Progression of anal intraepithelial neoplasia in HIV-positive individuals: predisposing factors.
Progression of anal intraepithelial neoplasia in HIV-positive individuals: predisposing factors.
复制标题
HIV 阳性个体肛门上皮内瘤变的进展：诱发因素。
DOI：
10.1007/s10151-019-01951-w
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发表时间：
2019
影响因子：
3.3
通讯作者：
Ford,MM
中科院分区：
文献类型：
--
作者：
McCutcheon,T;Hawkins,AT;Muldoon,RL;Hopkins,MB;Geiger,TM;Ford,MM
本研究的目的是评估影响人类免疫缺陷病毒（HIV）阳性个体肛门发育不良进展的患者因素。方法对2012 - 2017年hiv阳性成人乳头瘤病毒相关肛门病变进行回顾性队列研究。所有患者均行手术切除或活检，并在手术室电灼病变，未使用高分辨率镜检查。排除最初表现为鳞状细胞癌的患者。该研究旨在调查第一次可用组织学与随访组织学或阴性检查之间的进展。回顾患者档案并收集数据。进行了连续变量和分类变量的双变量分析。结果161例患者符合纳入标准。其中97%是男性。平均年龄41岁。35%是非洲裔美国人，47%是白种人。中位随访间隔331天（IQR 120-615天）后，14例（9%）患者出现疾病进展。由于肛门巴氏涂片上HSIL而在麻醉下接受检查的患者，在初次就诊时可见病变与病情进展相关（p= 0.0.2）。较低的初始CD4计数（p= 0.01）和肛门尖锐湿疣的初始手术病理（p= 0.01）也与进展有关。高危血清型无变化或回归（p= 0.01）。结论：在我们的大队列hiv阳性患者中，未经高分辨率镜检查治疗的进展率很低。最值得注意的是，在初始表现时可见病变，CD4计数较低时与进展相关。肛门尖锐湿疣的初始手术病理与进展相关，而高危血清型与消退或稳定相关。危险因素的识别对艾滋病毒阳性肛门尖锐湿疣/肛门发育不良患者的术后监测和咨询具有重要意义。
BackgroundThe aim of the present study was to evaluate patient factors that affect the progression of anal dysplasia in human immunodeficiency virus (HIV)-positive individuals.MethodsA retrospective cohort study of HIV-positive adults with human papilloma virus related anal lesions was performed from 2012 to 2017. All patients underwent surgical excision or biopsy and fulguration of lesions in the operating room without using high resolution anoscopy. Patients with initial presentation of squamous cell carcinoma were excluded. The study was designed to investigate progression between the first available histology and either the follow up histology or a negative examination. Patient files were reviewed and data was collected. A bivariate analysis of continuous and categorical variables was performed.ResultsOne hundred and sixty-one patients met the inclusion criteria. Ninety-seven percent were male. Mean age was 41 years. Thirty-five percent were African American and 47% were Caucasian. After a median follow-up interval of 331 days (IQR 120–615 days) 14 (9%) of patients had progression of disease. Visible lesions on initial presentation, as opposed to lesions found in patients undergoing examination under anesthesia because of HSIL on anal pap smear, was associated with progression (p= 0.0.2). A lower initial CD4 count (p= 0.01) and initial surgical pathology of anal condylomata (p= 0.01) were also associated with progression. High-risk serotype was associated with no change or regression (p= 0.01).ConclusionsIn our large cohort of HIV-positive patients treated without high resolution anoscopy the rate of progression was low. Most notably, visible lesions at initial presentation and CD4 count when lower were associated with progression. Initial surgical pathology of anal condylomata was associated with progression, while high-risk serotypes correlated with regression or stability. Identification of risk factors has important implications concerning postoperative surveillance and counseling of HIV-positive patients with anal condylomata/ anal dysplasia.