Prevalence, clearance, and incidence of human papillomavirus type-specific infection at the anal and penile site of HIV-infected men.
ABSTRACT BACKGROUND: We studied the type-specific infection of human papillomavirus (HPV)
at the anal canal and penile site in a cohort of HIV-infected men.
METHODS: Prevalence, clearance, and incidence of specific HPV types in the anal
canal and penis were determined in 733 HIV-infected men from the Spanish CAn Ruti
HIV+ Men ([CARH•MEN]) cohort (538 men who have sex with men [MSM] and 195
RESULTS: In both groups, the most prevalent high-risk type was HPV-16 (anal canal
[31.6% MSM; 6.8% heterosexual] and penis [4.8% MSM; 6.8% heterosexual]). The most
prevalent low-risk type was HPV-6 (anal canal [23.2% MSM; 12.8% heterosexual],
penis [8.1% MSM; 8.9% heterosexual]). Anal prevalence was significantly higher in
MSM, as was incidence, except for HPV-16, which was similar between male groups
(5.9 new cases per 1000 person-months [95% confidence interval, 4.3-7.9] in MSM;
4.4 [95% confidence interval, 2.5-7.2] in heterosexual men; P > 0.05). The anal
clearance rate of the different HPV types and retention time of infection were
similar in both groups, as well as the HPV infection of the penis.
CONCLUSIONS: HIV-infected MSM had a high prevalence of HPV infection at the anal
canal; however, heterosexual HIV-infected men were also at risk for acquiring and
sustaining persistent high-risk HPV types at the anal and penile site and are at
risk for developing dysplasia in the future. All HIV-infected men should be
recommended for routinely anal HPV screening.
- SourceAvailable from: Monique F.S. Beltrão[Show abstract] [Hide abstract]
ABSTRACT: Introduction Human papillomavirus (HPV) is the most clinically common sexually transmitted infection due to its carcinogenic power and the high number of lesions that it causes at different sites of the human body. Material and methods Genital tract organs are the most common sites where the virus can be found, but by increasing the sensitivity of diagnostic technique, it is possible to identify viral presence in different regions of the body such as the stomach, the lung, and the urinary tract. These findings break with the traditional HPV skin/genital tropic profile and demonstrate that the virus is capable of infecting a wide variety of cells, tissues, and organs or can, at least, survive in these areas. The widespread presence of the HPV in the human body, often in latent form, led us to consider the hypothesis that HPV latency may be associated with no disease. Conclusion This observation raises further questions about the possibility of the virus not causing disease in specific sites of the human body, but rather, behaving like a commensal/opportunistic microorganism.Archives of Gynecology and Obstetrics 09/2014; 291(3). DOI:10.1007/s00404-014-3480-5 · 1.28 Impact Factor
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ABSTRACT: Objectives Our purpose was to investigate prevalence, incidence and risk factors of anal high risk-HPV infections and cytological abnormalities in HIV-positive individuals. Methods A cohort of consecutively enrolled HIV-positive patients underwent, at baseline visit, a sexual behaviors questionnaire, anoscopy, HPV testing and cytological examination. Hybridization and multiplex-PCR were used for DNA detection and typing; HPV E6-E7 mRNA expression was analyzed in HR-HPV+ patients. Logistic regression was used to assess predictors of HR-HPV infection and anal dysplasia. Results 233 HIV-infected patients were enrolled (81% males, median age 44 years). HR-HPV was detected in 144 anal swabs and showed a positive association with CDC stage C and a negative association with a higher CD4 count and the use of a NNRTI-based antiretroviral regimen. HR-HPV DNA detection and anal warts at baseline were associated to cytological abnormalities; a detectable HIV-RNA independently predicted new onset anal dysplasia at follow-up (incidence 15.4 per 100 patients-year). Incidence of new HR-HPV infection was 44.2 per 100 patients-year. Conclusions The relevance of screening for anal dysplasia in HIV+ patients is emphasized, especially in those with detectable plasma HIV-RNA, anal HR-HPV infection or compromised immunological status.Journal of Infection 08/2014; 70(1). DOI:10.1016/j.jinf.2014.07.025 · 4.02 Impact Factor
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ABSTRACT: Objectives(1) To model the natural history of anal neoplasia in HIV-infected patients using a 3-state Markov model of anal cancer pathogenesis, adjusting for cytology misclassification; and (2) to estimate the effects of selected time-varying covariates on transition probabilities.DesignA retrospective cytology-based inception screening cohort of HIV-infected adults was analyzed using a 3-state Markov model of clinical pathogenesis of anal neoplasia.MethodsLongitudinally ascertained cytology categories were adjusted for misclassification using estimates of cytology accuracy derived from the study cohort. Time-varying covariate effects were estimated as hazard ratios.Results(1) There was a moderate to high probability of regression of the high grade squamous intraepithelial lesion (HSIL) state (27–62%) at 2 years after initial cytology screening; (2) the probability of developing invasive anal cancer (IAC) during the first 2 years after a baseline HSIL cytology is low (1.9–2.8%); (3) infrared coagulation (IRC) ablation of HSIL lesions is associated with a 2.2–4.2 fold increased probability of regression to <HSIL; and (4) antiretroviral therapy, suppressed HIV plasma viral load, and CD4 ≥350/mm3 are each associated with reduced probability of progression from <HSIL to HSIL.ConclusionsThe finding of moderate to high rates of regression of the HSIL state accompanied by low rates of progression to IAC should inform both screening and precursor treatment guideline development. There appears to be a consistent and robust beneficial effect of antiretroviral therapy, suppressed viral load, and higher CD4 on the transition from the <HSIL state to the HSIL state.PLoS ONE 08/2014; 9(8):e104116. DOI:10.1371/journal.pone.0104116 · 3.53 Impact Factor