Impact of risk factors on prevalence of anal HPV infection in women with simultaneous cervical lesion

Abstract

The aim of our study was to determine the risk factors associated with anal HPV infection in HIV-negative women with high-grade cervical lesion. The study group included 172 "high-risk" women who underwent conization for high-grade cervical intraepithelial lesion or microinvasive cervical cancer (CIN 2+). The control group consisted of 100 "low-risk" women with non-neoplastic gynecologic diseases. All participants completed a questionnaire detailing medical history and sexual risk factors and were subjected to anal and cervical HPV genotyping. Concurrent cervical and anal HPV infections were detected in 42.4% (73/172) women of the study group, and in 8.0% (8/100) of women in the control group, respectively. The subgroup with concurrent HPV infections (n=73) dominated women with CIN 3 and microinvasive cancer and anal HPV 16 infections (n=53). Women with concurrent infections more frequently reported any type of sexual contact with the anus including non-penetrative anal sex (OR 2.62, p=0.008). Reporting >5 lifetime sexual partners (OR 2.43, p=0.041), smoking > 60 cigarettes per week (OR 2.33, p=0.048), and a history of penetrative anal intercourse (OR 3.87, p=0.002) were observed as the significant risk factors in women with multiple concurrent HPV infections. Our data support anal HPV testing and anal Pap smear screening in all women with severe cervical lesions caused by HPV 16 and a history of any sexual contact with the anus, heavy smoking and/or more than 5 lifetime sexual partners. Key words: anal cancer, cervical intraepithelial neoplasia, HPV, risk factorAnal cancer is an uncommon disease, but its incidence has grown during the last decades in most developed countries [1]. The population at the highest risk of developing anal cancer includes HIV-infected subjects, males who have sex with males and transplant recipients [2][3][4][5][6]. Despite this fact, a still significant proportion of anal cancers are detected in generally healthy and HIV-negative subjects. Moreover, anal cancers are more frequently detected in women than in men [7]. In the U.S., invasive anal squamous cell carcinoma rates increased among females by 1.7 % per year between 1973 and 2005 [1]. In 2012 there were an estimated 6230 new cases of anal cancer in the U.S., with 3980 (63.9 %) cases occurring in women and only 2250 (36.1 %) cases in men [8]. Similarly, in the Czech Republic the prevalence of anal cancer is constantly higher among women than in men. In 2010 there were 129 new cases of anal cancer, with 85 (65.9 %) cases in women and 44 (34.1 %) cases in men.This gender difference is not clearly explained. Since more than 90 % of anal cancers are caused by high-risk human papillomavirus (HR HPV) infection [9], possible reasons for the greater risk in women include history of cervical intraepithelial neoplasia (CIN) and cervical cancer [10][11][12]. The only two studies dealing with women with lower genital tract intraepithelial lesions or cancers which also looked at anal HPV showed 45 -51 % HPV prevalence in this group [13,14]. ...

Evaluation of anal cytology and dysplasia in women with a history of lower genital tract dysplasia and malignancy

“…Most experts recommend anal screening for HIV+ men and women as well as men who have sex with men [3], and the American Cancer Society suggests that those at increased risk of anal intraepithelial neoplasia (AIN) may benefit from screening, including women who have had cervical or vulvar cancer [4]. A recent study by Slama, et al examined 172 high-risk women with cervical intraepithelial neoplasia 2 or greater (CIN2+) compared to 100 women with non-neoplastic gynecologic disease [5]. They found that concurrent cervical and anal HPV infection was found in 42% of the high-risk women vs. 8% of controls.…”

Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine in HIV-positive Spanish men who have sex with men (MSM)

“…On analysing the combinations of viruses pertaining to the species 16 and 18, we observed that up to 50% of the study participants were infected by the viral species HPV16 and 37% by the species HPV18. HPV16 is the genotype that has been shown most frequently, in the majority of published studies, to be associated with ano-genital pathology in both genders [37, 38]. HIV infection is among the associated risk factors in MSM patients [39].…”

Involvement of TP53 and TP16 expression in human papillomavirus-associated non-small cell lung cancer

“…Recent studies suggest that HPV infection is an important cause of cervical cancer (5,6). HPVs are commonly divided into high-risk and low-risk types, with the high-risk type HPV 16 representing the predominant type associated with cervical cancer (7).…”