HPV-associated anal lesions in HIV+ patients: long-term results regarding quality of life

Abstract

Purpose HIV infection and concomitant HPV-associated anal lesions may significantly impact on patients' quality of life (QoL), as they are predicted to have negative effects on health, psyche, and sexuality. Material and methods Fifty-two HIV+ patients with HPV-associated anal lesions were enrolled in a survey approach after undergoing routine proctologic assessment and therapy for HPV-associated anal lesions if indicated over a time span of 11 years (11/2004-11/2015). Therapy consisted of surgical ablation and topic treatment. QoL was analyzed using the SF-36 and the CECA questionnaires. Results Fifty-two of 67 patients (77.6%) were successfully contacted and 29/52 provided full information. The mean age was 43.8 ± 12.8 years. The median follow-up from treatment to answering of the questionnaire was 34 months. Twenty-one percent (6/29) of the patients reported suffering from recurrence of condyloma acuminata, three patients from anal dysplasia (10.3%). In the SF-36, HIV+ patients did not rate their QoL as significantly different over all items after successful treatment of HPVassociated anal lesions. In the CECA questionnaire, patients with persisting HPV-associated anal lesions reported significantly higher emotional stress levels and disturbance of everyday life compared to patients who had successful treatment (71.9/100 ± 18.7 vs. 40.00/100 ± 27.4, p = 0.004). Importantly, the sexuality of patients with anal lesions was significantly impaired (59.8/ 100 ± 30.8 vs. 27.5/100 ± 12.2, p = 0.032). Conclusion HPV-associated anal lesions impact significantly negative on QoL in HIV+ patients. Successful treatment of HPVassociated anal lesions in HIV+ patients improved QoL. Specific questionnaires, such as CECA, seem to be more adequate than the SF-36 in this setting.

Knowledge and Perceived Emotions Regarding an Anal Cancer Preventive Program in People Diagnosed With HIV

“…In relation to sexuality, the attitudes of our participants were variable, as also described elsewhere in the literature. 17,27 Most described changes in their sexual practices after AC screening, as also previously described among people with and without HIV infection with anal HPV lesions 27,41 and in women with cervical cancer and HPV. 42 Nonetheless, some participants did not change their sexual habits for more than the recommended 2 to 3 days after screening.…”

“…Moreover, the results so far obtained are disparate. After screening, some studies reported decreased subjective sexual pleasure along with avoidance of sexual contact 27 or feelings of guilt about acquiring HPV as the result of sustained sexual practices 28 . However, other studies observed that being included in AC prevention programs did not universally affect the sexuality of the participants 17 .…”