Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35242, USA.
Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35242, USA.
BMC Infect Dis. 2020 Feb 14;20(1):144. doi: 10.1186/s12879-020-4822-5.
The southeastern US is an epicenter for incident HIV in the US with high prevalence of human papillomavirus (HPV) co-infections. However, epidemiologies of HPV-associated clinical conditions (CC) among people living with HIV-1 infection (PLWH) are not fully known.
Electronic medical records (EMR) of PLWH attending one of the leading HIV clinics in the southeastern US between 2006 and 2018 were reviewed and analyzed. The retrospective study was nested within the University of Alabama at Birmingham HIV clinical cohort, which has electronically collected over 7000 PLWH's clinical and sociobehavioral data since 1999. Incidence rates of HPV-related CC including anogenital warts, penile, anal, cervical, and vaginal/vulvar low- and high-grade squamous intraepithelial lesions (LSIL and HSIL) were estimated per 10,000 person years. Joinpoint regressions were performed to examine temporal changes in the trends of incident CC. All rates and trends were stratified by gender and race.
Of the 4484 PLWH included in the study (3429 men, 1031 women, and 24 transgender), we observed 1038 patients with HPV-related CC. The median nadir CD4 count (cells/uL) was higher in the HPV-condition free group than the case groups (P < 0.0001). Anogenital warts, anal LSIL, HSIL, and cancer were more likely to be diagnosed among HIV-infected men than women. White men presented more frequently with anal LSIL and anal and penile cancers than black men (P < 0.03). White women were also more likely to be diagnosed with cervical HSIL (P = 0.023) and cancer (P = 0.037) than black women.
There were significant differences between gender and race with incidence of HPV-related CC among HIV patients. EMR-based studies provide insights on understudied HPV-related anogenital conditions in PLWH; however, large-scale studies in other regions are needed to generalize current findings and draw public health attention to co-infection induced non-AIDS defining comorbidities among PLWH.
美国东南部是美国艾滋病毒新发病例的中心，人乳头瘤病毒（HPV）合并感染率较高。然而，人类免疫缺陷病毒 1 型感染（PLWH）患者中 HPV 相关临床病症（CC）的流行病学情况尚不完全清楚。
对美国东南部一家领先的艾滋病毒诊所于 2006 年至 2018 年间就诊的 PLWH 的电子病历（EMR）进行了回顾和分析。这项回顾性研究嵌套在伯明翰阿拉巴马大学的 HIV 临床队列中，该队列自 1999 年以来已经电子收集了超过 7000 名 PLWH 的临床和社会行为数据。每 10000 人年估计 HPV 相关 CC（包括生殖器疣、阴茎、肛门、宫颈和阴道/外阴低级别和高级别鳞状上皮内病变（LSIL 和 HSIL））的发病率。采用 Joinpoint 回归分析来检测 CC 发病趋势的时间变化。所有比率和趋势均按性别和种族进行分层。
在纳入研究的 4484 名 PLWH 中（3429 名男性，1031 名女性和 24 名跨性别者），我们观察到 1038 名患者患有 HPV 相关 CC。HPV 无病症组的中位 CD4 计数（细胞/μL）比病例组高（P<0.0001）。与女性相比，生殖器疣、肛门 LSIL、HSIL 和癌症更可能在 HIV 感染男性中诊断。白人男性比黑人男性更常被诊断为肛门 LSIL 和肛门及阴茎癌（P<0.03）。白人女性也更有可能被诊断为宫颈 HSIL（P=0.023）和癌症（P=0.037），而黑人女性则较少（P<0.03）。
在 HIV 患者中，性别和种族之间存在 HPV 相关 CC 发病率的显著差异。基于 EMR 的研究提供了关于 PLWH 中 HPV 相关生殖器疾病的研究不足的见解；然而，需要在其他地区开展大规模研究，以推广当前发现，并引起公众对 PLWH 中合并感染引起的非艾滋病定义合并症的关注。
