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Abstract：
BACKGROUND: 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.
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.
摘要：
背景：与男性发生性关系的男性（MSM），尤其是那些艾滋病毒携带者，患肛门癌的风险增加。其前体的患病率和发生率，肛门高级别鳞状上皮内病变（HSILs），在急性HIV感染期间开始抗逆转录病毒治疗的MSM中,还有待探讨.
方法：曼谷急性HIV感染队列的参与者，泰国,谁同意参加这项研究，已注册。所有参与者在急性HIV感染期间被诊断并开始抗逆转录病毒治疗。人乳头瘤病毒（HPV）基因分型和高分辨率肛门镜检查，随后进行肛门活检，在基线和6个月访问时进行。
结果：共有89名MSM和4名变性女性被纳入分析。入学时的中位年龄为26岁。组织学肛门HSIL的基线患病率为11.8%。共随访147.0人年,初次组织学肛门HSIL的发生率为19.7/100人年.与肛门HSIL事件相关的因素是肛门HPV16（调整后的危险比[aHR]4.33，95％CI1.03-18.18），肛门HPV18/45（aHR6.82，95%CI1.57-29.51），其他肛门高危型HPV（aHR4.23，95%CI1.27-14.14），梅毒感染（aHR4.67，95％CI1.10-19.90）和CD4计数<350细胞/mm3（aHR3.09，95％CI1.28-7.48）。
结论：在急性HIV感染期间启动抗逆转录病毒治疗，我们发现,在男男性行为者和变性女性中,肛交HSIL的患病率与无HIV者相似.随后的肛门HSIL发生率，虽然低于那些长期感染艾滋病毒的人，仍然高于没有艾滋病毒的人。肛门HSIL的筛查和管理应该是所有MSM长期HIV护理的关键部分。
方法：曼谷急性HIV感染队列的参与者，泰国,谁同意参加这项研究，已注册。所有参与者在急性HIV感染期间被诊断并开始抗逆转录病毒治疗。人乳头瘤病毒（HPV）基因分型和高分辨率肛门镜检查，随后进行肛门活检，在基线和6个月访问时进行。
结果：共有89名MSM和4名变性女性被纳入分析。入学时的中位年龄为26岁。组织学肛门HSIL的基线患病率为11.8%。共随访147.0人年,初次组织学肛门HSIL的发生率为19.7/100人年.与肛门HSIL事件相关的因素是肛门HPV16（调整后的危险比[aHR]4.33，95％CI1.03-18.18），肛门HPV18/45（aHR6.82，95%CI1.57-29.51），其他肛门高危型HPV（aHR4.23，95%CI1.27-14.14），梅毒感染（aHR4.67，95％CI1.10-19.90）和CD4计数<350细胞/mm3（aHR3.09，95％CI1.28-7.48）。
结论：在急性HIV感染期间启动抗逆转录病毒治疗，我们发现,在男男性行为者和变性女性中,肛交HSIL的患病率与无HIV者相似.随后的肛门HSIL发生率，虽然低于那些长期感染艾滋病毒的人，仍然高于没有艾滋病毒的人。肛门HSIL的筛查和管理应该是所有MSM长期HIV护理的关键部分。
