The natural history of anal high-grade squamous intraepithelial lesions among MSM and transgender women in an acute HIV cohort in Thailand.

IF 3.1 2区医学 Q3 IMMUNOLOGY

AIDS Pub Date : 2025-09-01 Epub Date: 2025-05-20 DOI:10.1097/QAD.0000000000004238

Supanat Thitipatarakorn, Nipat Teeratakulpisarn, Siriporn Nonenoy, Aphakan Klinsukontakul, Sujittra Suriwong, Sumitr Tongmuang, Piranun Hongchookiat, Napasawan Chinlaertworasiri, Pravit Mingkwanrungruang, Carlo Sacdalan, Kultida Poltavee, Nitiya Chomchey, Tippawan Pankam, Stephen J Kerr, Reshmie A Ramautarsing, Donn Colby, Nittaya Phanuphak

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引用次数: 0

Abstract

Objective: To describe the incidence and clearance rates of anal high-grade squamous intraepithelial lesions (HSIL) among MSM and transgender women who initiated immediate antiretroviral therapy during acute HIV acquisition.

Design: A prospective cohort study of MSM and transgender women diagnosed with acute HIV acquisition in Bangkok, Thailand.

Methods: Participants who were enrolled from May 2017 to June 2020 underwent anal human papillomavirus (HPV) genotyping, high-resolution anoscopy, and anal biopsies as indicated, at baseline and 6-monthly follow-up visits.

Results: Among 89 MSM and 4 transgender women (median age 26 years), the anal HSIL incidence rate was 22.7 per 100 person-years over 180.9 person-years, while the clearance rate was 119.4 per 100 person-years over 32.7 person-years. After adjusting for age, smoking, and baseline CD4 + cell count, incident anal HSIL was greater in those with persistent HPV 16 [adjusted hazards ratio (aHR) 14.98, 95% confidence interval (CI) 1.73-129.48], nonpersistent HPV 16 (aHR 15.12, 95% CI 1.84-124.50), persistent non-16 cancer-associated HPV types (aHR 17.90, 95% CI 2.34-136.74), and nonpersistent non-16 cancer-associated HPV types (aHR 10.65, 95% CI 1.34-84.93) compared to participants with consistently negative cancer-associated HPV. Persistent (aHR 0.17, 95% CI 0.04-0.66) and nonpersistent HPV 16 (aHR 0.22, 95% CI 0.05-0.98) were associated with lower HSIL clearance likelihood.

Conclusion: Among predominantly young participants initiating antiretroviral therapy during acute HIV acquisition, anal HSIL showed high incidence yet markedly high clearance rates. Anal HPV 16 infection increased risk of incident anal HSIL and decreased lesion clearance. HPV vaccination and HSIL screening/treatment should be implemented despite rapid antiretroviral therapy initiation.

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泰国急性HIV队列中男男性行为者和变性女性肛门高级鳞状上皮内病变的自然病史

目的：了解急性HIV感染期立即接受抗逆转录病毒治疗的男男性行为者（MSM）和跨性别女性肛门高级鳞状上皮内病变（HSIL）的发生率和清除率。设计：对泰国曼谷诊断为急性艾滋病毒感染的男男性行为者和变性妇女进行前瞻性队列研究。方法：2017年5月至2020年6月期间入组的参与者在基线和6个月随访时接受了肛门人乳头瘤病毒（HPV）基因分型、高分辨率肛门镜检查和肛门活检。结果：89名MSM女性和4名跨性别女性（中位年龄26岁）中，肛门HSIL发病率为22.7 / 100人-年（180.9人-年），清除率为119.4 / 100人-年（32.7人-年）。在调整了年龄、吸烟和基线CD4后，与癌症相关HPV持续阴性的参与者相比，持续性HPV 16 （aHR 14.98, 95% CI 1.73-129.48）、非持续性HPV 16 （aHR 15.12, 95% CI 1.84-124.50）、持续性非16癌症相关HPV类型（aHR 17.90, 95% CI 2.34-136.74）和非持续性非16癌症相关HPV类型（aHR 10.65, 95% CI 1.34-84.93）的肛门HSIL发生率更高。持续性（aHR 0.17, 95% CI 0.04-0.66）和非持续性HPV 16 （aHR 0.22, 95% CI 0.05-0.98）与较低的HSIL清除率相关。结论：在急性HIV感染期间开始抗逆转录病毒治疗的主要年轻参与者中，肛门HSIL的发病率高，但清除率明显高。肛门HPV 16感染增加了发生肛门HSIL的风险，并降低了病变清除率。尽管开始快速抗逆转录病毒治疗，仍应实施HPV疫苗接种和HSIL筛查/治疗。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

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