{"title":"泰国曼谷同性性行为者和变性女性中肛门高级别鳞状上皮内病变的流行率和发病率，这些人在感染艾滋病毒急性期接受了诊断和治疗","authors":"Supanat Thitipatarakorn, Nipat Teeratakulpisarn, Siriporn Nonenoy, Aphakan Klinsukontakul, Sujittra Suriwong, Jirat Makphol, Piranun Hongchookiat, Thanyapat Chaya-ananchot, Napasawan Chinlaertworasiri, Pravit Mingkwanrungruang, Carlo Sacdalan, Kultida Poltavee, Tippawan Pankam, Stephen J. Kerr, Reshmie Ramautarsing, Donn Colby, Nittaya Phanuphak","doi":"10.1002/jia2.26242","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03–18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57–29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27–14.14), syphilis infection (aHR 4.67, 95% CI 1.10–19.90) and CD4 count <350 cells/mm<sup>3</sup> (aHR 3.09, 95% CI 1.28–7.48).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.</p>\n </section>\n </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26242","citationCount":"0","resultStr":"{\"title\":\"Prevalence and incidence of anal high-grade squamous intraepithelial lesions in a cohort of cisgender men and transgender women who have sex with men diagnosed and treated during acute HIV acquisition in Bangkok, Thailand\",\"authors\":\"Supanat Thitipatarakorn, Nipat Teeratakulpisarn, Siriporn Nonenoy, Aphakan Klinsukontakul, Sujittra Suriwong, Jirat Makphol, Piranun Hongchookiat, Thanyapat Chaya-ananchot, Napasawan Chinlaertworasiri, Pravit Mingkwanrungruang, Carlo Sacdalan, Kultida Poltavee, Tippawan Pankam, Stephen J. Kerr, Reshmie Ramautarsing, Donn Colby, Nittaya Phanuphak\",\"doi\":\"10.1002/jia2.26242\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03–18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57–29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27–14.14), syphilis infection (aHR 4.67, 95% CI 1.10–19.90) and CD4 count <350 cells/mm<sup>3</sup> (aHR 3.09, 95% CI 1.28–7.48).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.</p>\\n </section>\\n </div>\",\"PeriodicalId\":201,\"journal\":{\"name\":\"Journal of the International AIDS Society\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2024-05-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26242\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the International AIDS Society\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jia2.26242\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the International AIDS Society","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jia2.26242","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
导言 男男性行为者（MSM），尤其是艾滋病毒感染者，罹患肛门癌的风险增加。在急性艾滋病感染期间开始接受抗逆转录病毒治疗的男男性行为者中，肛门癌的前体--肛门高级别鳞状上皮内病变（HSILs）的患病率和发病率尚有待研究。 方法 在泰国曼谷的一个急性 HIV 感染队列中，招募了同意参加本研究的参与者。所有参与者均在感染艾滋病病毒的急性期确诊并开始接受抗逆转录病毒治疗。在基线和 6 个月一次的访问中进行了人类乳头瘤病毒 (HPV) 基因分型和高分辨率肛门镜检查，随后根据需要进行了肛门活检。 结果 共有 89 名男男性行为者和 4 名变性女性被纳入分析。入组年龄中位数为 26 岁。肛门HSIL组织学基线发病率为11.8%。在总共 147.0 人年的随访中，组织学意义上的肛门 HSIL 初次发病率为每 100 人年 19.7 例。与肛门HSIL事件相关的因素有肛门HPV16（调整后危险比[aHR]4.33，95% CI 1.03-18.18）、肛门HPV18/45（aHR 6.82，95% CI 1.57-29.51）、其他肛门高危HPV16（调整后危险比[aHR]4.33，95% CI 1.03-18.18）。51）、其他肛门高危 HPV（aHR 4.23，95% CI 1.27-14.14）、梅毒感染（aHR 4.67，95% CI 1.10-19.90）和 CD4 细胞数<350 cells/mm3 （aHR 3.09，95% CI 1.28-7.48）。 结论 我们发现，在急性 HIV 感染期间开始抗逆转录病毒治疗后，顺性别男性和变性男男性行为者中肛门 HSIL 的发病率与未感染 HIV 的人群相似。随后的肛门HSIL发病率虽然低于长期感染艾滋病病毒者，但仍高于未感染艾滋病病毒者。肛门HSIL的筛查和管理应成为所有男男性行为者长期艾滋病护理的重要组成部分。
Prevalence and incidence of anal high-grade squamous intraepithelial lesions in a cohort of cisgender men and transgender women who have sex with men diagnosed and treated during acute HIV acquisition in Bangkok, Thailand
Introduction
Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored.
Methods
Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits.
Results
A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03–18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57–29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27–14.14), syphilis infection (aHR 4.67, 95% CI 1.10–19.90) and CD4 count <350 cells/mm3 (aHR 3.09, 95% CI 1.28–7.48).
Conclusions
With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.
期刊介绍：
The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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