Viral CO‐infections in human papillomavirus‐associated anogenital lesions according to the serostatus for the human immunodeficiency virus

Abstract

In HIV-infected men, human papillomavirus (HPV) infection is strongly linked with the development of anogenital lesions but is not a sufficient factor to explain the neoplastic transformation of such lesions. We investigated the association between HPV and herpesvirus infections in penile and anal lesions from 54 HIV-seronegative and 54 HIV-seropositive men by means of colposcopy, histopathology and in situ hybridization. Our patients showed condyloma acuminata (39%), papular warts (35%) and macular warts (26%). High-grade lesions were predominant in the HIV+ men, whereas low-grade lesions were more frequent in the HIV- men. In the HIV+ group, potential oncogenic HPV were the most frequently detected (83.4%) whereas the "low-risk" HPV were found chiefly in HIV- men (62.1%). The CD4 number was lower in patients showing "high-risk" HPV than in men showing lesions without HPV or with non-oncogenic HPV. HPV types 6/11 were found mainly associated with koilocytosis or with AIN(PIN)I. Oncogenic HPV were more often detected in AIN(PIN)II-III. The herpesviruses DNA detection revealed a higher prevalence of HSVI and -2 than CMV and EBV in the studied biopsies. The frequency of HSV and CMV detection was higher in the HIV+ than in the HIV- men. A link was found between the "high-risk" HPV and the CMV detection whatever the population considered. The detection in HPV lesions of other sexually transmitted viral agents could therefore represent an important means of preventing progression of the anogenital disease, especially in immunosuppressed patients.

Genital Human Papillomavirus Infection and Associated Penile Intraepithelial Neoplasia in Males Infected with the Human Immunode.ciency Virus

“…1,28 This finding is not in agreement with reports demonstrating that the potentially oncogenic HPV types were no more common in men with antibodies to HIV than in those who were HIV seronegative. 26 High-risk HPV types were detected in both groups, mainly in smears with high grade lesions (PIN 2-3), and low-risk types (6/11) were associated essentially with HPV-PIN 1, as found by previous studies.…”

“…26 High-risk HPV types were detected in both groups, mainly in smears with high grade lesions (PIN 2-3), and low-risk types (6/11) were associated essentially with HPV-PIN 1, as found by previous studies. HIV infection might promote the persistence or reactivation of HPV in the genital tract and the progression of neoplasia, 1,28,31 as previously reported by dot-blot and polymerase chain reaction in anal swabs from HIV-seropositive homosexual men, 3 and it might facilitate the primary HPV infection. 24 Iatrogenic immunosuppression in renal transplant recipients, 9 in patients with chemotherapy for malignancy and in pregnant women 2 has been associated with more-severe dysplasia due to HPV infection.…”

“…Disruption of cellular and/or humoral immunity, however, could be a causative factor in infection with highrisk HPV. 1 As seen in women, HIV disease may affect local epithelial immunity by decreasing the quantity or function of Langerhans' cells. 5 Some reports also noted the presence of natural killer cells in cervical warts, showing the major role of cell-mediated immunity in such lesions.…”

“…5 Some reports also noted the presence of natural killer cells in cervical warts, showing the major role of cell-mediated immunity in such lesions. 1 The strong association between HIV and HPV without measurable immunosuppression may be explained by direct interactions between the two viruses. 27,30 Such interactions may also contribute to the pathogenesis of neoplasia.…”

Human Immunodeficiency Virus Type 1 <i>tat</i> Gene Enhances Human Papillomavirus Early Gene Expression

“…The relevance of studies on the HIV and HPV interaction is due to the increase of HPV infection in HIV-positive subjects and the likely resulting increment of HPV-reiated ano genital neoplasia [3,46,47], HPV activation in HIV-seropositive patients could be due to the immunodeficiency. However, both viruses are sexually transmitted, and HIV or its gene prod ucts, such as the Tat protein, could superinfect/ interact with HPV-infected epithelial cells by several mechanisms: HIV can infect epithelial 6I cells in contact with HIV-infected Tcells/macrophages via the basolateral membrane [26], or as a result of the expression of Fc receptors on the cell surface that can be induced by human cytomegalovirus; Fc receptors may facilitate the entry of HIV immunocomplexes into fibro blasts, which are not otherwise permissive to HIV infection [48].…”