Palefsky J M
Department of Laboratory Medicine and Stomatology, University of California, San Francisco 94143, USA.
J Natl Cancer Inst Monogr. 1998(23):15-20. doi: 10.1093/oxfordjournals.jncimonographs.a024166.
Human immunodeficiency virus (HIV)-positive women have a higher prevalence of human papillomavirus (HPV) infection in the cervix and anus, as well as squamous intraepithelial lesions (SILs) at these sites, than do HIV-negative women matched for age and HIV risk factors. Similarly, HIV-positive homosexual or bisexual men have a higher prevalence of anal HPV infection and anal SIL than do HIV-negative homosexual or bisexual men. In HIV-positive individuals, the prevalence of HPV infection, the proportion infected with multiple HPV types, and the prevalence of anogenital SILs increase with decreasing CD4 count. This situation may reflect loss of systemic immune response to HPV antigens or local HPV-HIV interactions at the tissue or cellular level. Despite the high levels of anogenital SILs, to date, there has not been a significant increase in reported cases of invasive anogenital cancer in HIV-positive individuals. However, several years may be required for SIL to progress to invasive cancer, and the advent of newer therapies for HIV that are expected to prolong survival may paradoxically increase the risk of progression to cancer in individuals with SILs if these lesions do not regress spontaneously and remain untreated.
与年龄及艾滋病病毒（HIV）风险因素相匹配的HIV阴性女性相比，HIV阳性女性宫颈和肛门处人乳头瘤病毒（HPV）感染率更高，这些部位的鳞状上皮内病变（SIL）发生率也更高。同样，与HIV阴性同性恋或双性恋男性相比，HIV阳性同性恋或双性恋男性肛门HPV感染率和肛门SIL发生率更高。在HIV阳性个体中，HPV感染率、感染多种HPV类型的比例以及肛门生殖器SIL发生率随CD4细胞计数的降低而增加。这种情况可能反映了对HPV抗原的全身免疫反应丧失，或组织或细胞水平上局部HPV与HIV的相互作用。尽管肛门生殖器SIL水平较高，但迄今为止，HIV阳性个体中侵袭性肛门生殖器癌的报告病例数并未显著增加。然而，SIL进展为侵袭性癌症可能需要数年时间，如果这些病变不能自发消退且未得到治疗，那么预计可延长生存期的新型HIV治疗方法的出现可能反而会增加患有SIL个体进展为癌症的风险。
