Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC.
Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA.
J Low Genit Tract Dis. 2018 Oct;22(4):340-347. doi: 10.1097/LGT.0000000000000437.
Anal cancer rates are increasing among HIV-infected persons. Although an efficacious human papillomavirus (HPV) vaccine is available, HPV vaccination rates remain low. Therefore, providers perform anal cancer screening, but there is no consensus on the optimal methods or timing of screening. This study was performed to determine the prevalence of and factors associated with anal squamous intraepithelial lesions in sexually active HIV-infected young men who have sex with men and transgender women.
We performed a single-center, retrospective study of sexually active HIV-infected young men who have sex with men and transgender women aged 13 to 24 years at an HIV clinic in Atlanta GA from 2009 to 2016. We used analysis of variance and χ tests of independence to evaluate bivariate associations and identify demographic, behavioral, and clinical risk factors.
Of 314 subjects with a mean (SD) age of 20.4 (2.1) years at initial anal cytology testing, 5% had completed the HPV vaccine series at or before the time that cytology was obtained. Ninety-five percent of the anal cytology tests obtained were abnormal, and 72 (29%) of those subjects returned for diagnostic testing either by intraoperative biopsy or high-resolution anoscopy. Fifty-seven percent of those who underwent biopsy had histologic high-grade squamous intraepithelial lesions including 2 cases of carcinoma in situ. A history of greater than 20 lifetime sexual partners was associated with abnormal histology (probability < 0.001, p = .017).
Our study highlights the value of early, standardized screening to avoid missing anal dysplasia or cancer, particularly in unvaccinated persons with high numbers of sexual partners.
感染 HIV 的人群中肛门癌发病率正在上升。尽管已有有效的人乳头瘤病毒（HPV）疫苗，但 HPV 疫苗接种率仍然较低。因此，医务人员会对肛门癌进行筛查，但对于筛查的最佳方法和时间尚未达成共识。本研究旨在确定性活跃的 HIV 感染的男男性行为者和跨性别女性中，与肛门鳞状上皮内病变相关的流行率和因素。
我们对 2009 年至 2016 年在佐治亚州亚特兰大的一家 HIV 诊所就诊的年龄在 13 至 24 岁之间的性活跃的 HIV 感染的男男性行为者和跨性别女性进行了单中心回顾性研究。我们使用方差分析和卡方检验独立评估了双变量相关性，并确定了人口统计学、行为和临床危险因素。
在进行初始肛门细胞学检查的 314 名平均（SD）年龄为 20.4（2.1）岁的受试者中，有 5%在接受细胞学检查时或之前已经完成了 HPV 疫苗系列接种。95%的肛门细胞学检查结果异常，其中 72 名（29%）受试者接受了诊断性检测，包括术中活检或高分辨率肛门镜检查。接受活检的受试者中有 57%的人存在组织学高级别鳞状上皮内病变，包括 2 例原位癌。有超过 20 个性伴侣的病史与异常组织学相关（概率 < 0.001，p =.017）。
我们的研究强调了早期标准化筛查的价值，以避免错过肛门发育不良或癌症，特别是在未接种疫苗且性伴侣较多的人群中。
