Robbins Hilary A, Wiley Dorothy J, Ho Ken, Plankey Michael, Reddy Susheel, Joste Nancy, Darragh Teresa M, Breen Elizabeth C, Young Stephen, D'Souza Gypsyamber
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Room E6132, Baltimore, MD 21205, USA.
School of Nursing, University of California Los Angeles, Los Angeles, CA, USA.
Papillomavirus Res. 2018 Jun;5:143-149. doi: 10.1016/j.pvr.2018.04.001. Epub 2018 Apr 4.
Men who have sex with men (MSM) are at increased risk for anal cancer. In cervical cancer screening, patterns of repeated cytology results are used to identify low- and high-risk women, but little is known about these patterns for anal cytology among MSM.
We analyzed Multicenter AIDS Cohort Study (MACS) data for MSM who were offered anal cytology testing annually (HIV-positive) or every 2 years (HIV-negative) for 4 years.
Following an initial negative (normal) cytology, the frequency of a second negative cytology was lower among HIV-positive MSM with CD4 ≥ 500 (74%) or CD4 < 500 (68%) than HIV-negative MSM (83%) (p < 0.001). After an initial abnormal cytology, the frequency of a second abnormal cytology was highest among HIV-positive MSM with CD4 < 500 (70%) compared to CD4 ≥ 500 (53%) or HIV-negative MSM (46%) (p = 0.003). Among HIV-positive MSM with at least three results, 37% had 3 consecutive negative results; 3 consecutive abnormal results were more frequent among CD4 < 500 (22%) than CD4 ≥ 500 (10%) (p = 0.008).
More than one-third of HIV-positive MSM have consistently negative anal cytology over three years. Following abnormal anal cytology, a repeated cytology is commonly negative in HIV-negative or immunocompetent HIV-positive men, while persistent cytological abnormality is more likely among HIV-positive men with CD4 < 500.
男男性行为者（MSM）患肛门癌的风险增加。在宫颈癌筛查中，重复细胞学检查结果的模式用于识别低风险和高风险女性，但对于MSM的肛门细胞学检查这些模式知之甚少。
我们分析了多中心艾滋病队列研究（MACS）的数据，该研究中的MSM每年（HIV阳性）或每两年（HIV阴性）接受4年的肛门细胞学检查。
在初次细胞学检查为阴性（正常）后，CD4≥500的HIV阳性MSM（74%）或CD4＜500的HIV阳性MSM（68%）中第二次细胞学检查为阴性的频率低于HIV阴性MSM（83%）（p＜0.001）。在初次细胞学检查异常后，CD4＜500的HIV阳性MSM中第二次细胞学检查异常的频率最高（70%），相比之下，CD4≥500的HIV阳性MSM为（53%），HIV阴性MSM为（46%）（p = 0.003）。在至少有三次检查结果的HIV阳性MSM中，37%有连续三次阴性结果；CD4＜500的MSM中连续三次异常结果比CD4≥500的MSM更常见（22%比10%）（p = 0.008）。
超过三分之一的HIV阳性MSM在三年中肛门细胞学检查一直为阴性。在肛门细胞学检查异常后，HIV阴性或免疫功能正常的HIV阳性男性重复细胞学检查通常为阴性，而CD4＜500的HIV阳性男性中细胞学异常持续存在的可能性更大。
