Hidalgo-Tenorio Carmen, Calle-Gómez Inmaculada, Moya Raquel, Omar Mohamed, Lopez-Hidalgo Javier, Rodriguez-Granges Javier, Muñoz Leopoldo, García-Martinez Carmen
Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Universidad de Granada.
Internal Medicine Department, Hospital de Baza.
AIDS. 2025 May 1;39(6):649-657. doi: 10.1097/QAD.0000000000004113. Epub 2025 Jan 13.
Objectives were to determine the prevalence/incidence of HPV-related dysplasia and clearance/acquisition rates of high-risk HPV (HR-HPV) genotypes in genital mucosa of women with HIV (WWHIV) and oropharyngeal and anal mucosa of people with HIV (PWH) and to evaluate factors related to HR-HPV infection in oropharyngeal mucosa at 12-months.
Prospective, longitudinal study with 12-month follow-up, enrolled PWH between December 2022 and April 2023. At baseline and 12 months, HIV-related clinical and analytical variables were recorded, oropharyngeal mucosa exudates were taken for PCR studies for human papilloma virus (HPV) and other sexually transmitted infections, whereas anal and female genital samples were self-sampled for HPV detection and genotyping by PCR and thin-layer cytology.
Two hundred and seventy-six PWH with mean age of 45.3 years, 79% men, 24.3% with history of AIDS, 100% under antiretroviral therapy (ART), and 30.1% with completed HPV vaccination. HPV infection prevalence in oropharyngeal mucosa was 11.6% at baseline, most frequently by genotype 16 (2.2%), without dysplasia. No oropharyngeal dysplasia was observed at 12 months, and HR-HPV clearance and acquisition rates were 5.5 and 4.4%, respectively. Incidence of anal high grade squamous intraepithelial lesion (HSIL) was 1811.6 cases × 100 000 people-year, and HR-HPV clearance and acquisition rates were 16.2 and 25.6%, respectively. Incidence of CIN2/CIN3 or cervical cancer was zero, and HR-HPV clearance and acquisition rates were 11.3 and 7.5%. HIV-RNA viral load less than 50 copies/ml protected against HPV infection in oropharyngeal mucosa [97.2 vs. 87%, hazard ratio 0.044; 95% confidence interval (95% CI 0.042 - 0.956)].
Among PWH, HSIL incidence and HR-HPV acquisition rate are higher in anal versus oropharyngeal and genital mucosae. Nondetectability protects against oropharyngeal HPV infection.
目的是确定感染人类免疫缺陷病毒（HIV）的女性（WWHIV）生殖器黏膜以及HIV感染者（PWH）口咽和肛门黏膜中HPV相关发育异常的患病率/发病率以及高危型HPV（HR-HPV）基因型的清除/感染率，并评估12个月时口咽黏膜中与HR-HPV感染相关的因素。
一项前瞻性纵向研究，随访12个月，于2022年12月至2023年4月招募PWH。在基线和12个月时，记录与HIV相关的临床和分析变量，采集口咽黏膜渗出物用于人乳头瘤病毒（HPV）和其他性传播感染的PCR研究，而肛门和女性生殖器样本通过PCR和薄层细胞学进行自我采样以检测HPV并进行基因分型。
276名PWH，平均年龄45.3岁，79%为男性，24.3%有艾滋病病史，100%接受抗逆转录病毒治疗（ART），30.1%完成HPV疫苗接种。口咽黏膜中HPV感染患病率在基线时为11.6%，最常见的基因型为16型（2.2%），无发育异常。12个月时未观察到口咽发育异常，HR-HPV清除率和感染率分别为5.5%和4.4%。肛门高级别鳞状上皮内病变（HSIL）的发病率为1811.6例/100000人年，HR-HPV清除率和感染率分别为16.2%和25.6%。CIN2/CIN3或宫颈癌的发病率为零，HR-HPV清除率和感染率分别为11.3%和7.5%。HIV-RNA病毒载量低于50拷贝/ml可预防口咽黏膜中的HPV感染[97.2%对87%，风险比0.044；95%置信区间（95%CI 0.042 - 0.956）]。
在PWH中，肛门黏膜的HSIL发病率和HR-HPV感染率高于口咽和生殖器黏膜。检测不到可预防口咽HPV感染。
