Burgos Joaquin, Curran Adria, Tallada Natalia, Guelar Ana, Navarro Jordi, Landolfi Stefania, Villar Judith, Crespo Manel, Ribera Esteve, Falcó Vicenç
aInfectious Diseases Department bAnatomical Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) cInternal Medicine Department, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Spain.
AIDS. 2015 Mar 27;29(6):695-702. doi: 10.1097/QAD.0000000000000603.
To assess the value of several factors to predict the risk of progression to high-grade anal intraepithelial neoplasia (HGAIN) in a cohort of HIV-infected MSM.
Longitudinal study of 556 HIV-infected MSM who underwent screening for anal dysplasia (include anal cytology and high-resolution anoscopy at each visit).
Progression rate to HGAIN was estimated by Kaplan-Meier analysis. Predictors of progression were assessed by Cox-proportional hazards regression.
Sixty-eight incidents HGAIN cases over 649 person-years of follow-up were diagnosed, resulting in a progression rate of 10.5 cases/100 person-years [95% confidence interval (CI), 8.1-13.3). The cumulative incidence of HGAIN was 7.2% at 12 months (95% CI, 4.3-10.1) and 16.2% at 24 months (95% CI, 11.7-20.7). Independent risk factors for progression were as follows: abnormal cytology [hazard ratio (HR), 2.5 (95% CI, 1.2-4.9) if low-grade squamous intraepithelial lesion, HR 2.76 (95% CI, 1.4-5.3) if atypical squamous cells of uncertain significance and HR 7.73 (95% CI, 2.3-25.4) if high-grade squamous intraepithelial lesion], abnormal high-resolution anoscopy (HR 3.57; 95% CI, 2-6.4) and infection by 16 or 18 human papillomavirus (HR 1.63; 95% CI, 1-2.6). To be receiving HAART (HR 0.4; 95% CI, 0.2-0.7) and have stable sexual couple (HR 0.62; 95% CI, 0.4-0.9) were protective factors. Patients with favorable predictors had an incident rate of 2.86 cases/100 person-years (95% CI, 3.5-10.3).
The rate of progression to HGAIN varies according to different predictors that should be considered when assessing the particular risk of each patient. Patients with low risk of progression could be screened at longer intervals.
We describe the risk of progression to HGAIN in a cohort of 556 HIV-infected MSM. The incidence rate of HGAIN varies widely according to different predictors. These factors should be considered when assessing the particular risk of each patient.
评估多个因素在预测一组感染HIV的男男性行为者（MSM）进展为高级别肛门上皮内瘤变（HGAIN）风险中的价值。
对556名感染HIV的MSM进行纵向研究，这些患者每次就诊时均接受肛门发育异常筛查（包括肛门细胞学检查和高分辨率肛门镜检查）。
采用Kaplan-Meier分析估计进展为HGAIN的发生率。通过Cox比例风险回归评估进展的预测因素。
在649人年的随访中，诊断出68例HGAIN事件，进展率为10.5例/100人年[95%置信区间（CI），8.1 - 13.3]。HGAIN的累积发生率在12个月时为7.2%（95%CI，4.3 - 10.1），在24个月时为16.2%（95%CI，11.7 - 20.7）。进展的独立危险因素如下：细胞学异常[风险比（HR），低级别鳞状上皮内病变时为2.5（95%CI，1.2 - 4.9），意义不明确的非典型鳞状细胞时为2.76（95%CI，1.4 - 5.3），高级别鳞状上皮内病变时为7.73（95%CI，2.3 - 25.4）]，高分辨率肛门镜检查异常（HR 3.57；95%CI，2 - 6.4）以及感染16型或18型人乳头瘤病毒（HR 1.63；95%CI，1 - 2.6）。正在接受高效抗逆转录病毒治疗（HAART）（HR 0.4；95%CI，0.2 - 0.7）和有固定性伴侣（HR 0.62；95%CI，0.4 - 0.9）为保护因素。具有有利预测因素的患者发生率为2.86例/100人年（95%CI，3.5 - 10.3）。
进展为HGAIN的发生率因不同的预测因素而异，在评估每位患者的特定风险时应予以考虑。进展风险低的患者可延长筛查间隔时间。
我们描述了556名感染HIV的MSM队列中进展为HGAIN的风险。HGAIN的发生率因不同的预测因素而有很大差异。在评估每位患者的特定风险时应考虑这些因素。
