JID：HIV患者直肠HPV高感染率和持久性导致癌症的高发

HIV感染者患HPV（人乳头状瘤病毒）相关癌症的风险较高，而且发病率与解剖位置有关，如HIV感染者直肠癌的发病率是普通人群的25倍，而口咽癌的发病率是普通人群的2-6倍。免疫缺陷人群中，宫颈癌风险的升高与宫颈HPV感染高发病率和高持久性相关。为了在HIV患者中探究HPV感染发病率和持久性的差异与不同直肠-口腔HPV患病率和癌症发生率的关系，来自美国巴尔的摩的Daniel C. Beachler和同事比较了HIV感染者直肠和口腔HPV感染的自然史，研究结果在线发表在2013年4月17日的Journal of Infectious Diseases上。研究发现，HIV患者直肠HPV感染的高发病率和持久性导致癌症的高发。

研究涉及了404名HIV感染者，每半年收集他们的口腔灌洗液和直肠拭子样本，用PGMY09/11引物和反向线性斑点杂交检测样本中37型HPV，而用校正后的Wei-Lin-Weissfeld模型研究HPV持续性风险因素。

研究结果显示，直肠HPV感染的患病率（84% vs 28%）、月发病率（14.5% vs 3.1%）和年发病率（54% vs 29%）比口腔感染要高（p值都是小于0.001）。其中，与同性恋男性和女性相比，异性恋男性直肠HPV感染发病率较低，而口腔HPV感染的发病率较高（p-interaction<0.001）。校正分析HPV感染持续性的风险因素，发现患病率高于发病率（aHR=4.0，95%CI=3.5-4.8），直肠感染HPV高于口腔感染（aHR=1.5，95%CI=1.2-1.9）。

研究显示，在HIV感染者中，直肠HPV感染率高于口腔感染率且其持久性导致了直肠HPV相关癌症率比口腔高。

与HIV相关的拓展阅读：

• J HEPATOL：HCV病毒血症或基因型并不影响HIV/HCV共感染的死亡风险
• 单一母乳喂养可遏制母乳中HIV
• Epidemiol Infect:HIV患者需加强防范肝炎感染
• J Infect Dis：药物增强剂COBI可提高齐多夫定的抗HIV疗效
• J Vir：我国艾滋病疫苗能有效控制HIV病毒通过粘膜途径感染
• JAMA Intern Med：HIV感染者易发心梗 更多信息请点击：有关HIV更多资讯

Natural history of anal versus oral HPV infection in HIV-infected men and women
Background
HIV-infected individuals are at greater risk for HPV-associated anal than oropharyngeal cancers. The prevalence of anal versus oral HPV infections is higher in this population, but whether this is explained by higher incidence or persistence is unknown.
Methods
Oral rinse and anal swab samples were collected semi-annually from 404 HIV-infected adults in Baltimore, MD. Samples were tested for 37 HPV types using PGMY09/11 primers and reverse line-blot hybridization. Risk factors for HPV persistence were explored using adjusted Wei-Lin-Weissfeld models.
Results
The prevalence (84% vs. 28%), incidence (145 vs. 31 per 1000 person-months) and twelve-month persistence (54% vs. 29%) were higher for anal versus oral HPV infections, respectively (each p<0.001). Heterosexual men had lower incidence of anal HPV than men-who-have-sex-with-men and women, but a higher incidence of oral HPV infection (p-interaction<0.001). In adjusted analyses, risk factors for HPV persistence included prevalent versus incident (aHR=4.0, 95%CI=3.5-4.8) and anal versus oral HPV infections (aHR=1.5, 95%CI=1.2-1.9).
Conclusion
The higher incidence and persistence of anal versus oral HPV infections likely contributes to the higher burden of anal as compared to oral HPV-associated cancers in HIV infected individuals.