Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis

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• 作者：Dorothy A Machalek ; BSc^a ; Mary Poynten ; PhD^a ; Fengyi Jin ; PhD^a ; Prof Christopher K Fairley ; PhD^b ; ^c ; Annabelle Farnsworth ; FRCPA^d ; Prof Suzanne M Garland ; FRCPA^e ; ^f ; ^g ; Richard J Hillman ; MD^a ; ^h ; Kathy Petoumenos ; PhD^a ; Jennifer Roberts ; FRCPA^d ; Sepehr N Tabrizi ; PhD^e ; ^f ; ^g ; David J Templeton ; PhD^a ; ⁱ ; Prof Andrew E Grulich ; PhD^a ; ^{agrulich@kirby.unsw.edu.au}
• 刊名：Lancet Oncology
• 出版年：2012
• 期刊代码：184_14702045
• 类别：med
• 出版时间：May, 2012
• 卷：13
• 期：5
• 页码：487-500
• 文件大小：441 K

摘要

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Summary

Background

Men who have sex with men (MSM) are at greatly increased risk of human papillomavirus (HPV)-associated anal cancer. Screening for the presumed cancer precursor, high-grade anal intraepithelial neoplasia (AIN), followed by treatment in a manner analogous to cervical screening, has been proposed. We aimed to assess available data for anal HPV disease that can inform pre-cancer screening programmes.

Methods

We searched PubMed, OVID Medline, and Embase for all studies published before Nov 1, 2011, that reported prevalence and incidence of anal HPV detection, AIN, and anal cancer in MSM. We calculated summary estimates using random-effects meta-analysis.

Findings

53 studies met the inclusion criteria, including 31 estimates of HPV prevalence, 19 estimates of cytological abnormalities, eight estimates of histological abnormalities, and nine estimates of anal cancer incidence. Data for incident HPV and high-grade AIN were scarce. In HIV-positive men, the pooled prevalence of anal HPV-16 was 35路4%(95%CI 32路9-37路9). In the only published estimate, incidence of anal HPV-16 was 13路0%(9路6-17路6), and clearance occurred in 14路6%(10路2-21路2) of men per year. The pooled prevalence of histological high-grade AIN was 29路1%(22路8-35路4) with incidences of 8路5%(6路9-10路4) and 15路4%(11路8-19路8) per year in two estimates. The pooled anal cancer incidence was 45路9 per 100鈥?00 men (31路2-60路3). In HIV-negative men, the pooled prevalence of anal HPV-16 was 12路5%(9路8-15路4). Incidence of HPV-16 was 11路8%(9路2-14路9) and 5路8%(1路9-13路5) of men per year in two estimates. The pooled prevalence of histological high-grade AIN was 21路5%(13路7-29路3), with incidence of 3路3%(2路2-4路7) and 6路0%(4路2-8路1) per year in two estimates. Anal cancer incidence was 5路1 per 100鈥?00 men (0-11路5; based on two estimates). There were no published estimates of high-grade AIN regression.

Interpretation

Anal HPV and anal cancer precursors were very common in MSM. However, on the basis of restricted data, rates of progression to cancer seem to be substantially lower than they are for cervical pre-cancerous lesions. Large, good-quality prospective studies are needed to inform the development of anal cancer screening guidelines for MSM.

Funding

Australian Government Department of Health and Ageing.