在东南亚男男性行为者和跨性别女性中，高危肛门 HPV 持续性感染的发生率、清除率、持续性及相关因素。
Incidence, clearance, persistence and factors related with high-risk anal HPV persistence in South-East Asian MSM and transgender women.
机构信息
Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
出版信息
AIDS. 2020 Nov 1;34(13):1933-1941. doi: 10.1097/QAD.0000000000002654.
OBJECTIVES
Persistent anal high-risk human papillomavirus (HR-HPV) infection is a major risk factor for anal cancer among MSM and transgender women (TGW). We aimed to estimate incidence, clearance, and persistence of anal HR-HPV in HIV-positive and HIV-negative MSM and TGW, and to assess factors for HR-HPV persistence.
DESIGN
Prospective cohort study.
METHODS
MSM and TGW aged at least 18 years, were enrolled from Indonesia, Malaysia, and Thailand, then followed up 6-monthly for 12 months. Anal swabs were collected at every visit for HR-HPV genotypes to define anal HR-HPV incidence, clearance, and persistence. Logistic regression was used to evaluate factors associated with HR-HPV persistence.
RESULTS
Three hundred and twenty-five MSM and TGW were included in this study, of whom 72.3% were HIV-positive. The incidence of anal HR-HPV persistence was higher in HIV-positive than HIV-negative MSM participants (28.4/1000 vs. 13.9/1000 person-months). HIV-positive participants had HR-HPV lower clearance rate than HIV-negative participants (OR 0.3; 95% CI 0.1-0.7). The overall persistence of HR-HPV was 39.9% in HIV-positive and 22.8% HIV-negative participants. HPV-16 was the most persistent HR-HPV in both HIV-positive and HIV-negative participants. HIV infection (aOR 2.87; 95% CI 1.47-5.61), living in Kuala Lumpur (aOR 4.99; 95% CI 2.22-11.19) and Bali (aOR 3.39; 95% CI 1.07-10.75), being employed/freelance (aOR 3.99; 95% CI 1.48-10.77), and not being circumcised (aOR 2.29; 95% CI 1.07-4.88) were independently associated with anal HR-HPV persistence.
CONCLUSION
HIV-positive MSM and TGW had higher risk of persistent anal HR-HPV infection. Prevention program should be made available and prioritized for HIV-positive MSM and TGW where resources are limited.
目的
持续性肛门高危型人乳头瘤病毒（HR-HPV）感染是男男性行为者（MSM）和跨性别女性（TGW）肛门癌的主要危险因素。本研究旨在评估 HIV 阳性和 HIV 阴性 MSM 和 TGW 中肛门 HR-HPV 的发病率、清除率和持续性，并评估 HR-HPV 持续性的相关因素。
设计
前瞻性队列研究。
方法
本研究纳入了年龄至少 18 岁的印度尼西亚、马来西亚和泰国的 MSM 和 TGW，然后每 6 个月随访 12 个月。每次就诊时采集肛门拭子进行 HR-HPV 基因型检测，以确定肛门 HR-HPV 的发病率、清除率和持续性。采用 logistic 回归评估与 HR-HPV 持续性相关的因素。
结果
本研究共纳入 325 名 MSM 和 TGW，其中 72.3%为 HIV 阳性。HIV 阳性 MSM 参与者的肛门 HR-HPV 持续性发病率高于 HIV 阴性参与者（28.4/1000 与 13.9/1000 人月）。HIV 阳性参与者的 HR-HPV 清除率低于 HIV 阴性参与者（OR 0.3；95%CI 0.1-0.7）。HIV 阳性和 HIV 阴性参与者的 HR-HPV 总持续性分别为 39.9%和 22.8%。HPV-16 是 HIV 阳性和 HIV 阴性参与者中最具持续性的 HR-HPV。HIV 感染（aOR 2.87；95%CI 1.47-5.61）、居住在吉隆坡（aOR 4.99；95%CI 2.22-11.19）和巴厘岛（aOR 3.39；95%CI 1.07-10.75）、有工作/自由职业（aOR 3.99；95%CI 1.48-10.77）和未行包皮环切术（aOR 2.29；95%CI 1.07-4.88）与肛门 HR-HPV 持续性独立相关。
结论
HIV 阳性 MSM 和 TGW 肛门 HR-HPV 持续性感染的风险较高。在资源有限的情况下，应制定并优先为 HIV 阳性 MSM 和 TGW 提供预防方案。
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