High-risk human papillomavirus infection and associated factors in the anal canal of HIV-positive patients in Medellín, 2017–2018

ABSTRACT OBJECTIVE To estimate the prevalence of high-risk human papillomavirus (HR-HPV) anal infection and associated factors in human immunodeficiency virus (HIV) positive patients in Medellín. METHODS Descriptive cross-sectional study in 300 HIV-positive patients, adults, with history of anal intercourse, treated in two health care services of Medellín 2017–2018. We conducted a structured survey on sociodemographics, sexual behavior and medical history. HPV was detected in anal swabs tested by the COBAS 4800 system. Exploratory data analysis of risk factors associated with HR-HPV was conducted by chi-square test of independence and both raw and adjusted prevalence ratios used the Poisson regression model, at a 95% confidence interval. RESULTS The high-risk HPV had a prevalence of 82.7%; HPV16 had a prevalence of 32.7%, HPV18 a prevalence of 21.7% and other HPV types scored 78.3%. The high-risk HPV prevalence in women was of 68.2% and 83.8% in men. The risk factors associated with high-risk HPV after adjustment were age under 30 years, elementary education, casual sex partners, and first sexual activity before 18 years old. CONCLUSIONS The high incidence of high-risk HPV, along with the occurrence of coinfections by multiple types in the study population shows their susceptibility to develop some type of anal intra-epithelial neoplasia. It is important to establish sexual health programs focused on primary health care.

摘要

## 研究目的
本研究旨在评估麦德林地区人类免疫缺陷病毒（human immunodeficiency virus, HIV）阳性人群中高危型人乳头瘤病毒（high-risk human papillomavirus, HR-HPV）肛门感染的流行情况及其相关影响因素。

## 研究方法
本研究为描述性横断面研究，纳入2017-2018年在麦德林两家医疗机构就诊的300例有肛交史的成年HIV阳性患者。研究人员采用结构化问卷收集受试者的社会人口学特征、性行为及病史资料；通过采集肛门拭子标本，采用COBAS 4800检测系统进行HPV检测。采用卡方独立性检验对HR-HPV感染的相关危险因素进行探索性数据分析，并采用泊松回归模型计算粗患病率比与调整后患病率比，置信区间设置为95%。

## 研究结果
高危型HPV总体流行率为82.7%；其中HPV16型流行率为32.7%，HPV18型为21.7%，其余型别HPV占比78.3%。女性人群中高危型HPV流行率为68.2%，男性为83.8%。经调整后，与高危型HPV感染相关的危险因素包括年龄＜30岁、初等教育水平、存在临时性性伴侣以及首次性行为年龄＜18岁。

## 研究结论
本研究人群中高危型HPV感染率较高，且存在多型别混合感染情况，提示该人群罹患各类肛门上皮内瘤变的风险较高。因此，构建以基层医疗为核心的性健康干预方案具有重要意义。