Marchetti Giulia, Comi Laura, Bini Teresa, Rovati Marco, Bai Francesca, Cassani Barbara, Ravizza Marina, Tarozzi Marco, Pandolfo Alessandro, Dalzero Serena, Opocher Enrico, Romagnoli Solange, Carrassi Antonio, Bosari Silvano, d'Arminio Monforte Antonella
Department of Health Sciences, Institute of Infectious and Tropical Diseases, San Paolo Hospital, University of Milan, Via A Di Rudinì 8, 20142 Milan, Italy.
Surgery Chair, Department of Health Sciences, San Paolo Hospital, University of Milan, 20142 Milan, Italy.
J Sex Transm Dis. 2013;2013:915169. doi: 10.1155/2013/915169. Epub 2013 Mar 5.
The aim of this study was to assess the prevalence of HPV infection and determinants of abnormal cytology in HIV-positive patients. In a cross-sectional study, patients of both sexes, asymptomatic for HPV, underwent anorectal (men)/cervical (women) and oral swabs. Cytology and HPV-PCR detection/genotyping (high- and low-risk genotypes, HR-LR/HPV) were performed. A total of 20% of the 277 enrolled patients showed oral HPV, with no atypical cytology; in men, anal HPV prevalence was 81% with 64% HR genotypes. In women, cervical HPV prevalence was 58% with 37% HR-HPV. The most frequent genotypes were HPV-16 and HPV-18; 37% of men and 20% of women harbored multiple genotypes. Also, 47% of men showed anal squamous intraepithelial lesions (SILs); 6% had high- and 35% low-grade SILs (HSILs/LSILs); 5% had atypical squamous cells of undetermined significance (ASC-US). HR-HPV was independently associated with anal-SIL in men (P = 0.039). Moreover, 37% of women showed cervical SIL: 14 ASC-US, 15 LSILs, 4 HSILs, and 1 in situ cancer. The presence of both LR and HR-HPV in women was independently associated with SIL (P = 0.003 and P = 0.0001). HR-HPV and atypical cytology were frequently identified in our cohort. HPV screening should be mandatory in HIV-infected subjects, and vaccine programs for HPV-negative patients should be implemented.
本研究的目的是评估HIV阳性患者中HPV感染的患病率以及异常细胞学的决定因素。在一项横断面研究中，HPV无症状的男女患者接受了肛门直肠（男性）/宫颈（女性）和口腔拭子检查。进行了细胞学检查和HPV-PCR检测/基因分型（高危和低危基因型，HR-LR/HPV）。在277名登记患者中，共有20%的患者口腔有HPV，无非典型细胞学表现；在男性中，肛门HPV患病率为81%，高危基因型为64%。在女性中，宫颈HPV患病率为58%，高危HPV为37%。最常见的基因型是HPV-16和HPV-18；37%的男性和20%的女性携带多种基因型。此外，47%的男性有肛门鳞状上皮内病变（SILs）；6%有高级别和35%有低级别SILs（HSILs/LSILs）；5%有意义不明确的非典型鳞状细胞（ASC-US）。高危HPV与男性肛门SIL独立相关（P = 0.039）。此外，37%的女性有宫颈SIL：14例ASC-US、15例LSILs、4例HSILs和1例原位癌。女性同时存在低危和高危HPV与SIL独立相关（P = 0.003和P = 0.0001）。在我们的队列中经常发现高危HPV和非典型细胞学表现。HIV感染受试者应强制进行HPV筛查，应为HPV阴性患者实施疫苗接种计划。
