Surawicz C M, Critchlow C, Sayer J, Hurt C, Hawes S, Kirby P, Goldbaum G, Kiviat N
Department of Medicine, University of Washington School of Medicine, Seattle, USA.
Am J Gastroenterol. 1995 Oct;90(10):1776-8.
Anal cancer and anal human Papillomavirus (HPV) infection are increased in homosexual men.
We screened high risk homosexual men as part of a longitudinal study examining the effect of HIV infection on the risk of development of high grade anal intraepithelial neoplasia (AIN II, III).
We found seven men who had histological evidence of AIN II-III with visually normal findings by anoscopy. Two men were HIV-seronegative, five were HIV-seropositive, and only one of the HIV-seropositive men had a low CD4 count < 200. Abnormal cytological results seen over follow-up periods of 3 months to 2.5 yr suggest the persistence of visually inapparent anal abnormalities. Two of the men had had small internal warts at earlier examinations, and three of the seven men subsequently developed visually abnormal anal findings. All men had HPV 16 DNA detected at some point.
We hypothesize that high grade anal neoplasia may develop deep in the glands and can be detected by cytology before visible lesions are detected even with the aid of a colposcope. However, the implications of finding high grade anal cytology are not known at this time. Natural history studies are ongoing.
同性恋男性的肛管癌和肛门人乳头瘤病毒（HPV）感染率有所上升。
作为一项纵向研究的一部分，我们对高危同性恋男性进行了筛查，该研究旨在考察HIV感染对高级别肛管上皮内瘤变（AIN II、III级）发生风险的影响。
我们发现7名男性有AIN II - III级的组织学证据，但肛门镜检查的外观结果正常。2名男性HIV血清学检测为阴性，5名男性HIV血清学检测为阳性，且在HIV血清学检测为阳性的男性中只有1人的CD4计数低，<200。在3个月至2.5年的随访期内观察到的异常细胞学结果提示，外观上不明显的肛门异常持续存在。其中2名男性在早期检查时有小的内痔，7名男性中有3名随后出现了外观异常的肛门表现。所有男性在某个时间点均检测到HPV 16 DNA。
我们推测高级别肛管瘤变可能在腺体内深处发生，即使借助阴道镜，在可见病变被检测到之前，通过细胞学检查也可检测到。然而，目前尚不清楚发现高级别肛管细胞学结果的意义。自然史研究正在进行中。
