Stier Elizabeth A, Sebring Meagan C, Mendez Audrey E, Ba Fatimata S, Trimble Debra D, Chiao Elizabeth Y
Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA.
Department of Medicine, Baylor College of Medicine, Houston, TX.
Am J Obstet Gynecol. 2015 Sep;213(3):278-309. doi: 10.1016/j.ajog.2015.03.034. Epub 2015 Mar 19.
The aim of this study was to systematically review the findings of publications addressing the epidemiology of anal human papillomavirus (HPV) infection, anal intraepithelial neoplasia, and anal cancer in women. We conducted a systematic review among publications published from Jan. 1, 1997, to Sept. 30, 2013, to limit to publications from the combined antiretroviral therapy era. Three searches were performed of the National Library of Medicine PubMed database using the following search terms: women and anal HPV, women anal intraepithelial neoplasia, and women and anal cancer. Publications were included in the review if they addressed any of the following outcomes: (1) prevalence, incidence, or clearance of anal HPV infection, (2) prevalence of anal cytological or histological neoplastic abnormalities, or (3) incidence or risk of anal cancer. Thirty-seven publications addressing anal HPV infection and anal cytology remained after applying selection criteria, and 23 anal cancer publications met the selection criteria. Among HIV-positive women, the prevalence of high-risk (HR)-HPV in the anus was 16-85%. Among HIV-negative women, the prevalence of anal HR-HPV infection ranged from 4% to 86%. The prevalence of anal HR-HPV in HIV-negative women with HPV-related pathology of the vulva, vagina, and cervix compared with women with no known HPV-related pathology, varied from 23% to 86% and from 5% to 22%, respectively. Histological anal high-grade squamous intraepithelial lesions (anal intraepithelial neoplasia 2 or greater) was found in 3-26% of the women living with HIV, 0-9% among women with lower genital tract pathology, and 0-3% for women who are HIV negative without known lower genital tract pathology. The incidence of anal cancer among HIV-infected women ranged from 3.9 to 30 per 100,000. Among women with a history of cervical cancer or cervical intraepithelial neoplasia 3, the incidence rates of anal cancer ranged from 0.8 to 63.8 per 100,000 person-years, and in the general population, the incidence rates ranged from 0.55 to 2.4 per 100,000 person-years. This review provides evidence that anal HPV infection and dysplasia are common in women, especially in those who are HIV positive or have a history of HPV-related lower genital tract pathology. The incidence of anal cancer continues to grow in all women, especially those living with HIV, despite the widespread use of combined antiretroviral therapy.
本研究的目的是系统回顾关于女性肛门人乳头瘤病毒（HPV）感染、肛门上皮内瘤变和肛门癌流行病学的出版物研究结果。我们对1997年1月1日至2013年9月30日发表的出版物进行了系统回顾，以限定为联合抗逆转录病毒治疗时代的出版物。使用以下检索词在国立医学图书馆的PubMed数据库中进行了三次检索：女性与肛门HPV、女性肛门上皮内瘤变、女性与肛门癌。如果出版物涉及以下任何结果，则纳入本综述：（1）肛门HPV感染的患病率、发病率或清除率；（2）肛门细胞学或组织学肿瘤异常的患病率；或（3）肛门癌的发病率或风险。应用选择标准后，有37篇关于肛门HPV感染和肛门细胞学的出版物留存，23篇肛门癌出版物符合选择标准。在HIV阳性女性中，肛门高危（HR）-HPV的患病率为16%-85%。在HIV阴性女性中，肛门HR-HPV感染的患病率为4%至86%。与无已知HPV相关病理的女性相比，患有外阴、阴道和宫颈HPV相关病理的HIV阴性女性中肛门HR-HPV的患病率分别为23%至86%和5%至22%。在感染HIV的女性中，3%-26%发现有组织学上的肛门高级别鳞状上皮内病变（肛门上皮内瘤变2级或更高），在下生殖道有病理改变的女性中为0%-9%，在无已知下生殖道病理改变的HIV阴性女性中为0%-3%。HIV感染女性中肛门癌的发病率为每10万人3.9至30例。在有宫颈癌或宫颈上皮内瘤变3级病史的女性中，肛门癌的发病率为每10万人年0.8至63.8例，在一般人群中，发病率为每10万人年0.55至2.4例。本综述提供的证据表明，肛门HPV感染和发育异常在女性中很常见，尤其是在HIV阳性或有HPV相关下生殖道病理病史的女性中。尽管联合抗逆转录病毒疗法已广泛应用，但所有女性，尤其是感染HIV的女性，肛门癌的发病率仍在持续上升。
