男男性行为人群肛门人乳头瘤病毒16型和18型新发感染和自然清除的队列研究

刘礼荣; 席苗苗; 陈珍; 张泽文; 张国珍; 王璐; 戴江红

Abstract

刘礼荣,席苗苗,陈珍,张泽文,张国珍,王璐,戴江红.男男性行为人群肛门人乳头瘤病毒16型和18型新发感染和自然清除的队列研究[J].Chinese journal of Epidemiology,2021,42(5):872-877

男男性行为人群肛门人乳头瘤病毒16型和18型新发感染和自然清除的队列研究

A cohort study on the new infections and natural clearance of anal human papillomavirus types 16 and 18 in men who have sex with men

Received:August 26, 2020

DOI：10.3760/cma.j.cn112338-20200826-01099

KeyWord: 人乳头瘤病毒男男性行为者感染清除

English Key Word: Human papillomavirus Men who have sex with men Infection Clearance

FundProject:国家自然科学基金（81560539，81860590）

Author Name	Affiliation	E-mail
Liu Lirong	School of Public Health, Xinjiang Medical University, Urumqi 830011, China
Xi Miaomiao	School of Public Health, Xinjiang Medical University, Urumqi 830011, China
Chen Zhen	School of Public Health, Xinjiang Medical University, Urumqi 830011, China
Zhang Zewen	School of Public Health, Xinjiang Medical University, Urumqi 830011, China
Zhang Guozhen	School of Public Health, Xinjiang Medical University, Urumqi 830011, China
Wang Lu	School of Public Health, Xinjiang Medical University, Urumqi 830011, China
Dai Jianghong	School of Public Health, Xinjiang Medical University, Urumqi 830011, China	epi102@sina.com

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Abstract:

目的了解乌鲁木齐市MSM肛门HPV16型和18型的感染和自然清除情况。方法采用动态队列研究的方法，按照队列研究样本量计算公式以HPV16型新发感染率估计样本量为712人。依托乌鲁木齐市MSM社会组织用滚雪球方式招募MSM 810名，每6个月随访1次。采集肛门脱落细胞分析HPV16型和18型感染率，利用Poission回归估计新发感染密度和持续感染密度，采用Cox比例风险模型探寻新发感染、持续感染和感染自然清除的影响因素。结果招募MSM 810名，将随访次数≥2次的482名MSM纳入分析，随访994.7人年，随访次数和随访时间的M（P₂₅，P₇₅）分别为4（3，5）次和2.2（1.8，2.6）年。HPV16型和18型的基线感染率分别为8.5%（41/482）和3.3%（16/482），两型基线混合感染率为0.6%（3/482）。HPV16型和18型的首次新发感染密度分别为10.06（95%CI：8.12~12.45）/100人年和5.24（95%CI：3.95~6.96）/100人年；HPV16型和18型感染自然清除率分别为71.2%（89/125）和71.8%（46/64），HPV18型随访1.5年的感染自然清除率高于HPV16型（97.7%比94.1%）。HPV16型和18型的持续感染率分别为4.5%（20/441）和1.7%（8/466）。无婚史者比有婚史者的HPV16型持续感染风险低（aHR=0.29，95%CI：0.12~0.71）。最近6个月肛交未使用安全套者HPV18型自然清除率是使用安全套者2.63倍（95%CI：1.08~6.42）。结论乌鲁木齐市MSM HPV16和18型新发感染较常见，自然清除率均较高。相比于HPV18型，HPV16型有更高的新发感染率和持续感染率，自然清除率低，致病风险较大。

English Abstract:

Objective To understand the infection status and elimination of anal human papillomavirus (HPV) among men who have sex with men (MSM) in Urumqi, Xinjiang. Methods The sample size formula in cohort study, a dynamic cohort study method, was used, with the sample size estimated to be 712 according to the new infection rate of HPV16. With the help from non-government organzitions in Urumqi, we recruited 810 MSMs by the snowballing method, and a follow-up program was carried every six months. Anal exfoliated cells were collected to analyze HPV type 16 and 18 infection rates. For statistical analyses, Poisson regression was used to estimate the density of new infections and persistent infections. Cox proportional hazard model was used to explore the influencing factors on both new and persistent infections and the diseases' natural clearing. Results A total of 810 MSM were recruited, and 482 MSMs with the number of follow-ups more than 2 times were included in the analysis, with the total follow-up numbers as 994.7 person-years. The median number of follow-up and follow-up times was 4 (P₂₅,P₇₅:3,5) times, and 2.2 (P₂₅,P₇₅:1.8, 2.6) years. The baseline infection rates of HPV16 and HPV18 were 8.5% (41/482) and 3.3% (16/482), respectively. And the baseline mixed infection rate of the two types was 0.6% (3/482). The first new infection densities of HPV16 and HPV18 were 10.06 (95%CI:8.12-12.45)/100 person-years and 5.24 (95%CI:3.95-6.96)/100 person-years. The rate of natural infection clearance of HPV16 and HPV18 were 71.2% (89/125) and 71.8% (46/64), respectively. The natural clearance rate of HPV18 after 1.5 years follow-up was higher than HPV16 (97.7% vs. 94.1%). The persistent infection rate of HPV16 and HPV18 were 4.5% (20/441) and 1.7% (8/466), respectively. The risk of persistent HPV16 infection among unmarried subjects was lower than that of married subjects (aHR=0.29,95%CI:0.12-0.71). The natural clearance rate of HPV18 without condom use in anal intercourse in the last six months was 2.63 times higher than that of condom use (95%CI:1.08-6.42).Conclusions HPV16 and 18 new infections are more common among MSM in Urumqi, and the natural clearance rate is higher. Compared with HPV18, HPV16 has a higher density of new and persistent infections, a low natural clearance rate, and a greater risk of the diseases.

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