DʼSouza Gypsyamber, Wentz Alicia, Wiley Dorothy, Shah Nisha, Barrington Francine, Darragh Teresa M, Joste Nancy, Plankey Michael, Reddy Susheel, Breen Elizabeth C, Young Stephen, Cranston Ross D
*Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †School of Nursing, University of California, Los Angeles, CA; ‡Department of Pathology, University of California, San Francisco, CA; §Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM; ‖Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC; ¶Department of Infectious Disease, Northwestern University, Chicago, IL; #Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA; **Tricore Reference Laboratories. Albuquerque, NM; and ††Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
J Acquir Immune Defic Syndr. 2016 Apr 15;71(5):570-6. doi: 10.1097/QAI.0000000000000910.
To evaluate the prevalence of anal cytology (ACyt) abnormalities among HIV-infected and HIV-uninfected men who have sex with men (MSM).
Multicenter cohort study of 723 HIV-infected and 788 HIV-uninfected MSM with ACyt, with a second ACyt collected 2 years later. A referral for high-resolution anoscopy was suggested for abnormal ACyt.
ACyt samples were collected using a polyester swab and liquid cytology media and read in a central laboratory.
Prevalence of any abnormal ACyt was 25% in HIV-uninfected MSM and increased to 38%, 41%, and 47% among HIV-infected MSM with current CD4 T-cell counts ≥500, 350-499, and <350 cells/mm (P < 0.001), respectively. Anal HPV16 DNA was also more common in HIV-infected than HIV-uninfected MSM (25% versus 16%, P < 0.001). Abnormal baseline ACyt together with prevalent HPV16 DNA detection was present in only 7% of HIV-uninfected MSM compared to 18% of HIV-infected MSM with current CD4 < 350, P < 0.001. Among HIV-infected men, 56% of the men with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions ASCs-US/LSILs and 81% of men with atypical squamous cells cannot exclude high-grade (ASC-H/)/high-grade squamous intraepithelial lesions (HSIL) had lower grade ACyt findings 18-30 months later ("regressed"). However, 19% of untreated HIV-infected men with ASC-H/HSIL cytology maintained that same grade of cytology in their second test approximately 2 years later, and 15% with ASC-US/LSIL "progressed" to ASC-H/HSIL. Abnormal ACyt had high sensitivity (96%) but low specificity (17%) for biopsy-proven HSIL.
Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current antiretroviral therapy era.
评估感染人类免疫缺陷病毒（HIV）和未感染HIV的男男性行为者（MSM）中肛门细胞学（ACyt）异常的患病率。
对723名感染HIV和788名未感染HIV的MSM进行多中心队列研究，这些人接受了ACyt检测，并在2年后采集了第二次ACyt样本。对于ACyt异常者，建议转诊进行高分辨率肛门镜检查。
使用聚酯拭子和液体细胞学培养基采集ACyt样本，并在中央实验室进行解读。
未感染HIV的MSM中任何ACyt异常的患病率为25%，在当前CD4 T细胞计数≥500、350 - 499和<350个细胞/mm³的感染HIV的MSM中，该患病率分别升至38%、41%和47%（P < 0.001）。肛门人乳头瘤病毒16型（HPV16）DNA在感染HIV的MSM中也比未感染HIV的MSM更常见（25%对16%，P < 0.001）。未感染HIV的MSM中只有7%在基线ACyt异常的同时检测到HPV16 DNA流行，而当前CD4<350的感染HIV的MSM中这一比例为18%，P < 0.001。在感染HIV的男性中，56%意义不明确的非典型鳞状细胞或低级别鳞状上皮内病变（ASCs-US/LSILs）患者以及81%非典型鳞状细胞不能排除高级别（ASC-H）/高级别鳞状上皮内病变（HSIL）患者在18 - 30个月后ACyt结果级别降低（“消退”）。然而，19%未经治疗的感染HIV且细胞学检查为ASC-H/HSIL的男性在大约2年后的第二次检测中维持相同的细胞学级别，15%的ASCs-US/LSIL患者“进展”为ASC-H/HSIL。对于活检证实的HSIL，ACyt异常具有高敏感性（96%）但低特异性（17%）。
在当前抗逆转录病毒治疗时代，感染HIV的男性中ACyt异常的患病率仍然较高。
