Systematic Evaluation and Description of Anal Pathology in HIV-Infected Patients During the HAART Era
Systematic Evaluation and Description of Anal Pathology in HIV-Infected Patients During the HAART Era
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DOI：
10.1007/dcr.0b013e3181a65f5f
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发表时间：
2009-06-01
影响因子：
3.9
通讯作者：
Duval, Xavier
中科院分区：
文献类型：
--
作者：
Abramowitz, Laurent;Benabderrahmane, Dalila;Duval, Xavier
目的：本研究旨在确定高效抗逆转录病毒治疗时代 HIV 感染门诊患者宏观肛门病变的患病率及相关因素。方法：随机抽取在 Bichat 大学医院传染病科接受随访护理的 HIV 感染患者样本，受邀参加由肛门镜检查和标准化问卷组成的系统筛查项目。结果：516 名患者中，473 名（92%）参加了。总体而言，208 名患者 (44%) 至少有一个肛门肉眼可见病变：108 名患者 (22.8%) 患有人乳头状瘤 (HPV) 相关病变（伴有或不伴有不典型增生的尖锐湿疣），67 名患者 (14.2%) 患有痔疮疾病，50 名患者 (10.6%) 患有肛裂，44 名患者 (9.3%) 患有其他肛门病变。肛门湿疣的独立显着相关因素是肛门湿疣病史（OR，2.09）和男男性行为者每月性交次数中位数（OR，1.03）；异性恋男性有生殖器湿疣病史（OR，26.74）和无保护性交史（OR，7.47）；女性的 CD4 细胞计数低于 200/mm(3)（OR，6.02）、接受性肛交（OR，6.37）以及肛门湿疣病史（OR，16.69）。与 HIV 感染相关的性行为或特征均与痔疮疾病或肛裂无关。结论：由于 HIV 感染患者未报告的肛门病变发生率很高，这些病变可能具有高度传染性，涉及肛门肿瘤的风险或对生活质量产生负面影响，因此应对 HIV 感染人群进行系统的肛门筛查。
PURPOSE: This study aimed to determine the prevalence of macroscopic anal lesions and associated factors in HIV-infected outpatients during the era of highly active antiretroviral therapy.METHODS: A randomly selected sample of patients with HIV-infection receiving follow-up care in the infectious diseases department of Bichat University Hospital was invited to participate in a systematic screening program consisting of anal examination with anoscopy and a standardized questionnaire.RESULTS: Of 516 patients, 473 (92 percent) participated. Overall, 208 patients (44 percent) had at least one anal macroscopic lesion: 108 patients (22.8 percent) had human papilloma (HPV)-related lesions (condyloma with or without dysplasia), 67 (14.2 percent) had hemorrhoidal disease, 50 (10.6 percent) had anal fissures, and 44 (9.3) percent had other anal lesions. Independent significantly associated factors for anal condyloma were history of anal condyloma (OR, 2.09) and median number of episodes of sexual intercourse per month (OR, 1.03) in men who have sex with men; history of genital condyloma (OR, 26.74), and unprotected sexual intercourse (OR, 7.47) in heterosexual men; and CD4 cell count below 200/mm(3) (OR, 6.02), receptive anal intercourse (OR, 6.37), and history of anal condyloma (OR, 16.69) in women. Neither sexual behavior nor characteristics related to HIV infection were associated with hemorrhoidal disease or anal fissure.CONCLUSIONS: Because patients with HIV infections have a high prevalence of unreported anal lesions that may be highly contagious, involve risk of anal neoplasia, or negatively affect quality of life, systematic anal screening should be conducted in the HIV-infected population.