Hidalgo-Tenorio Carmen, de Jesus Samantha E, Esquivias Javier, Pasquau Juan
Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, España.
Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, España.
Enferm Infecc Microbiol Clin (Engl Ed). 2018 Nov;36(9):555-562. doi: 10.1016/j.eimc.2017.10.014. Epub 2017 Dec 6.
Anal cancer is one of the most common non-AIDS defining malignancies, especially in men who have sex with men and women living with HIV (WLHIV).
To evaluate the prevalence and incidence of precursor lesions (high-grade squamous intraepithelial lesions [HSIL]) and anal cancer in our cohort of women and to compare them to cervical lesions; to calculate the percentage of patients that acquire and clear oncogenic genotypes (HR-HPV) in the anal canal; and to determine predictive factors for anal HPV infection.
Prospective-longitudinal study (May 2012-December 2016). At baseline (V1) and follow up visits, anal mucosa samples were taken in liquid medium for cytology and HPV PCR. In cases of abnormal anal cytology and/or positive HR-HPV PCR results, a high resolution anoscopy was performed. Patients were also referred to the gynaecologist.
Ninety five women with an average age of 43.7years were included. At baseline, 11.6% had cervical abnormalities (4.1% CIN1, 2.2% CIN2/3, 1.1% cervical cancer), 64.3% anal abnormalities (50% LSIL/AIN1, 9.5% HSIL/AIN2/3 and 2.4% anal cancer) and 49.4% had HR-HPV genotypes. During 36months of follow up, the incidence of anal HSIL was 16×1,000 person-years; 14.8% acquired HR-HPV genotypes and 51.2% cleared them, P=.007. No patients presented CIN1/2/3/ or cervical cancer. In the multivariate analysis we found the following predictive factors for HR-HPV infection: smoking (RR: 1.55, 95%CI: 0.99-2.42), number of sexual partners >3 (RR: 1.69; 95%CI: 1.09-2.62), cervical and anal dysplasia (RR: 1.83; 95%CI: 1.26-2.67) and (RR: 1.55; 95%CI: 1.021-2.35), respectively.
Despite clearance rates of anal oncogenic genotypes being higher than acquisition rates, prevalence and incidence of HSIL were still high and greater than cervical HSIL. Therefore, screening for these lesions should perhaps be offered to all WLHIV.
肛管癌是最常见的非艾滋病定义的恶性肿瘤之一，在男男性行为者和感染艾滋病毒的女性（HIV感染者）中尤为常见。
评估我们队列中女性前驱病变（高级别鳞状上皮内病变[HSIL]）和肛管癌的患病率和发病率，并将其与宫颈病变进行比较；计算肛管中获得并清除致癌基因型（高危型人乳头瘤病毒[HR-HPV]）的患者百分比；并确定肛管HPV感染的预测因素。
前瞻性纵向研究（2012年5月至2016年12月）。在基线（V1）和随访时，采集肛管黏膜样本于液体培养基中进行细胞学检查和HPV PCR检测。对于肛管细胞学异常和/或HR-HPV PCR结果阳性的病例，进行高分辨率肛门镜检查。患者也被转诊至妇科医生处。
纳入95名平均年龄为43.7岁的女性。基线时，11.6%有宫颈异常（4.1%为CIN1，2.2%为CIN2/3，1.1%为宫颈癌），64.3%有肛管异常（50%为低级别鳞状上皮内病变/肛管上皮内瘤变1级[LSIL/AIN1]，9.5%为高级别鳞状上皮内病变/肛管上皮内瘤变2/3级[HSIL/AIN2/3]，2.4%为肛管癌），49.4%有HR-HPV基因型。在36个月的随访期间，肛管HSIL的发病率为16/1000人年；14.8%获得HR-HPV基因型，51.2%清除了这些基因型，P = 0.007。没有患者出现CIN1/2/3或宫颈癌。在多变量分析中，我们发现以下HR-HPV感染的预测因素：吸烟（相对风险：1.55，95%置信区间：0.99 - 2.42）、性伴侣数>3（相对风险：1.69；95%置信区间：1.09 - 2.62）、宫颈和肛管发育异常（相对风险：1.83；95%置信区间：1.26 - 2.67）以及（相对风险：1.55；95%置信区间：1.
尽管肛管致癌基因型的清除率高于获得率，但HSIL的患病率和发病率仍然很高，且高于宫颈HSIL。因此，或许应该对所有HIV感染者进行这些病变的筛查。
