilcoxon rank tests.
One hundred and ninety-four MSM [mean (standard deviation (SD)) age 36 (10) years; 51% HIV-positive) were recruited. The median number of sexual contacts in the preceding 12 months was 4 (interquartile range 2-10). HIV-positive subjects had a mean (SD) CD4 count of 557 (217) cells/μL, and 84% were on highly active antiretroviral therapy (HAART). Thirty-one samples were B-globin negative and thus excluded from further analysis. A total of 113 subjects (69%) had detectable HPV DNA. Sixty-eight subjects (42%) had an HR-HPV type detected. HR HPV type 16 was detected in 44 samples (27%), HR-HPV type 18 in 26 samples (16%) and HR-HPV type 31 in 14 samples (23%). Twenty-eight subjects (17%) had more than one type of HR-HPV type detected. When HPV and HR-HPV were stratified by age, those > 35 years had a higher prevalence (P = 0.001 and P = 0.028, respectively). HIV-positive subjects were more likely than HIV-negative subjects to have any detectable HPV (77% vs. 61%, respectively; P = 0.04), to have HR-HPV type 18 or 31 (P = 0.05 and P = 0.006, respectively) and to be infected with more than one HR-HPV type (31% vs. 3%, respectively; P < 0.001). Within the HIV-positive group, the prevalence of HPV was higher in those not on HAART (P = 0.041), although it did not differ when stratified by CD4 count.
The identified prevalence of anal HPV infection was high. Emerging patterns of HPV-related disease strengthen the call for universal vaccination of boys and girls with consideration of catch-up and targeted vaccination of high-risk groups such as MSM and those with HIV infection.
人乳头瘤病毒（HPV）相关肛门癌的发病率正在上升。男男性行为者（MSM），尤其是那些合并感染HIV的人，受到的影响尤为严重。记录HPV感染的分子流行病学对于指导政策制定者制定通用和/或针对性的疫苗指南非常重要。
进行了一项前瞻性队列研究。邀请年龄大于18岁的HIV阳性和HIV阴性MSM参与。由医护人员采集肛门拭子，使用共识引物溶液相聚合酶链反应（PCR）检测肛门HPV感染，随后针对高危（HR）HPV 16、18和31型进行型特异性PCR检测。使用χ²检验和Wilcoxon秩和检验分析组间差异。
招募了194名MSM[平均（标准差）年龄36（10）岁；51%为HIV阳性]。前12个月中性接触的中位数为4次（四分位间距2 - 10次）。HIV阳性受试者的平均（标准差）CD4细胞计数为557（217）个/μL，84%正在接受高效抗逆转录病毒治疗（HAART）。31份样本β-珠蛋白检测为阴性，因此被排除在进一步分析之外。共有113名受试者（69%）检测到HPV DNA。68名受试者（42%）检测到HR-HPV型。44份样本（27%）检测到HR HPV 16型，26份样本（16%）检测到HR-HPV 18型，14份样本（23%）检测到HR-HPV 31型。28名受试者（17%）检测到不止一种HR-HPV型。按年龄对HPV和HR-HPV进行分层时，年龄大于35岁者的患病率较高（分别为P = 0.001和P = 0.028）。HIV阳性受试者比HIV阴性受试者更有可能检测到任何HPV（分别为77%和61%；P = 0.04）、检测到HR-HPV 18或31型（分别为P = 0.05和P = 0.006）以及感染不止一种HR-HPV型（分别为31%和3%；P < 0.001）。在HIV阳性组中，未接受HAART者的HPV患病率较高（P = 0.041），尽管按CD4细胞计数分层时无差异。
所确定的肛门HPV感染患病率较高。HPV相关疾病的新发病模式进一步呼吁对男孩和女孩进行普遍疫苗接种，并考虑对高危人群如MSM和HIV感染者进行补种和针对性疫苗接种。
