肛门细胞学病变和 HPV 感染与肛门癌高危人群。

Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer.

机构信息

Sexually Transmitted Infection/Human Immunodeficiency Virus Unit, San Gallicano Dermatological Institute, IFO-IRCCS, Rome, Italy.

Pathology Department, Regina Elena National Cancer Institute, IFO-IRCCS, Rome, Italy.

出版信息

Cancer Cytopathol. 2018 Jul;126(7):461-470. doi: 10.1002/cncy.22003. Epub 2018 Apr 25.

DOI:10.1002/cncy.22003

PMID:29694716

Abstract

BACKGROUND

Anal cytology may be useful for evaluating lesions associated with human papillomavirus (HPV) in individuals at increased risk for anal cancer.

METHODS

Liquid-based cytology was used to assess anal cytological lesions among human immunodeficiency virus (HIV)-infected and HIV-uninfected men who have sex with men (MSM). The Linear Array HPV genotyping test was used for HPV detection.

RESULTS

This cross-sectional study included 1021 MSM, of whom 388 were HIV-infected (38.0%). Anal cytological lesions (atypical squamous cells of undetermined significance or more severe [ASCUS+]) were observed in 32.5% and 53.2% of the HIV-uninfected and HIV-infected individuals, respectively (P < .0001). The highest ASCUS + prevalence was observed among ≥45-year-old HIV-uninfected MSM (37.3%) and 25-to 29-year-old HIV-infected MSM (66.7%). High-grade squamous intraepithelial lesions (HSILs) peaked in ≥ 45-year-old HIV-uninfected subjects and 35- to 39-year-old HIV-infected subjects. Individuals with anal infections with high-risk (HR) HPV types were 3 to 4 times more likely to have an ASCUS + report. An HPV-16 and/or HPV-18 infection increased the odds of HSIL or more severe cytology (HSIL+) for HIV-infected MSM almost 4 times. MSM concurrently infected with HR and low-risk HPVs were significantly more likely to have low-grade squamous intraepithelial lesions or more severe cytology (LSIL+) than those infected with only HR types. No significant associations were found between cytological abnormalities and the HIV load and nadir and current CD4 + counts.

CONCLUSIONS

The prevalence of anal cytological lesions is high in MSM, even in HIV-infected individuals treated with combined antiretroviral therapy. In these subjects, HSILs occur more frequently and at a younger age in comparison with HIV-uninfected counterparts. Specific diagnostic procedures should be implemented to manage individuals at increased risk for anal cancer with an abnormal anal Papanicolaou test. Cancer Cytopathol 2018. © 2018 American Cancer Society.

摘要

背景

分析细胞学可能有助于评估与人类乳头瘤病毒（HPV）相关的病变，这些病变与人类免疫缺陷病毒（HIV）感染且有性接触的男男性行为者（MSM）发生肛门癌的风险增加有关。

方法

本研究采用液基细胞学检查对 HIV 感染和未感染的 MSM 进行肛门细胞学病变检查。线性 HPV 基因分型检测用于 HPV 检测。

结果

本横断面研究纳入了 1021 名 MSM，其中 388 名 HIV 感染者（38.0%）。未感染 HIV 的个体和感染 HIV 的个体的肛门细胞学病变（非典型鳞状细胞意义不明确或更严重[ASCUS+]）分别为 32.5%和 53.2%（P<.0001）。45 岁以上的未感染 HIV 的 MSM 的 ASCUS+发生率最高（37.3%），而 25 至 29 岁的 HIV 感染的 MSM 的 ASCUS+发生率最高（66.7%）。高级别鳞状上皮内病变（HSIL）出现在≥45 岁的未感染 HIV 的 MSM 和 35 至 39 岁的感染 HIV 的 MSM 中。感染高危型（HR）HPV 类型的个体发生 ASCUS+报告的可能性是未感染 HIV 的个体的 3 至 4 倍。感染 HPV-16 和/或 HPV-18 的 HIV 感染 MSM 发生 HSIL 或更严重细胞学（HSIL+）的可能性几乎增加了 4 倍。同时感染 HR 和低危型 HPV 的 MSM 发生低级别鳞状上皮内病变或更严重细胞学（LSIL+）的可能性显著高于仅感染 HR 型的 MSM。细胞学异常与 HIV 载量、病毒载量最低点和当前 CD4+计数之间无明显相关性。