Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Infect Dis. 2023 Apr 18;227(8):932-938. doi: 10.1093/infdis/jiac398.
Women with human immunodeficiency virus (WWH) have an elevated risk for human papillomavirus (HPV)-associated anal cancer. Primary anal cancer screening results from this population could inform practice guidelines.
In total, 381 WWH with anal cytology screening, high-risk HPV (hrHPV) testing and genital (cervical or vaginal) cotesting within 6 months were identified during 2012-2019. Those with anal cytology of atypical squamous cells of undetermined significance (ASCUS) or worse underwent high-resolution anoscopy and biopsy. Independent predictors of anal hrHPV, HPV16, and histological anal high-grade squamous intraepithelial lesions (aHSIL) were identified using adjusted logistic regression models.
Prevalence of anal hrHPV, HPV16, and ASCUS or worse cytology was 61%, 13%, and 68%. Histological aHSIL was detected in 42% of WWH with ASCUS or worse anal cytology. Prevalence of genital hrHPV, HPV16, and ASCUS or worse cytology was 30%, 4%, and 28%. Genital hrHPV predicted anal hrHPV (odds ratio [OR], 5.05), while genital HPV16 predicted anal HPV16 (OR, 9.52). Genital hrHPV and anal HPV16 predicted histological aHSIL (ORs, 2.78 and 10.9).
Anal HPV disease was highly prevalent in this primary screening cohort of WWH. While genital screening results predicted anal disease, rates of isolated anal HPV disease were substantial, supporting universal anal cancer screening for this population.
人类免疫缺陷病毒（HIV）阳性女性（WWH）患人乳头瘤病毒（HPV）相关肛门癌的风险增加。对该人群进行原发性肛门癌筛查的结果可以为实践指南提供依据。
在 2012 年至 2019 年期间，共发现 381 例接受肛门细胞学筛查、高危型 HPV（hrHPV）检测和生殖器（宫颈或阴道）联合检测且在 6 个月内进行的 WWH。对具有非典型鳞状细胞意义不明确（ASCUS）或更差的肛门细胞学的患者进行高分辨率肛门镜检查和活检。使用调整后的逻辑回归模型确定肛门 hrHPV、HPV16 和组织学肛门高级别鳞状上皮内病变（aHSIL）的独立预测因素。
肛门 hrHPV、HPV16 和 ASCUS 或更差细胞学的患病率分别为 61%、13%和 68%。在具有 ASCUS 或更差肛门细胞学的 WWH 中，42%的患者检测到组织学 aHSIL。生殖器 hrHPV、HPV16 和 ASCUS 或更差细胞学的患病率分别为 30%、4%和 28%。生殖器 hrHPV 预测肛门 hrHPV（优势比 [OR]，5.05），而生殖器 HPV16 预测肛门 HPV16（OR，9.52）。生殖器 hrHPV 和肛门 HPV16 预测组织学 aHSIL（ORs，2.78 和 10.9）。
在该 WWH 的原发性筛查队列中，肛门 HPV 疾病的患病率很高。虽然生殖器筛查结果预测了肛门疾病，但孤立性肛门 HPV 疾病的发生率也相当高，支持对该人群进行普遍的肛门癌筛查。
