南非约翰内斯堡市中心区感染艾滋病毒男性的肛门生殖器人乳头瘤病毒（HPV）感染、相关疾病及危险因素的患病率：一项队列研究的基线结果
Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: baseline findings from a cohort study.
作者信息
Chikandiwa Admire, Chimoyi Lucy, Pisa Pedro T, Chersich Matthew F, Muller Etienne E, Michelow Pamela, Mayaud Philippe, Delany-Moretlwe Sinead
机构信息
Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
出版信息
BMC Public Health. 2017 Jul 4;17(Suppl 3):425. doi: 10.1186/s12889-017-4354-0.
BACKGROUND
Persistent high-risk human papillomavirus (HR-HPV) infection is associated with the development of anogenital cancers, particularly in men living with HIV (MLWH). We describe the prevalence of anogenital HPV infection, abnormal anal cytology and anogenital warts (AGWs) in MLWH in Johannesburg, and explore whether HPV infection and receipt of antiretroviral treatment is associated with detection of abnormal anal cytology and AGWs.
METHODS
We enrolled a cohort of 304 sexually-active MLWH ≥18 years, who completed a questionnaire and physical examination. Genital swabs were collected from all men and intra-anal swabs from 250 (82%). Swabs were tested for HPV DNA and genotypes, and anal smears graded using the Bethesda classification. Factors associated with anogenital disease were assessed by logistic regression models.
RESULTS
Two thirds were receiving antiretroviral treatment, for a median 33 months (IQR = 15-58) and 54% were HIV-virologically suppressed. Only 5% reported ever having sex with men. Among 283 genital swabs with valid results, 79% had any HPV, 52% had HR-HPV and 27% had >1 HR-HPV infection. By comparison, 39% of the 227 valid intra-anal swabs had detectable HPV, 25% had any HR-HPV and 7% >1 HR infection. While most anal smears were normal (51%), 20% had ASCUS and 29% were LSIL. No cases had HSIL or cancer. Infection with >1 HR type (adjusted OR [aOR] = 2.39; 95%CI = 1.02-5.58) and alpha-9 types (aOR = 3.98; 95%CI = 1.42-11.16) were associated with having abnormal cytology. Prevalence of AGWs was 12%. Infection with any LR type (aOR = 41.28; 95%CI = 13.57-125.62), >1 LR type (aOR = 4.14; 95%CI = 1.60-10.69), being <6 months on antiretroviral treatment (aOR = 6.90; 95%CI = 1.63-29.20) and having a CD4+ count <200 cells/μL (aOR = 5.48; 95%CI: 1.60-18.78) were associated with having AGWs.
CONCLUSIONS
In this population, anogenital HR-HPV infection and associated low-grade disease is common, but severe anal dysplasia was not detected. Findings reinforce the need for HPV vaccination in men for preventing both AGWs and HR-HPV infection. Given the absence of anal HSILs, however, the findings do not support the use of anal screening programmes in this population.
背景
持续性高危型人乳头瘤病毒（HR-HPV）感染与肛门生殖器癌的发生有关，尤其是在感染艾滋病毒的男性（MLWH）中。我们描述了约翰内斯堡MLWH中肛门生殖器HPV感染、肛门细胞学异常和肛门生殖器疣（AGW）的患病率，并探讨HPV感染和接受抗逆转录病毒治疗是否与肛门细胞学异常和AGW的检测有关。
方法
我们招募了304名年龄≥18岁的性活跃MLWH队列，他们完成了问卷调查和体格检查。从所有男性中采集生殖器拭子，从250名男性（82%）中采集肛门内拭子。对拭子进行HPV DNA和基因型检测，并使用贝塞斯达分类法对肛门涂片进行分级。通过逻辑回归模型评估与肛门生殖器疾病相关的因素。
结果
三分之二的人正在接受抗逆转录病毒治疗，中位时间为33个月（四分位间距=15-58），54%的人艾滋病毒病毒学得到抑制。只有5%的人报告曾与男性发生过性行为。在283份有有效结果的生殖器拭子中，79%检测出任何HPV，52%检测出HR-HPV，27%检测出一种以上HR-HPV感染。相比之下，在227份有效的肛门内拭子中，39%检测出可检测到的HPV，25%检测出任何HR-HPV，7%检测出一种以上HR感染。虽然大多数肛门涂片正常（51%），但20%有非典型鳞状细胞不能明确意义（ASCUS），29%为低度鳞状上皮内病变（LSIL）。没有病例为高度鳞状上皮内病变（HSIL）或癌症。感染一种以上HR型（调整后的比值比[aOR]=2.39；95%置信区间[CI]=1.02-5.58）和α-9型（aOR=3.98；95%CI=1.42-11.16）与细胞学异常有关。AGW的患病率为12%。感染任何低风险（LR）型（aOR=41.28；95%CI=13.57-125.62）、一种以上LR型（aOR=4.14；95%CI=1.60-10.69）、接受抗逆转录病毒治疗不到6个月（aOR=6.90；95%CI=1.63-29.20）以及CD4+细胞计数<200个/μL（aOR=5.48；95%CI：1.60-18.78）与患有AGW有关。
结论
在这一人群中，肛门生殖器HR-HPV感染及相关的低度疾病很常见，但未检测到严重的肛门发育异常。研究结果强化了男性接种HPV疫苗以预防AGW和HR-HPV感染的必要性。然而，鉴于没有肛门HSIL病例，研究结果不支持在这一人群中开展肛门筛查项目。
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