在一项横断面研究中，长期抗逆转录病毒治疗与HIV阳性男男性行为者中较少的肛管高级别鳞状上皮内病变相关。
Prolonged antiretroviral therapy is associated with fewer anal high-grade squamous intraepithelial lesions in HIV-positive MSM in a cross-sectional study.
作者信息
Libois Agnès, Feoli Francesco, Nkuize Marcel, Delforge Marc, Konopnicki Deborah, Clumeck Nathan, De Wit Stéphane
机构信息
Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Pathology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.
出版信息
Sex Transm Infect. 2017 Feb;93(1):15-17. doi: 10.1136/sextrans-2015-052444. Epub 2016 Mar 30.
OBJECTIVE
HIV-positive men who have sex with men (MSM) are at increased risk of anal cancer. We evaluate the risk factors for anal high-grade squamous intraepithelial lesion (HSIL) (the precursor of anal cancer) in HIV-positive MSM.
METHODS
In this cross-sectional study within a cohort, 320 HIV-positive MSM were screened by anal cytology followed by high-resolution anoscopy (HRA) in case of abnormal cytology. Risk factors for anal HSIL were analysed.
RESULTS
Men were mostly middle-aged Caucasians with median CD4+ T lymphocytes of 638 cells/µL, 87% on combined antiretroviral therapy (cART) for a median of 5 years. 198 anal cytology samples were normal. In the 122 patients with abnormal cytology, HRA with biopsies were performed: 12% (n=15) normal, 36% (n=44) anal low-grade squamous intraepithelial lesion (LSIL) and 51% (n=63) anal HSIL. Comparing patients with or without anal HSIL (normal cytology or normal biopsy or LSIL), we found in multivariate analysis significantly fewer anal HSIL in patients with cART ≥24 months (OR 0.32 CI 95% 0.162 to 0.631, p=0.001).
CONCLUSIONS
Prolonged cART (≥24 months) is associated with fewer anal HSIL.
目的
男男性行为者（MSM）中的HIV阳性者患肛门癌的风险增加。我们评估了HIV阳性MSM发生肛门高级别鳞状上皮内病变（HSIL，肛门癌的前驱病变）的风险因素。
方法
在一项队列中的横断面研究中，对320名HIV阳性MSM进行肛门细胞学筛查，若细胞学异常则进一步进行高分辨率肛门镜检查（HRA）。分析肛门HSIL的风险因素。
结果
研究对象大多为中年白种人，CD4 + T淋巴细胞中位数为638个/µL，87%接受联合抗逆转录病毒治疗（cART），治疗时间中位数为5年。198份肛门细胞学样本正常。在122名细胞学异常的患者中，进行了HRA及活检：12%（n = 15）正常，36%（n = 44）为肛门低级别鳞状上皮内病变（LSIL），51%（n = 63）为肛门HSIL。比较有或无肛门HSIL的患者（细胞学正常或活检正常或为LSIL），我们在多变量分析中发现，接受cART≥24个月的患者中肛门HSIL显著较少（比值比0.32，95%置信区间0.162至0.631，p = 0.001）。
结论
长期cART（≥24个月）与较少的肛门HSIL相关。
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