Sambo Margherita, Bailoni Alessandra, Mariani Federico, Granai Massimo, Calomino Natale, Mancini Virginia, D'Antiga Anna, Montagnani Francesca, Tumbarello Mario, Lazzi Stefano, Roviello Franco, Fabbiani Massimiliano
Department of Medical Biotechnologies, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy.
Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy.
Diagnostics (Basel). 2025 Jan 16;15(2):198. doi: 10.3390/diagnostics15020198.
Anal HPV infection can cause squamous intraepithelial lesions (SILs), which are precursors of anal squamous cell carcinoma (SCC). The early detection of HPV infections and improvement of effective screening programmes are, therefore, essential to prevent progression from pre-cancerous lesions to SCC, especially in people living with HIV (PLWH), who represent a population at higher risk of HPV infection and associated lesions. Among prevention strategies, HPV vaccination is relevant too, but its efficacy in persons already infected by HPV is still debated. : This is a retrospective single-center study on a cohort of PLWH who performed longitudinal screening for anal dysplasia and HPV infection. The screening included cytological and molecular analyses. : A total of 110 PLWH performed at least one anal HPV screening, with an overall prevalence of HPV infection of 86.4% [23.6% low risk (LR)-HPV and 62.7% high risk (HR)-HPV genotypes]. Abnormal cytology was demonstrated in 39.1% of subjects, of whom ASCUS 6.4%, LSIL 30.9% and HSIL 1.8%. In total, 80 patients (72.7%) had an available longitudinal screening. No patient developed SCC during follow-up. However, a high incidence of new cytological abnormalities and new HPV infections was observed. On the other side, clearance of some HPV genotypes was also frequent, confirming that HPV infection is a dynamic process. A CD4 cell count > 500/mmc was an independent predictor of HPV clearance. HPV vaccination was performed on 30.9% of patients. A trend toward an increased clearance of HPV genotypes included in 9-valent vaccine was observed in vaccinated patients (40.6% versus 30.8% in unvaccinated, = 0.079). : A high prevalence of HPV infection and SILs was observed in our cohort of PLWH. A high incidence of new HPV infections and HPV-associated lesions was also observed in the longitudinal cohort, highlighting the need of strengthening immunization programs and continuous screening for anal HPV infection. Whether HPV vaccination may be efficacious in patients already infected by HPV remains to be determined.
肛门人乳头瘤病毒（HPV）感染可导致鳞状上皮内病变（SILs），而鳞状上皮内病变是肛门鳞状细胞癌（SCC）的癌前病变。因此，早期检测HPV感染并改进有效的筛查方案对于预防癌前病变进展为SCC至关重要，尤其是对于感染HIV的人群（PLWH），他们是HPV感染及相关病变的高危人群。在预防策略中，HPV疫苗接种也很重要，但其对已感染HPV的人群的疗效仍存在争议。 这是一项对一组PLWH进行的回顾性单中心研究，这些PLWH对肛门发育异常和HPV感染进行了纵向筛查。筛查包括细胞学和分子分析。 共有110名PLWH进行了至少一次肛门HPV筛查，HPV感染的总体患病率为86.4%[23.6%为低风险（LR）-HPV，62.7%为高风险（HR）-HPV基因型]。39.1%的受试者细胞学异常，其中非典型鳞状细胞（ASCUS）为6.4%，低度鳞状上皮内病变（LSIL）为30.9%，高度鳞状上皮内病变（HSIL）为1.8%。共有80名患者（72.7%）进行了有效的纵向筛查。随访期间无患者发生SCC。然而，观察到新的细胞学异常和新的HPV感染发生率很高。另一方面，一些HPV基因型的清除也很常见，这证实了HPV感染是一个动态过程。CD4细胞计数>500/mmc是HPV清除的独立预测因素。30.9%的患者接种了HPV疫苗。在接种疫苗的患者中，观察到九价疫苗所含HPV基因型清除率有增加的趋势（接种疫苗者为40.6%，未接种疫苗者为30.8%，P=0.079）。 在我们的PLWH队列中观察到HPV感染和SILs的高患病率。在纵向队列中也观察到新的HPV感染和HPV相关病变的高发生率，这突出了加强免疫计划和持续筛查肛门HPV感染的必要性。HPV疫苗接种对已感染HPV的患者是否有效仍有待确定。
