Internal Medicine, Mount Sinai Beth Israel, New York, New York.
Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Dis Colon Rectum. 2019 May;62(5):579-585. doi: 10.1097/DCR.0000000000001307.
Data on tissue distribution of human papillomavirus types in anal high-grade squamous intraepithelial lesions are limited and the impact on treatment outcomes poorly understood.
We aimed to investigate potential predictors of treatment failure after electrocautery ablation, including human papillomavirus type(s) isolated from index lesions.
This was a retrospective cohort study.
The study was conducted at a tertiary academic referral center in New York City.
Seventy-nine HIV-infected patients with a diagnosis of anal high-grade squamous intraepithelial lesions between January 2009 and December 2012 were included, and genomic DNA was extracted from biopsy tissue.
The prevalence of human papillomavirus types in index lesions and surveillance biopsies after electrocautery ablation were analyzed to evaluate treatment response.
Of 79 anal high-grade squamous intraepithelial lesions, 71 (90%) tested positive for ≥1 human papillomavirus type; 8 (10%) had no human papillomavirus detected. The most common type was 16 (39%), followed by 33 (15%). Human papillomavirus type 18 was seen in 3%. Sixty-one patients (77%) underwent electrocautery ablation and had subsequent surveillance biopsies. Surveillance biopsies yielded benign findings or low-grade squamous intraepithelial lesions in 31 (51%) of 61 and recurrent high-grade squamous intraepithelial lesions in 30 (49%) of 61 patients (mean follow-up: 35 mo). Ablation response did not differ significantly based on baseline demographics, smoking history, history of anogenital warts, mean CD4 T-cell count, antiretroviral-therapy use, and HIV viral load (<50 copies/mL). The recurrence of high-grade lesions was not significantly associated with high-risk human papillomavirus types detected in index lesions.
Human papillomavirus genotyping in surveillance biopsies was not performed.
Anal high-grade squamous intraepithelial lesions in HIV-infected patients contain a wide range of human papillomavirus types, and individual lesions commonly harbor multiple types concomitantly. Recurrence of anal high-grade squamous intraepithelial lesions after electrocautery ablation occurs frequently and is not affected by high-risk human papillomavirus types. See Video Abstract at http://links.lww.com/DCR/A833.
有关肛门高级别鳞状上皮内病变中人乳头瘤病毒（HPV）类型的组织分布数据有限，其对治疗结果的影响也知之甚少。
我们旨在研究电灼消融治疗后治疗失败的潜在预测因素，包括从病变部位分离出的 HPV 类型。
这是一项回顾性队列研究。
该研究在纽约市的一家三级学术转诊中心进行。
纳入 2009 年 1 月至 2012 年 12 月间诊断为肛门高级别鳞状上皮内病变的 79 例 HIV 感染患者，从活检组织中提取基因组 DNA。
分析电灼消融后的病变和监测活检中的 HPV 类型，以评估治疗反应。
79 例肛门高级别鳞状上皮内病变中，71 例（90%）检测到≥1 种 HPV 类型呈阳性；8 例（10%）未检测到 HPV。最常见的类型是 16 型（39%），其次是 33 型（15%）。HPV 18 型为 3%。61 例患者（77%）接受了电灼消融，并进行了后续监测活检。61 例患者中有 31 例（51%）的监测活检结果为良性或低度鳞状上皮内病变，30 例（49%）为复发的高级别鳞状上皮内病变（平均随访：35 个月）。消融反应与基线人口统计学特征、吸烟史、生殖器疣病史、平均 CD4 T 细胞计数、抗逆转录病毒治疗使用情况和 HIV 病毒载量（<50 拷贝/mL）无关。高危 HPV 类型在病变中的检出与高级别病变的复发无显著相关性。
在监测活检中未进行 HPV 基因分型。
在 HIV 感染患者中，肛门高级别鳞状上皮内病变中包含广泛的 HPV 类型，且单个病变通常同时存在多种类型。电灼消融治疗后肛门高级别鳞状上皮内病变的复发很常见，且不受高危 HPV 类型的影响。观看视频摘要请访问 http://links.lww.com/DCR/A833。
