Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Sex Transm Infect. 2022 Jun;98(4):247-254. doi: 10.1136/sextrans-2021-055019. Epub 2021 Jun 29.
To explore the prevalence and risk factors of anogenital human papillomavirus (HPV) infection and neoplasia among women living with HIV (WLHIV) in China.
A cross-sectional survey was conducted from 2019 to 2020, 409 WLHIV aged 18 years and older were recruited from an HIV treatment clinic in Yunnan, China. Cervical and anal samples were collected for HPV testing of 15 HPV genotypes and cytological interpretation. Women positive for cervical HPV or cytological abnormalities were recalled for colposcopy examination and biopsy when necessary. Prevalence of anogenital HPV infection and neoplasia were compared by logistic regression.
HPV prevalence was 34.2% (140/409) for cervical and 34.7% (142/409) for anal (high-risk HPV being 30.6% (125/409) and 30.3% (124/409), respectively). The most frequent genotypes were HPV-52, HPV-16 and HPV-58 in the cervix, HPV-52, HPV-53 and HPV-39 in the anus, with strong correlation between cervical and anal positivity, both overall and at a type-specific level. Cervical HPV was most associated with short duration of combination antiretroviral therapies (cART) (≤2 vs >2 years, adjusted OR (aOR)=2.25, 95% CI: 1.22 to 4.12) and high initial HIV viral load (≥1000 vs <1000 copies/mL, aOR=1.98, 95% CI: 1.10 to 3.58). Anal HPV was most associated with low nadir CD4 count (<200 vs ≥200 cells/µL, aOR=1.80, 95% CI: 1.01 to 3.22) and low current CD4 count (<350 vs ≥500 cells/µL, aOR=2.06, 95% CI: 1.00 to 4.36). CIN2+ prevalence was 4.6% and associated with low nadir CD4 count (aOR=4.63, 95% CI: 1.24 to 17.25).
Cervical and anal HPV were strongly correlated and, together with associated neoplasia, were highly prevalent among WLHIV in China. Early initiation of cART to avoid severe immunodeficiency should decrease anogenital HPV prevalence and related cancer burden among WLHIV. Incorporating anogenital cancer prevention services into HIV/AIDS care is warranted.
探讨中国 HIV 感染者（WLHIV）中肛门生殖器人乳头瘤病毒（HPV）感染和肿瘤的流行情况及其危险因素。
本横断面研究于 2019 年至 2020 年期间在云南省的一家 HIV 治疗诊所进行，共招募了 409 名年龄在 18 岁及以上的 WLHIV。采集宫颈和肛门样本，对 15 种 HPV 基因型进行 HPV 检测和细胞学解读。对宫颈 HPV 阳性或细胞学异常的妇女进行阴道镜检查和必要时的活检。采用 logistic 回归比较肛门生殖器 HPV 感染和肿瘤的患病率。
宫颈 HPV 阳性率为 34.2%（140/409），肛门 HPV 阳性率为 34.7%（142/409）（高危型 HPV 阳性率分别为 30.6%（125/409）和 30.3%（124/409））。最常见的基因型是宫颈 HPV-52、HPV-16 和 HPV-58，肛门 HPV-52、HPV-53 和 HPV-39，宫颈和肛门 HPV 阳性之间具有很强的相关性，无论是整体还是特定类型水平。宫颈 HPV 与联合抗逆转录病毒治疗（cART）的治疗时间较短（≤2 年 vs >2 年，调整后的 OR（aOR）=2.25，95%CI：1.22 至 4.12）和初始 HIV 病毒载量较高（≥1000 拷贝/mL 与 <1000 拷贝/mL，aOR=1.98，95%CI：1.10 至 3.58）显著相关。肛门 HPV 与较低的 CD4 计数最低值（<200 个/μL 与≥200 个/μL，aOR=1.80，95%CI：1.01 至 3.22）和当前 CD4 计数较低（<350 个/μL 与≥500 个/μL，aOR=2.06，95%CI：1.00 至 4.36）显著相关。CIN2+的患病率为 4.6%，与 CD4 计数最低值较低有关（aOR=4.63，95%CI：1.24 至 17.25）。
中国 HIV 感染者的宫颈和肛门 HPV 具有很强的相关性，与相关肿瘤一起，其患病率很高。早期开始 cART 以避免严重免疫缺陷，应降低 WLHIV 肛门生殖器 HPV 的流行率和相关癌症负担。将肛门生殖器癌预防服务纳入 HIV/AIDS 护理是必要的。
