Schofield Alice M, Sadler Laura, Nelson Linsey, Gittins Matthew, Desai Mina, Sargent Alex, McMahon Raymond F T, Hill James, Crosbie Emma J, Patnick Julietta, Kitchener Henry C
aInstitute of Cancer Sciences, The University of Manchester bCentre for Biostatistics, Institute of Population Health, The University of Manchester cManchester Cytology Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester dClinical Virology, Central Manchester University Hospitals NHS Foundation Trust, Manchester eDepartment of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester fGeneral Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester gPublic Health England, Sheffield, UK.
AIDS. 2016 Jun 1;30(9):1375-83. doi: 10.1097/QAD.0000000000001045.
The study sought to establish the feasibility and acceptability of anal screening among men MSM.
Prospective cohort study.
Sexual health clinics in tertiary care.
Known HIV-positive and negative MSM who have anoreceptive intercourse.
Anal screening with human papilloma virus (HPV) testing, liquid-based cytology and high-resolution anoscopy with biopsy of anoscopic abnormalities. Participants completed questionnaires at baseline and at 6 months.
Anal HPV was highly prevalent in MSM (HIV-positive, 88% and HIV-negative, 78%). Despite the high prevalence of cytological abnormality in both HIV-positive (46.2%) and negative (35.0%) MSM, almost half of anal intraepithelial neoplasia (AIN) of all grades were associated with negative cytology. Anoscopically directed biopsies detected AIN3 or worse (AIN3+) in 14 of 203 (6.9%) of HIV-positive MSM and three of 81 (3.7%) HIV-negative MSM. The corresponding prevalence of AIN2+ was 26.6 and 20.9%, respectively. One case of AIN3 was detected at the second visit. Screening was considered to be highly acceptable by participants.
The high prevalence of high-risk-HPV and frequency of false negative cytology in this study suggest that high-resolution anoscopy would have most clinical utility, as a primary screening tool for anal cancer in a high-risk group. The prevalence of AIN3+ in HIV-positive MSM lends support for a policy of screening this group, but the high prevalence of lower grade lesions which do not warrant immediate treatment and the limitations of treating high-grade lesions requires careful consideration in terms of a screening policy.
本研究旨在确定男男性行为者（MSM）进行肛门筛查的可行性和可接受性。
前瞻性队列研究。
三级医疗中心的性健康诊所。
已知有肛门性交行为的HIV阳性和阴性MSM。
进行人乳头瘤病毒（HPV）检测、液基细胞学检查以及对肛门镜检查异常部位进行活检的肛门筛查。参与者在基线和6个月时完成问卷调查。
肛门HPV在MSM中高度流行（HIV阳性者为88%，HIV阴性者为78%）。尽管HIV阳性（46.2%）和阴性（35.0%）的MSM中细胞学异常的发生率都很高，但所有分级的肛门上皮内瘤变（AIN）中几乎有一半与细胞学阴性相关。在203名HIV阳性MSM中，有14名（6.9%）通过肛门镜引导活检检测出AIN3或更严重病变（AIN3+）；在81名HIV阴性MSM中，有3名（3.7%）检测出AIN3+。相应的AIN2+患病率分别为26.6%和20.9%。在第二次随访时检测到1例AIN3。参与者认为筛查是高度可接受的。
本研究中高危HPV的高流行率和细胞学假阴性的频率表明，高分辨率肛门镜检查作为高危人群肛门癌的主要筛查工具，具有最大的临床实用性。HIV阳性MSM中AIN3+的患病率支持对该群体进行筛查的政策，但不急需治疗的低级别病变的高患病率以及高级别病变治疗的局限性，在制定筛查政策时需要仔细考虑。
