乌鲁木齐市HIV阴性男男性行为者肛门HPV新发感染和感染清除研究

目的 了解乌鲁木齐市HIV阴性MSM肛门HPV新发感染和感染清除特征。方法 采用队列研究，通过乌鲁木齐市NGO组织于2016年4月11日至2021年11月30日以雪球抽样方式招募MSM 1269名，随访方式为每6个月1次，采集肛周脱落细胞进行HPV基因型检测，使用精确Poisson分布计算新发感染密度和感染清除密度，Cox比例风险模型分析新发感染、自然清除的影响因素。结果 将随访次数≥1 次的858名MSM纳入本次分析，中位年龄29.00（25.00,36.00） 月，中位随访时间26.28（10.57,48.82） 月，随访次数2.96（1.00,6.00）次。仅高危型、仅低危型和混合型新发感染密度分别是9.39/1000人月（95%CI:7.89~11.09）、4.45/1000人月（95%CI:3.52~5.54）、12.36/1000人月（95%CI:10.36~14.63），清除密度分别为108.78/1000人月（95%CI:94.37~124.78）、96.76/1000人月（95%CI:78.19~118.41）和86.87/1000人月（95%CI:77.12~97.50）。HPV 6型和16型有相对更高的新发感染率和更低的清除率。HPV感染6个月清除率在30%~40%左右，90%左右的MSM在24个月会清除HPV。多变量分析中，接受性肛交（αHR=1.514，95%CI:1.025~2.811）、无业或失业（αHR=1.746，95%CI:1.085~2.811）增加仅高危型新发感染风险；≤24岁（αHR=2.227，95%CI:1.087~4.563）增加仅低危型新发感染风险；同性性伴数越多（αHR=1.051，95%CI:1.008~1.096）增加混合型新发感染风险；未在浴池寻找性伴（αHR=2.267，95%CI:1.036~4.961）更容易清除仅低危型；本科及以上（αHR=1.785，95%CI:1.234~2.582）、未发生商业性行为（αHR=1.967，95%CI:1.191~3.248）有利于HPV16/18型感染清除。结论 乌鲁木齐市MSM肛门HPV新发感染率较高，其中HPV 6型和16型较高的新发感染率和低清除率需要关注，虽然HPV感染24个月内自然清除率在90%左右，但仍存在一定比例的再发感染，有必要在年轻男性中接种HPV疫苗。

Research of incidence and clearance of anal human papilloma virus in HIV-negative men who have sex with men,Urumqi

Objective To investigate the characteristics of anal HPV infection and clearance in HIV-negative MSM in Urumqi. Methods In a cohort study, a total of 1 269 MSM participants were recruited by snowball sampling from NGO in Urumqi from April 11, 2016 to November 30, 2021, followed up every 6 months. Perianal exfoliated cells were collected for HPV genotyping. Precise Poisson distribution was used to estimate the density of incidence and clearance. Cox proportional hazard model was used to analyze the influencing factors of incidence and clearance. Results 858 MSM patients with follow-up times greater or equal to 1 were included in this analysis. Their median age was 29.00 (25.00, 36.00) years, median follow-up time was 26.28 (10.57, 48.82) months, and follow-up times were 2.96 (1.00, 6.00) times. The new infection densities of high-risk only, low-risk only and mixed types were 9.39/1000 person-months (95%CI:7.89-11.09), 4.45/1000 person-months (95%CI:3.52-5.54), 12.36/1000 person-months (95%CI:10.36-14.63), respectively. The clearance densities were 108.78/1000 person-month (95%CI:94.37-124.78), 96.76/1000 person-month (95%CI:78.19-118.41) and 86.87/1000 person-month (95%CI:77.12-97.50), respectively. HPV 6 and 16 had relatively higher rates of incidence and lower clearance rates. The clearance rate of HPV infection was around 30% to 40% at 6 months, and around 90% of MSM would clear HPV at 24 months. In a multivariate analysis, receiving anal sex（αHR=1.514, 95%CI:1.025-2.811）, being unemployed or unemployed（αHR=1.746, 95%CI:1.085-2.811）increased the risk of incidence for high-risk only types; ≤24 years of age（αHR=2.227, 95%CI:1.087-4.563）increased the risk of incidence for low-risk only types; Having more same-sex partners（αHR=1.051, 95%CI:1.008-1.096）increased the risk of incidence for mixed types; Failure to seek sexual partners in baths（αHR=2.267, 95%CI:1.036-4.961）was easier to remove low-risk only types; Bachelor degree or above（αHR=1.785, 95%CI:1.234-2.582）and the absence of commercial sex（αHR=1.967, 95%CI:1.191-3.248）was beneficial to the clearance of HPV16/18 infection. Conclusion The incidence rate of anal HPV in MSM in Urumqi is high, and the high incidence rate and low clearance rate of HPV 6 and 16 should be paid attention to. Although the natural clearance rate of HPV within 24 months is about 90%, there is still a certain proportion of re-infection, so it is necessary to vaccinate young men against HPV.