人乳头瘤病毒感染与印度东部 HIV 阳性男性的肛门细胞学异常。
Human papillomavirus infection & anal cytological abnormalities in HIV-positive men in eastern India.
机构信息
Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
出版信息
BMC Infect Dis. 2018 Dec 27;18(1):692. doi: 10.1186/s12879-018-3618-3.
BACKGROUND
Oncogenic Human papillomavirus (HPV) infections are closely associated with anal cancer which is high among human immunodeficiency virus (HIV) infected males. There are no data regarding anal HPV infection and cytological abnormalities in HIV positive males receiving free therapy in the national program. Thus, this cross-sectional study was performed to assess the prevalence and risk factors of anal HPV infection and cytological abnormalities in HIV positive males.
METHODS
We screened 126 HIV-positive male patients attending the antiretroviral treatment center (ART) between 2014 and 2015 with anal papanicolaou smear cytology and HPV-DNA testing. HPV-DNA was detected by using polymerase chain reaction (PCR) method with two consensus primer sets E6 and MY09/11 and further analyzed for the presence of various HPV genotype by Sanger sequencing. Risk factors associated with anal cytological abnormalities and HPV infection was analyzed by using univariate and multivariate logistic regression models.
RESULTS
Out of 126, 52 were on antiretroviral therapy. 91% were married to female partners but during the study 48 (38%) gave positive history of anal intercourse with other men. Anal cytology was done in 95 patients, out of which 60 (63.15%) had cytological abnormalities. LSIL (low-grade squamous intraepithelial lesions) was present in 27 (45%), ASCUS (atypical squamous cells of undetermined significance) in 31 (52%) and ASC-H (atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion) in 2 (3.33%). In multivariate analysis, the risk factors for cytological abnormality were presence of history of anal intercourse (OR, 6.1; 95% CI, 2.0-18.7) and WHO stage III & IV (OR, 2.7; 95% CI, 1.1-7.5). HPV-DNA was detected in 33/119 (27.73%) patients. The most prevalent HPV type in the study was HPV-16 (10.08%), other HPV types detected were 18,31,35,17,66,72,52,68 and 107 (17.65%).
CONCLUSIONS
High prevalence of anal cytological abnormalities in our study suggests that regular anal Pap smear screening should be done in HIV positive males in the ART center.
背景
致癌性人乳头瘤病毒（HPV）感染与肛门癌密切相关，而肛门癌在人类免疫缺陷病毒（HIV）感染男性中发病率较高。在接受国家免费治疗计划的 HIV 阳性男性中，尚无关于肛门 HPV 感染和细胞学异常的数据。因此，进行了这项横断面研究，以评估 HIV 阳性男性中肛门 HPV 感染和细胞学异常的流行率和危险因素。
方法
我们筛查了 2014 年至 2015 年间在抗逆转录病毒治疗中心（ART）就诊的 126 名 HIV 阳性男性患者的肛门巴氏涂片细胞学和 HPV-DNA 检测。使用聚合酶链反应（PCR）方法，使用两个共识引物组 E6 和 MY09/11 检测 HPV-DNA，并通过 Sanger 测序进一步分析各种 HPV 基因型的存在。使用单变量和多变量逻辑回归模型分析与肛门细胞学异常和 HPV 感染相关的危险因素。
结果
在 126 名患者中，52 名正在接受抗逆转录病毒治疗。91%的患者与女性伴侣结婚，但在研究期间，有 48 名（38%）有与其他男性进行肛门性交的阳性病史。95 名患者进行了肛门细胞学检查，其中 60 名（63.15%）有细胞学异常。低级别鳞状上皮内病变（LSIL）27 例（45%），非典型鳞状细胞不能排除高度鳞状上皮内病变（ASC-H）2 例（3.33%）。在多变量分析中，细胞学异常的危险因素是有肛门性交史（OR，6.1；95%CI，2.0-18.7）和世界卫生组织（WHO）III 期和 IV 期（OR，2.7；95%CI，1.1-7.5）。在 119 名患者中检测到 33 名（27.73%）患者的 HPV-DNA。研究中最常见的 HPV 类型是 HPV-16（10.08%），其他检测到的 HPV 类型有 18、31、35、17、66、72、52、68 和 107（17.65%）。
结论
本研究中肛门细胞学异常的高发生率表明，在 ART 中心的 HIV 阳性男性中应定期进行肛门巴氏涂片筛查。
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