Anal Dysplasia Screening in People Living with HIV: Long-Term Follow-Up in a Large Cohort from Northwest Spain.

IF 3.4 2区 医学 Q2 INFECTIOUS DISEASES AIDS patient care and STDs Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI:10.1089/apc.2023.0231
Alexandre Pérez-González, Silvia Rodríguez-Rivero, Pilar Fernández-Veiga, Erene Flores, Eva Poveda, Joaquín González-Carreró, Sonia Pérez-Castro, Laura Labajo-Leal, Celia Miralles, Antonio Ocampo
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Abstract

Anal squamous cell carcinoma (SCC) is not a common disease in the general population, although its incidence is higher in people living with human immunodeficiency virus (PLWH). Anal SCC is caused by human papillomavirus (HPV) infection and arises from premalignant lesions termed squamous intraepithelial lesions (SILs). SIL surveillance programs are based on the early detection and treatment of SILs, especially those with a higher risk of transforming into cancer. An anal surveillance program has been under development in our institution since 2011. In this context, we performed a retrospective cohort study at the anal dysplasia unit of Álvaro-Cunqueiro Hospital (Spain). Epidemiological and clinical data were gathered from our Infectious Diseases Sample Collection (an open sample cohort including PLWH) from January 2011 to January 2022. A total of 493 PLWH were considered, 122 (24.7%) of whom were diagnosed with anal dysplasia at baseline, including 2 cases of anal SCC. Briefly, most of individuals were young men (median age, 38 years old) born in Spain (76%), whose vaccination rate before their inclusion in the program was scarce (<3%). Throughout the study period, 81 (16.4%) cases were diagnosed with high-grade squamous-intraepithelial lesions (HSILs) and 3 with anal SCC. At the baseline, severe immunosuppression (i.e., nadir CD4+ lymphocyte count below 200 cell/μL), and prior diagnosis of condyloma acuminata were more frequent within the group with SILs. Conversely, the baseline CD4+ lymphocyte count was similar among both groups. HPV-16 was related to a higher risk of HSILs (odds ratio: 2.76). At the end of the follow-up, 385 PLWH had been retained in care; one patient had died of anal cancer. Anal dysplasia was common (25% of cases), especially among patients infected by HPV-16, diagnosed with condyloma acuminata, and who were severely immunosuppressed. HPV-16 was the main risk factor for the presentation of HSILs.

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艾滋病病毒感染者的肛门发育不良筛查:西班牙西北部大型队列的长期随访。
肛门鳞状细胞癌(SCC)在普通人群中并不常见,但在人类免疫缺陷病毒感染者(PLWH)中发病率较高。肛门鳞状细胞癌是由人类乳头状瘤病毒(HPV)感染引起的,它产生于被称为鳞状上皮内病变(SIL)的恶性前病变。鳞状上皮内病变监测计划的基础是早期发现和治疗鳞状上皮内病变,尤其是那些转化为癌症风险较高的鳞状上皮内病变。我院自 2011 年起开始实施肛门监测计划。在此背景下,我们在阿尔瓦罗-昆凯罗医院(西班牙)肛门发育不良科开展了一项回顾性队列研究。流行病学和临床数据收集自 2011 年 1 月至 2022 年 1 月期间的传染病样本库(包括 PLWH 在内的开放样本队列)。研究共涉及 493 名 PLWH,其中 122 人(24.7%)在基线时被诊断为肛门发育不良,包括 2 例肛门 SCC。简而言之,大多数患者是出生在西班牙的年轻男性(中位数年龄为 38 岁)(76%),他们在加入该计划之前的疫苗接种率很低(+淋巴细胞计数低于 200 个细胞/μL),而且在患有 SIL 的群体中,之前诊断出尖锐湿疣的患者更多。相反,两组的基线 CD4+ 淋巴细胞计数相似。HPV-16与较高的HSIL风险有关(几率比:2.76)。随访结束时,有 385 名 PLWH 患者继续接受治疗;其中一名患者死于肛门癌。肛门发育不良很常见(占病例的 25%),尤其是在感染 HPV-16、确诊为尖锐湿疣和免疫力严重低下的患者中。HPV-16是出现HSIL的主要风险因素。
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来源期刊
AIDS patient care and STDs
AIDS patient care and STDs 医学-传染病学
CiteScore
7.00
自引率
22.40%
发文量
67
审稿时长
6-12 weeks
期刊介绍: AIDS Patient Care and STDs is the foremost journal providing the latest developments and research in diagnostics and therapeutics designed to prolong the lifespan and improve quality of life for HIV/AIDS patients. The Journal delivers cutting-edge clinical, basic science, sociologic, and behavior-based investigations in HIV/AIDS and other sexually transmitted infections. Clinical trials, quantitative and qualitative analyses of pilot studies, comprehensive reviews, and case reports are presented from leading experts and scientists around the world. AIDS Patient Care and STDs coverage includes: Prominent AIDS medications, therapies, and antiretroviral agents HIV/AIDS-related diseases, infections, and complications Challenges of medication adherence Current prevention techniques for HIV The latest news and developments on other STDs Treatment/prevention options, including pre- and post-exposure prophylaxis
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