Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India.
Department of Pathology, Hindu Rao Hospital, Delhi, India.
HIV Med. 2022 Apr;23(4):378-389. doi: 10.1111/hiv.13227. Epub 2022 Feb 12.
To provide a summary estimate of the prevalence of anal cytological abnormalities and human papillomavirus (HPV) infection as well as their covariates in women living with HIV (WLHIV).
Four databases - PubMed, Cochrane Library, ProQuest and Web of Science - were searched up to 31 May 2021 for studies reporting on the prevalence and/or covariates of abnormal anal cytology and/or anal HPV infection in WLHIV. The data were extracted independently by two authors using standardized extraction forms. Random effect models were used to estimate the summary effect sizes.
A total of 29 studies were included in the analysis. The overall prevalence of anal cytological abnormalities in WLHIV was 28.5% [95% confidence interval (CI): 22.8-35.5]. High-grade cytological lesions were seen in 12.1% (95% CI: 8.5-17.2) of the abnormal smears. HPV infection (any type) in the anal samples was detected in 60.7% (95% CI: 54.1-68.0) of the samples while high-risk HPV was found in 44.0% (95% CI: 37.6-51.5). A positive association was seen between anal cytological abnormality and factors such as receptive anal intercourse [meta-risk ratio (meta-RR) = 1.6, 95% CI: 1.3-1.8], having multiple sexual partners (1.6, 95% CI: 1.0-2.5), CD4 count < 200 cells/µL (4.6, 95% CI: 3.0-6.9), anal HPV (4.6, 95% CI: 2.4-8.8), abnormal cervical cytology (2.3, 95% CI: 2.0-2.8), and cervical HPV (meta-RR 4.6, 95% CI: 2.2-9.8). Anal HPV infection was significantly associated with cervical HPV positivity (2.5, 95% CI: 1.2-5.3).
Our results highlight the high prevalence of abnormal anal cytology and HPV infection in WLHIV. The positive association of anal cytological abnormality with parameters such as abnormal cervical cytology, cervical HPV infection and low CD4 count suggests that anal sex history and examination may be considered in WLHIV undergoing screening for sexually transmitted infection and possessing any of these risk factors.
总结分析人类免疫缺陷病毒（HIV）感染者（WLHIV）肛门细胞学异常和人乳头瘤病毒（HPV）感染的流行情况及其相关因素。
检索 PubMed、Cochrane Library、ProQuest 和 Web of Science 数据库，检索时间截至 2021 年 5 月 31 日，纳入分析 WLHIV 肛门细胞学异常和/或 HPV 感染的流行率及其相关因素的研究。两名作者独立使用标准化提取表提取数据。采用随机效应模型估计汇总效应量。
共纳入 29 项研究。WLHIV 肛门细胞学异常的总体患病率为 28.5%（95%置信区间：22.8%-35.5%）。异常涂片的高级别细胞学病变占 12.1%（95%置信区间：8.5%-17.2%）。在分析的样本中，HPV 感染（任何类型）的检出率为 60.7%（95%置信区间：54.1%-68.0%），高危型 HPV 检出率为 44.0%（95%置信区间：37.6%-51.5%）。肛门细胞学异常与接受肛交性行为（比值比 [OR] = 1.6，95%置信区间：1.3-1.8）、性伴侣数量多（OR = 1.6，95%置信区间：1.0-2.5）、CD4 计数<200 个/µL（OR = 4.6，95%置信区间：3.0-6.9）、肛门 HPV（OR = 4.6，95%置信区间：2.4-8.8）、宫颈细胞学异常（OR = 2.3，95%置信区间：2.0-2.8）和宫颈 HPV（OR = 4.6，95%置信区间：2.2-9.8）等因素呈正相关。肛门 HPV 感染与宫颈 HPV 阳性呈显著相关（OR = 2.5，95%置信区间：1.2-5.3）。
我们的研究结果强调了 WLHIV 中肛门细胞学异常和 HPV 感染的高流行率。肛门细胞学异常与宫颈细胞学异常、宫颈 HPV 感染和 CD4 计数低等参数呈正相关，提示在进行性传播感染筛查且具有这些危险因素的 WLHIV 中，可考虑进行肛门性行为史和检查。
