Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Papillomavirus Res. 2020 Dec;10:100200. doi: 10.1016/j.pvr.2020.100200. Epub 2020 May 31.
Anal precancers and cancers can be detected during screening with high-resolution anoscopy (HRA). The sensitivity of HRA depends on the burden and duration of human papillomavirus (HPV) among those screened as well as anoscopist proficiency, which is highly correlated with prior screening experience. Our objective was to compare the identification and type of HPV and the likelihood of HRA-detected precancer for men who have sex with men (MSM) undergoing their first HRA-screening in Nigeria.
MSM were recruited from an HIV test-and-treat cohort, TRUST/RV368, into a new anal cancer screening program. Anal swabs obtained during screening underwent Ion Torrent next-generation sequencing using barcoded HPV PCR broad-spectrum primers 5+/6+ to detect up to 161 HPVs. All high-risk (HR) HPVs and the most abundant low-risk (LR)-HPVs were evaluated as type-specific infections with some categorized as belonging to a multiple infection. HRA screening results included benign, low-grade squamous intraepithelial lesions (LSIL), or HSIL as detected by cytology or histology. Multivariable logistic regression was used to assess the association of HPV and other cofactors with any SIL.
Among 342 MSM, 60% were HIV-infected, 89% were under 35 years of age, and 51% had 8 or more years since anal coital debut. Of those with SIL, 89% had LSIL and only 11% had HSIL. Prevalence of any HPV and high-risk (HR)-HPV was 92% and 74%, respectively. The most prevalent genotypes in rank order were HPV6 (31%), HPV16 (23%), HPV42 (20%), HPV11 (18%), HPV45 (18%), and HPV51 (17%). For multiple HR-HPVs, 31% had a single HR-HPV, 32% had 2-3, and 10% had 4 or more. Low-risk HPVs, type 6 and/or 11, were common (42%) and were significantly associated with SIL (adjusted odds ratio [aOR]:1.8, 95% confidence interval [CI]: 1.1-3.1) together with perianal warts (aOR:6.7, 95% CI: 3.3-13.5). In contrast, HR-HPV and multiple HR-HPVs were not significantly associated with SIL (all p > 0.05).
Detection of HSIL was low. Although HR-HPV was abundant, HSIL development also depends on the duration of HR-HPV infections and the anoscopist's level of experience. As our cohort ages and the anoscopist becomes more skilled, detection of HSIL will likely improve.
通过高分辨率肛门镜检查（HRA）可以检测到肛门前癌和癌症。HRA 的灵敏度取决于筛查人群中 HPV 的负担和持续时间，以及肛门镜医生的熟练程度，这与先前的筛查经验密切相关。我们的目的是比较在尼日利亚首次接受 HRA 筛查的男男性行为者（MSM）中 HPV 的识别和类型，以及 HRA 检测到的癌前病变的可能性。
从 HIV 检测和治疗队列 TRUST/RV368 中招募 MSM 参加新的肛门癌筛查计划。在筛查期间获得的肛门拭子通过 Ion Torrent 下一代测序，使用带有 HPV PCR 广谱引物 5+/6+的条形码进行检测，可检测多达 161 种 HPV。所有高危（HR）HPV 和最丰富的低危（LR）HPV 都被评估为特定类型的感染，有些被归类为多重感染。HRA 筛查结果包括良性、低级别鳞状上皮内病变（LSIL）或通过细胞学或组织学检测到的高级别鳞状上皮内病变（HSIL）。多变量逻辑回归用于评估 HPV 和其他协变量与任何 SIL 的关联。
在 342 名 MSM 中，60%感染了 HIV，89%年龄在 35 岁以下，51%肛门性交开始后 8 年或以上。在患有 SIL 的患者中，89%患有 LSIL，只有 11%患有 HSIL。任何 HPV 和高危（HR）HPV 的患病率分别为 92%和 74%。按顺位排列，最常见的基因型分别为 HPV6（31%）、HPV16（23%）、HPV42（20%）、HPV11（18%）、HPV45（18%）和 HPV51（17%）。对于多个 HR-HPV，31%为单一 HR-HPV，32%为 2-3 个，10%为 4 个或更多。低危型 HPV，6 型和/或 11 型，较为常见（42%），与 SIL 显著相关（调整后的优势比 [aOR]：1.8，95%置信区间 [CI]：1.1-3.1），与肛周疣（aOR：6.7，95% CI：3.3-13.5）相关。相比之下，HR-HPV 和多个 HR-HPV 与 SIL 无显著相关性（均 p＞0.05）。
HSIL 的检出率较低。尽管 HR-HPV 大量存在，但 HSIL 的发展还取决于 HR-HPV 感染的持续时间和肛门镜医生的经验水平。随着我们的队列年龄增长，肛门镜医生的技能更加熟练，HSIL 的检出率可能会提高。
