Hidalgo-Tenorio Carmen, Gil-Anguita Concepción, Ramírez-Taboada Jessica, Esquivias Javier, López-Ruz Miguel A, Balgahata Omar Mohamed, Javier-Martinez Rosario, Pasquau Juan
Department of Infectious Diseases Department of Pathology, Virgen de las Nieves University Hospital, Granada Unit of Infectious Diseases, "University Hospital Complex", Jaen, Spain.
Medicine (Baltimore). 2017 Sep;96(39):e8109. doi: 10.1097/MD.0000000000008109.
Squamous cell carcinoma of anus (SCCA) is one of the most frequent non-AIDS-defining diseases in HIV patients, mainly in men who have sex with men (MSM), and it is associated with human papillomavirus (HPV) infection.To determine the prevalence of high-risk HPV (HR-HPV) genotypes, premalignant lesions (HSIL) and SCCA in a cohort of HIV-positive MSM; to study the distribution of HPV genotypes according to anal histology results; and to analyze risk factors for this infection.This prospective single-center study was conducted between May 2010 and September 2016. At the study visit, cotton swabs were used to collect anal samples for cytology study in ThinPrep Pap Test liquid medium (Thin Prep Processor 2000, Hologic Corp, USA), and for HPV PCR (Linear Array HPV Genotyping Test). After, high-resolution anoscopy (HRA) (Zeiss 150 fc) was carried out. Logistic regression analysis was performed to identify risk factors for HR-HPV infection.The study included 319 patients, with mean age of 36.7 years; HR-HPV was detected in 81.3%. The prevalence of HSIL was 13.5% and SCCA was 0.3%. With regard to the distribution of HPV genotypes according to histology results, HPV 16 was the most frequent genotype in normal anal mucosa (26.7%), in LSILs (36.9%), and in HSILs (38%). In multivariate analysis, CD4 nadir < 200 cells/μL was the factor associated with infection by HR-HPV (OR 3.66, 95% CI 1.05%-12.75%).HIV-positive MSM showed a high prevalence of HSIL+ lesions and of infection by oncogenic HPV, which appears to be favored by a deficient immune system. HPV 16 was the most frequently isolated genotype in anal mucosa, regardless of lesion type.
肛门鳞状细胞癌（SCCA）是HIV患者中最常见的非艾滋病定义疾病之一，主要见于男男性行为者（MSM），且与人类乳头瘤病毒（HPV）感染有关。为确定一组HIV阳性MSM队列中高危HPV（HR-HPV）基因型、癌前病变（HSIL）和SCCA的患病率；根据肛门组织学结果研究HPV基因型的分布；并分析这种感染的危险因素。这项前瞻性单中心研究于2010年5月至2016年9月进行。在研究访视时，使用棉拭子在ThinPrep Pap检测液体培养基（Thin Prep处理器2000，美国Hologic公司）中采集肛门样本用于细胞学研究，并用于HPV PCR（线性阵列HPV基因分型检测）。之后，进行高分辨率肛门镜检查（HRA）（蔡司150 fc）。进行逻辑回归分析以确定HR-HPV感染的危险因素。该研究纳入了319名患者，平均年龄为36.7岁；HR-HPV的检出率为81.3%。HSIL的患病率为13.5%，SCCA的患病率为0.3%。关于根据组织学结果的HPV基因型分布，HPV 16是正常肛门黏膜（26.7%）、低度鳞状上皮内病变（LSIL）（36.9%）和高度鳞状上皮内病变（HSIL）（38%）中最常见的基因型。在多变量分析中，CD4最低点<200个细胞/μL是与HR-HPV感染相关的因素（比值比3.66，95%置信区间1.05%-12.75%）。HIV阳性MSM显示HSIL+病变和致癌性HPV感染的患病率很高，这似乎受到免疫系统缺陷的影响。无论病变类型如何，HPV 16是肛门黏膜中最常分离出的基因型。
