Villoslada Aroa, Rodriguez Adrian, Sorni Patricia, Serrano Araceli, Salom Andrea, Collado Carmen, García-Gasalla Mercedes, Payeras Antoni
Hospital Universitari Son Llàtzer. Internal Medicine (Infectious diseases), Palma, Spain.
Health Research, Institute of the Balearic Islands (IdISBa), Palma, Spain.
J Med Virol. 2025 Sep;97(9):e70596. doi: 10.1002/jmv.70596.
Persistent high-risk human papillomavirus (hHPV) infection, especially HPV-16, plays a central role in the development of high-grade squamous intraepithelial lesions (HSIL). This study aimed to evaluate the performance of co-testing (cytology and hHPV detection) in a real-world cohort of men who have sex with men (MSM) and transgender women (TW) living with HIV. We conducted a prospective study (2017-2023) at a tertiary care center in Spain. MSM and TW living with HIV underwent screening with anal cytology and PCR-based hHPV testing. High-resolution anoscopy (HRA) with biopsy was performed in cases with abnormal cytology and/or hHPV positivity. Clinical, epidemiological, and HIV-related data were collected to identify risk factors for abnormal cytology and biopsy. 734 cytologies were performed in 380 participants. Abnormal cytology was found in 34%, most commonly ASCUS. hHPV was detected in 63.1% of samples; HPV-16 was the most prevalent genotype (19.4%), present in 60% of HSIL cytologies and 65% of AIN2-3 biopsies. Risk factors for abnormal cytology included nadir CD4 < 200 cells/μL (aOR 2.61), prior condylomas (aOR 2.66), and infection with any oncogenic HPV genotype (aOR 4.12). Among 91 HRAs, 29.6% showed AIN2-3% and 2.1% in situ carcinoma. HPV-16, HPV-52, and HPV-66 were most frequently associated with abnormal findings in the cytology. In conclusion, anal HPV infection was prevalent in MSM and TW living with HIV. The genotypes most frequently associated with abnormal cytology and histopathological findings were HPV-16, HPV-52, and HPV-66. These findings highlight the potential value of implementing co-testing strategies in anal dysplasia screening for this high-risk population.
持续性高危型人乳头瘤病毒（hHPV）感染，尤其是HPV-16感染，在高级别鳞状上皮内病变（HSIL）的发生发展中起核心作用。本研究旨在评估联合检测（细胞学和hHPV检测）在与男性发生性关系的男性（MSM）和感染HIV的跨性别女性（TW）这一真实队列中的表现。我们在西班牙一家三级医疗中心开展了一项前瞻性研究（2017 - 2023年）。感染HIV的MSM和TW接受了肛门细胞学检查和基于PCR的hHPV检测。对细胞学异常和/或hHPV阳性的病例进行了高分辨率肛门镜检查（HRA）及活检。收集临床、流行病学和HIV相关数据以确定细胞学异常和活检的危险因素。380名参与者共进行了734次细胞学检查。34%发现细胞学异常，最常见的是意义不明确的非典型鳞状细胞（ASCUS）。63.1%的样本检测到hHPV；HPV-16是最常见的基因型（19.4%），在60%的HSIL细胞学检查和65%的AIN2 - 3活检中出现。细胞学异常的危险因素包括CD4最低点＜200个细胞/μL（调整后比值比[aOR]为2.61）、既往有尖锐湿疣（aOR为2.66）以及感染任何致癌性HPV基因型（aOR为4.12）。在91次HRA中，29.6%显示为AIN2 - 3，2.1%为原位癌。HPV-16、HPV-52和HPV-66在细胞学检查中最常与异常结果相关。总之，肛门HPV感染在感染HIV的MSM和TW中很普遍。与细胞学异常和组织病理学结果最常相关的基因型是HPV-16、HPV-52和HPV-66。这些发现凸显了在这一高危人群的肛门发育异常筛查中实施联合检测策略的潜在价值。
