Anal HPV infection and correlates in HIV-infected patients attending a Sexually Transmitted Infection clinic in Brazil

Abstract

ObjectiveTo estimate the prevalence of anal HPV infection, genotype distribution, intraepithelial neoplasia (AIN) and correlates in a cohort of HIV-infected patients attending at Sexually Transmitted Infections (STI) clinic in Brazil.Study designA descriptive analysis was performed which includes, demographic, behavioral and clinical data. Anal specimens from HIV-positive men and women were collected during a regular visit and they were used for cytology and histopathology tests, as well as for HPV molecular identification.ResultsA total of 223 patients (143 females and 80 males) were enrolled in the study and, HPV was identified in 68.6% of the sample. The frequency of HR-HPV, HPV16/18 and multiple HPV infection were similar in both groups. The upstream regulatory region (URR) sequencing was carried out in 38 samples identified as HPV16-positive, and European variants were the most frequent (69.2%), followed by Africans (25.6%) and Asiatic-Americans (5.1%). Having more than 20 sexual partners was associated with multiple HPV infection (p = 0.000) while, anal sex and the first intercourse before 15 years of age was a risk factor for any HPV infection (p = 0.001). Being MSM (men who have sex with men) was a risk factor for any HPV and multiple infections (p = 0.002). The CD4 count >500 cells/mm3 was a protective factor for the HPV16/18 (p = 0.048) and multiple infections (p = 0.023), and the undetectable viral load and HAART treatment were both protective for any HPV (p = 0.010), HR-HPV (p = 0.091) and multiple infections (p = 0.006). Abnormal anoscopy was found in 23.7% (53/223) of the total number of patients, and this was significantly associated with all types of investigated HPV infections (p<0.0001).ConclusionsIn this study, anal HPV infection was common among young HIV-positive men and women, particularly in MSM. Anal cancer screening in patients at risk, such as those who are HIV-positive, and mainly those with anal HPV infection and a history of STI, will increase the likelihood of detecting anal intraepithelial neoplasia.

ART is key to clearing oncogenic HPV genotypes (HR-HPV) in anal mucosa of HIV-positive MSM

“…The sole protective factor against infection was ART that included integrase inhibitors (OR: 0.508, 95% CI: 0.277-0.935). These data confirm recent observations of the protective effects of ART and CD4 levels>500 cells/uL against infection by oncogenic HPV genotypes [26]. Other studies have described the presence of genital warts [27] and a deficient immune system [28] as risk factors for developing neoplasias associated with HR-HPV infection.…”

“…Both samples were immersed in thinlayer liquid medium and sent to the pathology laboratory of the hospital. Genotypes 16,18,26,31,33,35,39,45,[51][52][53]56,58,59,66,68,73, and 82 were considered to be HR-HPV genotypes. Genotypes 6,11,34,40,[42][43][44]54,55,57,61,[70][71][72]81,83,84, and 89 were considered to be low-risk (LR-HPV) genotypes.…”

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

“…Compared to the literature, these numbers are low . We assume that this observation is related to the good access to medical care, resulting in early diagnosis of HIV and HPV infection, easy access to antiretroviral therapy and better adherence to therapy . Our cohort also includes both genders regardless of sexual orientation while previous studies often concentrated on MSM only.…”

Sexually-transmitted infections: what is the true prevalence? A cross-sectional online survey of men who have sex with men in the Veneto Region of Italy

“…Another study, conducted in Spain, found a rising trend in the cases of gonorrhea, which was more pronounced among MSM [17]. A recent analysis showed that being MSM represented a risk factor for both HPV and multiple infections [18]genotype distribution, intraepithelial neoplasia (AIN). Our survey confirmed that co-infection is quite common (one in three of our MSM with STIs), and found gonorrhea the most often reported infection (18%).…”

“…Having multiple sexual partners is common in the MSM community, and still many do not use condoms consistently. Recent data indicated that less than 60% of MSM reported using a condom [18]genotype distribution, intraepithelial neoplasia (AIN, and evidence of a limited use of condoms emerged from another study too [19]. One of the reasons for this situation lies in that “safer sex” campaigns have lost traction in this population.…”