Burgos Joaquin, Curran Adria, Landolfi Stefania, Guelar Ana, Miguel Lucia, Dinares MaCarmen, Villar Judith, Navarro Jordi, Hernandez-Losa Javier, Falcó Vicenç
aInfectious Diseases Department bAnatomical Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) cInternal Medicine Department, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
AIDS. 2017 Jun 1;31(9):1245-1252. doi: 10.1097/QAD.0000000000001433.
To assess risk factors of high-grade anal intraepithelial neoplasia (HGAIN) recurrence in a cohort of HIV-infected MSM.
Consecutive HIV-infected 100 MSM with a history of successfully treated intra-anal HGAIN with electrocautery were followed with anal cytology, human papillomavirus (HPV) determination, and high-resolution anoscopy (HRA) at 3-6-month intervals. HGAIN recurrence was analyzed using Kaplan-Meier analysis. Risk factors of recurrence were assessed using Cox proportional hazards regression. The value of different tests for detecting recurrence was also assessed.
After a mean follow-up of 17.6 months, 39 of the 100 patients [39%, 95% confidence interval (CI): 29-49] developed recurrent HGAIN, 24 at the previously treated site, and 15 at a different site. The probability of recurrence was 23.5% at 12 months (95% CI: 13.9-33.1) and 53.3% at 24 months (95% CI: 34.3-72.7). Risk factors of recurrence were presence of hepatitis C antibodies (hazard ratio 2.79; 95% CI: 1.04-7.53), nadir CD4 cell count less than 200 cells/μl (hazard ratio 2.61; 95% CI: 1.06-6.44), and HGAIN lesions affecting at least two octants of anal circumference (hazard ratio 8.27; 95% CI: 1.1-62). Infection by at least two HPV oncogenic strains increased the risk of recurrence (hazard ratio 2.3; 95% CI: 0.98-5.42). HRA, anal cytology, and oncogenic HPV determination test showed a sensitivity of 100, 79.4, and 86.7%, and a specificity of 57.7, 36.6, and 34.7%, respectively, for detecting HGAIN recurrence.
The risk of HGAIN recurrence in HIV-infected MSM is high. Regular posttreatment follow-up of these patients is mandatory, and performing direct HRA appears to be the best strategy.
评估一组感染HIV的男男性行为者（MSM）中高级别肛门上皮内瘤变（HGAIN）复发的危险因素。
对100例有经电灼成功治疗肛门内HGAIN病史的连续感染HIV的MSM，每隔3 - 6个月进行肛门细胞学检查、人乳头瘤病毒（HPV）检测和高分辨率肛门镜检查（HRA）。采用Kaplan-Meier分析评估HGAIN复发情况。使用Cox比例风险回归评估复发的危险因素。还评估了不同检测方法对检测复发的价值。
平均随访17.6个月后，100例患者中有39例（39%，95%置信区间（CI）：29 - 49）出现HGAIN复发，24例在先前治疗部位复发，15例在不同部位复发。12个月时复发概率为23.5%（95% CI：13.9 - 33.1），24个月时为53.3%（95% CI：34.3 - 72.7））。复发的危险因素包括丙型肝炎抗体阳性（风险比2.79；95% CI：1.04 - 7.53））、最低点CD4细胞计数低于200个/μl（风险比2.61；95% CI：1.06 - 6.44））以及HGAIN病变累及至少两个肛门圆周象限（风险比8.27；95% CI：1.1 - 62））。感染至少两种HPV致癌株会增加复发风险（风险比2.3；95% CI：0.98 - 5.42））。HRA、肛门细胞学检查和致癌性HPV检测对检测HGAIN复发的敏感性分别为100%、79.4% 和86.7% ，特异性分别为57.7%、36.6% 和34.7%。
感染HIV的MSM中HGAIN复发风险很高。对这些患者进行定期的治疗后随访是必要的，而进行直接的HRA似乎是最佳策略。
