Nowak Rebecca G, Ndembi Nicaise, Dauda Wuese, Jibrin Paul, Bentzen Søren M, Nnaji Chinedu H, Olaomi Oluwole, Darragh Teresa M, Madukwe Jonathan, Crowell Trevor A, Baral Stefan D, Blattner William A, Charurat Manhattan E, Palefsky Joel M, Cullen Kevin J
University of Maryland School of Medicine, Baltimore, MD.
Institute of Human Virology Nigeria, Abuja, Nigeria.
J Glob Oncol. 2019 Jul;5:1-11. doi: 10.1200/JGO.19.00102.
Anal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria.
From August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL.
Median age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL.
Proficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening.
与其他育龄成年人相比，感染人类免疫缺陷病毒（HIV）的男男性行为者（MSM）患肛管癌的风险要高得多，但在撒哈拉以南非洲地区，筛查却很少见。我们报告了在尼日利亚阿布贾将高分辨率肛门镜检查（HRA）用作一线筛查工具的情况以及由此产生的早期结果。
2016年8月至2017年8月，424名MSM参加了TRUST/RV368（一个HIV预防与治疗联合队列）的肛管癌筛查子研究。HRA引导下的活检通过组织学诊断，对于高级别鳞状上皮内病变（HSIL）给予消融治疗。通过评估鳞状上皮内病变（SIL）随时间的检出率和活检比例来评估HRA的熟练程度。计算低级别鳞状上皮内病变和HSIL的患病率估计值及95%置信区间（CI）。采用多项逻辑回归来确定SIL风险最高的人群。
中位年龄为25岁（四分位间距[IQR]，22 - 29岁），首次性行为后的中位时间为8年（IQR，4 - 12年），59%（95%CI，54.2%至63.6%）感染了HIV。在200次筛查后，任何SIL的检出率趋于稳定，不到20%的人接受了两次或更多次活检。低级别鳞状上皮内病变和HSIL的初步患病率估计值分别为50.0%（95%CI，44.7%至55.3%）和6.3%（95%CI，4.0%至9.3%）。HIV感染、首次肛交后至少8年、同时有多个性伴侣以及患有外生殖器疣与SIL独立存在统计学关联。
随着时间推移，HRA的熟练程度随着经验的增加而提高。然而，HSIL的检出率较低，可能受到内生殖器疣导致视野受阻和活检率低的影响，这突出表明需要持续评估和指导以验证这一发现。HRA在一个对MSM友好的医疗机构中是一种可行的一线筛查工具。首次肛交后的年限和外生殖器疣可作为优先筛查的依据。
