Human papillomavirus seroprevalence and seroconversion among men living with HIV: Cohort study in South Africa.
男性 HIV 感染者中人乳头瘤病毒血清阳性率和血清转换: 南非队列研究。
- 作者列表："Chikandiwa A","Faust H","Chersich MF","Mayaud P","Dillner J","Delany-Moretlwe S
BACKGROUND:Men living with HIV (MLHIV) have a high burden of human papillomavirus (HPV)-related cancer. Understanding serological dynamics of HPV in men can guide decisions on introducing HPV vaccination and monitoring impact. We determined HPV seroprevalence and evaluated factors associated with HPV seroconversion among MLHIV in Johannesburg, South Africa. METHODS:We enrolled 304 sexually active MLHIV ≥18 years and collected socio-behavioral data, blood samples (CD4+ counts, HIV-1 plasma viral load [PVL] and HPV serology), genital and anal swabs (HPV DNA and HPV Viral Load [VL]) at enrolment and 6-monthly for up to 18 months. Antibodies to 15 HPV types were measured using HPV pseudovirions. Generalised estimating equations were used to evaluate correlates of HPV seroconversion. RESULTS:Median age at enrolment was 38 years (IQR:22-59), 25% reported >1 sexual partner in the past 3 months and 5% reported ever having sex with other men. Most participants (65%) were on antiretroviral therapy (ART), with median CD4+ count of 445 cells/µL (IQR:328-567). Seroprevalence for any-HPV type was 66% (199/303). Baseline seropositivity for any bivalent (16/18), quadrivalent (6/11/16/18) and nonavalent (6/11/16/18/31/33/45/52/58) vaccine-types were 19%, 37% and 60% respectively. At 18 months, type-specific seroconversion among 59 men whose genital samples were HPV-DNA positive but seronegative for the same type at enrolment was 22% (13/59). Type-specific seroconversion was higher among men with detectable HIV-PVL (adjusted odds-ratio [aOR]=2.78, 95%CI:1.12-6.77) and high HPV-VL (aOR=3.32, 95%CI:1.42-7.74). CONCLUSION:Seropositivity and exposure to nonavalent HPV types were high among MLHIV. HPV vaccination of boys before they become sexually active could reduce the burden of HPV infection among this at-risk population.
背景: 男性 HIV 感染者 (MLHIV) 人乳头瘤病毒 (HPV) 相关的癌症负担很高。了解男性 HPV 的血清学动态可以指导关于引入 HPV 疫苗接种和监测影响的决策。我们确定了南非约翰内斯堡 MLHIV 中 HPV 血清阳性率，并评估了与 HPV 血清转换相关的因素。 方法: 我们入组了 304 例 ≥ 18 岁的性活跃 MLHIV，收集社会行为数据、血液样本 (CD4 + 计数、 HIV-1 血浆病毒载量 [PVL] 和 HPV 血清学), 登记时的生殖器和肛门拭子 (HPV DNA 和 HPV 病毒载量 [VL])，每月 6 次，最长 18 个月。使用 HPV 假病毒粒子测量 15 种 HPV 类型的抗体。使用广义估计方程评价 HPV 血清转换的相关性。 结果: 入组时的中位年龄为 38 岁 (IQR: 22-59)，25% 的人报告在过去 3 个月内> 1 个性伴侣，5% 的人报告曾与其他男性发生过性行为。大多数参与者 (65%) 正在接受抗逆转录病毒治疗 (ART)，CD4 + 细胞计数中位数为 445 个/µ l (IQR: 328-567)。任何类型 HPV 的血清阳性率为 66% (199/303)。任何二价 (16/18) 、四价 (6/11/16/18) 和无价 (6/11/16/18/31/33/45/52/58) 疫苗类型的基线血清阳性率分别为 19% 、 37% 和 60%。18 个月时，59 例男性生殖器样本 HPV-DNA 阳性但登记时相同类型血清阴性的男性中，类型特异性血清转换为 22% (13/59)。在可检测到 HIV-PVL 的男性中，类型特异性血清转换较高 (校正比值比 [aOR] = 2.78，95% CI: 1.12-6.77) 和高 HPV-VL (aOR = 3.32，95% CI: 1.42-7.74)。 结论: MLHIV 感染者的血清阳性率和非价型 HPV 感染率较高。男孩在性活跃之前接种 HPV 疫苗可以减轻该高危人群 HPV 感染的负担。
METHODS:BACKGROUND:Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. AIM:To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. MATERIALS AND METHODS:An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. RESULTS:Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. CONCLUSION:Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.
METHODS::Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon's perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.
METHODS:STUDY OBJECTIVE:Prior research collectively shows that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. DESIGN:Cross sectional study among women with no prior diagnosis of endometriosis. SETTING:Fourteen clinical centers in Salt Lake City, Utah and San Francisco, California. PATIENTS:Four hundred and ninety five women, ages 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. INTERVENTIONS:Gynecologic laparoscopy/laparotomy, regardless of clinical indication. MEASUREMENTS AND MAIN RESULTS:Participants underwent anthropometric assessments, body composition, and body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised ASRM staging (I to IV) and typology of disease (superficial [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. While the majority of confidence intervals were wide and overlapping, three general impressions emerged: 1) women with versus without incident endometriosis had the lowest anthropometric/body composition indicators; 2) women with stage I or IV had lower indicators compared to women with stage II or III; and 3) women with OE and/or DIE tended to have the lowest indicators, while women with SE had the highest indicators. CONCLUSION:Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.