Swedish Kristin A, Goldstone Stephen E
Department of Internal Medicine, Montefiore Medical Center, Bronx, New York, United States of America.
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
PLoS One. 2014 Apr 8;9(4):e93393. doi: 10.1371/journal.pone.0093393. eCollection 2014.
The quadrivalent human papillomavirus vaccine (qHPV) is FDA-approved for use in males 9 to 26 years old to prevent anogenital condyloma. The objective of this study is to determine if qHPV is effective at preventing anal condyloma among men who have sex with men (MSM) aged 26 years and older.
This post-hoc analysis of a nonconcurrent cohort study evaluated 210 patients without history of anal condyloma and 103 patients with previously-treated anal condyloma recurrence-free for at least 12 months prior to vaccination/time zero. We determined the rate of anal condyloma development in vaccinated versus unvaccinated patients.
313 patients with mean age 42 years were followed for median 981 days. During 773.6 person-years follow-up, condyloma developed in 10 (8.6%) vaccinated patients (incidence of 3.7 per 100 person-years) and 37 (18.8%) unvaccinated patients (incidence 7.3 per 100 person-years; p = 0.05). Multivariable hazards ratio showed that qHPV was associated with decreased risk of anal condyloma development (HR 0.45; 95% CI 0.22-0.92; p = 0.03). History of anal condyloma was associated with increased risk of anal condyloma development (HR 2.28; 95% CI 1.28-4.05; p = 0.005), as was infection with oncogenic HPV (HR 3.87; 95% CI 1.66-9.03; p = 0.002).
Among MSM 26 years of age and older with and without history of anal condyloma, qHPV reduces the risk of anal condyloma development. A randomized controlled trial is needed to confirm these findings in this age group.
四价人乳头瘤病毒疫苗（qHPV）已获美国食品药品监督管理局（FDA）批准，用于9至26岁男性预防肛门生殖器湿疣。本研究的目的是确定qHPV在预防26岁及以上男男性行为者（MSM）肛门湿疣方面是否有效。
这项对非同期队列研究的事后分析评估了210例无肛门湿疣病史的患者以及103例在接种疫苗/时间零点前至少12个月肛门湿疣复发已治愈的患者。我们确定了接种疫苗和未接种疫苗患者肛门湿疣的发病几率。
313例平均年龄42岁的患者接受了中位时间为981天的随访。在773.6人年的随访期间，10例（8.6%）接种疫苗的患者发生了湿疣（发病率为每100人年3.7例），37例（18.8%）未接种疫苗的患者发生了湿疣（发病率为每100人年7.3例；p = 0.05）。多变量风险比显示，qHPV与肛门湿疣发病风险降低相关（风险比0.45；95%置信区间0.22 - 0.92；p = 0.03）。肛门湿疣病史与肛门湿疣发病风险增加相关（风险比2.28；95%置信区间1.28 - 4.05；p = 0.005），致癌性人乳头瘤病毒感染也与之相关（风险比3.87；95%置信区间1.66 - 9.03；p = 0.002）。
在有或无肛门湿疣病史的26岁及以上男男性行为者中，qHPV可降低肛门湿疣的发病风险。需要进行一项随机对照试验来证实该年龄组的这些发现。
