High prevalence of anal human papillomavirus infection and anal cancer precursors among HIV-infected persons in the absence of anal intercourse
High prevalence of anal human papillomavirus infection and anal cancer precursors among HIV-infected persons in the absence of anal intercourse
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DOI：
10.7326/0003-4819-138-6-200303180-00008
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发表时间：
2003-03-18
影响因子：
39.2
通讯作者：
Palefsky, JM
中科院分区：
文献类型：
--
作者：
Piketty, C;Darragh, TM;Palefsky, JM
背景：肛门癌及其前体病变，肛门鳞状上皮内病变（SILs），与人乳头瘤病毒（HPV）感染有关。肛门HPV感染和肛门SIL在hiv阳性的男男性行为者中很常见；接受性肛交被认为是HPV感染的方式。目的：了解糖尿病的患病率及危险因素。无肛交史的hiv阳性男性的肛门HPV感染和肛门SIL。设计：横断面研究。地点：法国巴黎蓬皮杜欧洲医院门诊部。患者：118名艾滋病毒感染者。测量：50例hiv阳性男性注射吸毒者，无肛交史，67例。通过肛门细胞学、肛门组织学和肛门检查评估与男性发生性行为的hiv感染者。HPV DNA检测。结果：50例异性注射吸毒者中有23例（46%）肛门感染HPV。低级别SIL (LSIL) 8例（16%），高级别SIL (HSIL) 9例（18%）。67例男男性行为者中，肛门HPV感染57例（85%），LSIL 33例（49%），HSIL 12例（18%）。在单因素分析中，注射吸毒者肛门异常细胞学或组织学发现的危险因素包括CD4（+）细胞计数小于250 × 10(6)个细胞/L（比值比，5.7 [95% Cl， 1.6至20.4]），血浆HIV RNA病毒载量大于1.7 log拷贝/mL（比值比，8.9 [Cl， 1.1至76.0]），既往艾滋病定义事件（比值比，4.3 [Cl， 1.2至15.6]），肛门HPV检测（比值比，5.7 [Cl， 1.6至20.4]）。男男性行为者的危险因素包括一生中有10次以上的接受性肛交（优势比5.6 [Cl， 1.6至19.8]）和肛门HPV检测（优势比8.7 [Cl， 1.9至39.0]）。结论：肛门HPV感染和肛门SIL可能在没有肛交的hiv阳性男性中获得。HSIL的患病率在hiv阳性注射吸毒者中很高。所有CD4（+）细胞计数低于500 × 10(6)个/L的hiv阳性男性，无论是否有肛交史，都应考虑进行肛门细胞学筛查；然而，需要进一步的研究来确定这种方法在这些人群中预防肛门癌的有效性。
Background: Anal cancer and its precursor lesion, anal squamous intraepithelial lesions (SILs), are associated with human papillomavirus (HPV) infection. Anal HPV infection and anal SIL are common in HIV-positive men who, have sex with men; receptive anal intercourse is presumed to be the mode of acquisition of HPV.Objective: To assess the prevalence and risk factors-for. anal HPV infection and anal SIL in HIV-positive men with no history of anal intercourse.Design: Cross-sectional study.Setting: Hopital Europeen Georges Pompidou outpatient clinic, Paris, France.Patients: 118 HIV-infected men.Measurements: 50 HIV-positive heterosexual male injection drug users with no history of anal intercourse and 67. HIV-infected men who had sex with men were evaluated by using anal cytologic, anal histologic, and anal. HPV DNA testing.Results: 23 of the 50 heterosexual Injection drug users (46%) had anal HPV infection. Low-grade SIL (LSIL) was found in 8 patients (16%) and high-grade SIL (HSIL) in 9 patients (18%). Among the 67 men who had sex with men, anal HPV infection was found in 57 patients (85%), LSIL in 33 patients (49%), and HSIL in 12 patients (18%). In univariate analysis, risk factors for abnormal anal cytologic or histologic findings in injection drug users included CD4(+) cell counts less than 250 x 10(6) cells/L (odds ratio, 5.7 [95% Cl, 1.6 to 20.4]), plasma HIV RNA viral load greater than 1.7 log copies/mL (odds ratio, 8.9 [Cl, 1.1 to 76.0]), previous AIDS-defining event (odds ratio, 4.3 [Cl, 1.2 to 15.6]), and anal HPV detection (odds ratio, 5.7 [Cl, 1.6 to 20.4]). Risk factors among men who had sex with men included having more than 10 lifetime receptive anal intercourse episodes (odds ratio, 5.6 [Cl, 1.6 to 19.8]) and anal HPV detection (odds ratio, 8.7 [Cl, 1.9 to 39.0]).Conclusions: Anal HPV infection and anal SIL may be acquired in the absence of anal intercourse in HIV-positive men. The prevalence of HSIL is high among HIV-positive injection drug users. All HIV-positive men with CD4(+) cell counts less than 500 x 10(6) cells/L, regardless of history of anal intercourse, should be considered for anal cytologic screening; however, additional studies are needed to determine the efficacy of this procedure to prevent anal cancer in these populations.