人类乳头瘤病毒在多个部位与HIV血清阳性个体的肛门鳞状上皮内病变相关。
Human Papillomavirus at Multiple Sites Associated with Anal Squamous Intraepithelial Lesions in HIV-Seropositive Individuals.
作者信息
Chuang Eleanore, Lim Eunjung, Milne Cris, Zhu Xuemei, Agsalda Melissa, Killeen Jeffrey, Miller F DeWolfe, Hernandez Brenda Y, Shiramizu Bruce
机构信息
Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, USA; Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii, USA.
Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, USA.
出版信息
Ann Clin Cytol Pathol. 2016;2(4). Epub 2016 Jul 12.
OBJECTIVE
HIV-Seropositive patients have higher risk of HPV infection even on anti-retroviral therapy. Infection with high-risk HPV genotypes can cause dysplasia leading to cancer. This study assessed HPV at different anatomical sites in HIV-seropositive individuals and factors associated with anal squamous intraepithelial lesions (ASIL).
METHODS
Specimens were obtained from multiple anatomical sites for each participant in conjunction with routine screening for anal dysplasia. Female specimens included cervical and anal cytologies and oral wash. Male specimens included anal cytologies, oral wash, and exfoliated cells from penile head, penile shaft, scrotum, and from uncircumcised subjects, inner foreskin. Demographic and clinical characteristics were recorded. Following DNA extraction, HIV DNA copy was assessed by qPCR; HPV was genotyped. Statistical analyses included calculation of odds ratios (OR) and 95% confidence intervals (CI), t-tests or Mann-Whitney tests.
RESULTS
Males were more likely to have ASIL: 29/50 (58%) compared to 1/11 females (9%) (OR=13.81, 95% CI: 1.64-116.32). HPV 6 or 11 in anal specimens was significantly associated with ASIL (OR= 6.29, 95% CI: 1.49-26.44). Number of HPV genotypes in anal specimens was also significant: ASIL+ (3.4 ± 3.1) versus ASIL- (1.6 ± 3.1) (p=0.009). Among 44 males, HPV was detected from at least one anatomical site for 33 participants (75%): 27 anus (61%), 19 oral wash (44%), 17 penile shaft (39%), 11 scrotum (26%), 10 penile head (23%), 0 foreskin. Detection of HPV in penile shaft specimens was significantly associated with ASIL (OR=6.79, 95% CI: 1.57-29.36) as was number of HPV genotypes in penile shaft specimens: ASIL+ (2.4 ± 4.0) versus ASIL- (0.6 ± 1.7) (p=0.025). Only 1/11 females had ASIL; only 1/11 females had cervical dysplasia: OR was not estimable due to small numbers.
CONCLUSIONS
Males were more prone to ASIL than females. HPV at anal as well as non-anal sites may be indicative of ASIL.
目的
即使接受抗逆转录病毒治疗，HIV血清阳性患者感染人乳头瘤病毒（HPV）的风险也更高。高危HPV基因型感染可导致发育异常进而引发癌症。本研究评估了HIV血清阳性个体不同解剖部位的HPV情况以及与肛管鳞状上皮内病变（ASIL）相关的因素。
方法
在对每位参与者进行肛管发育异常常规筛查的同时，从多个解剖部位获取标本。女性标本包括宫颈和肛管细胞学检查样本以及口腔冲洗液。男性标本包括肛管细胞学检查样本、口腔冲洗液，以及来自阴茎头、阴茎体、阴囊的脱落细胞，对于未行包皮环切术的男性，还包括包皮内板。记录人口统计学和临床特征。DNA提取后，通过定量聚合酶链反应（qPCR）评估HIV DNA拷贝数；对HPV进行基因分型。统计分析包括计算比值比（OR）和95%置信区间（CI）、t检验或曼-惠特尼检验。
结果
男性发生ASIL的可能性更大：29/50（58%），而女性为1/11（9%）（OR = 13.81，95% CI：1.64 - 116.32）。肛管标本中HPV 6或11与ASIL显著相关（OR = 6.29，95% CI：1.49 - 26.44）。肛管标本中HPV基因型数量也具有显著性差异：ASIL阳性组（3.4 ± 3.1）与ASIL阴性组（1.6 ± 3.1）（p = 0.009）。在44名男性中，33名参与者（75%）至少在一个解剖部位检测到HPV：27例在肛管（61%），19例在口腔冲洗液（44%），17例在阴茎体（39%），11例在阴囊（26%），10例在阴茎头（23%），包皮内板未检测到。阴茎体标本中检测到HPV与ASIL显著相关（OR = 6.79，95% CI：1.57 - 29.36），阴茎体标本中HPV基因型数量也具有显著性差异：ASIL阳性组（2.4 ± 4.0）与ASIL阴性组（0.6 ± 1.7）（p = 0.025）。只有1/11的女性发生ASIL；只有1/11的女性有宫颈发育异常：由于样本量小，OR无法估计。
结论
男性比女性更容易发生ASIL。肛管及非肛管部位的HPV可能提示ASIL。
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