BACKGROUND: The effect of antiretroviral therapy (ART) on the natural history of anal HR-HPV and anal lesion progression is not well established. We reviewed the association of ART and other HIV-related factors on anal HPV infection, anal intraepithelial neoplasia (AIN), and anal cancer among people living with HIV (PLHIV). METHODS: We searched Medline and Embase for studies from 1 January 1996 to 30 October 2019 that reported the association of HIV-related exposures (ART, HIV-RNA plasma viral load [PVL] and nadir or current CD4+ cell count) with outcomes of anal HR-HPV prevalence, incidence or persistence or prevalence, incidence, progression or regression of anal histological/cytological abnormalities, or anal cancer incidence. We assessed the risk of bias of included studies using the Newcastle-Ottawa scale. We performed random-effects meta-analyses; heterogeneity was examined using I 2 statistic. FINDINGS: 122 studies were included comprising 417,006 PLHIV (19%, 44% and 5% women, men-whohave-sex-with-men; men-who-have-sex-with-women, respectively; 32% of studies did not stratify findings by gender and/or sexual orientation). PLHIV taking ART had 35% lower HR-HPV prevalence compared to ART-naïve (crude Odds Ratio[cOR]=0.65, 95%CI:0.54-0.79; I 2 =12.1%) in 18 studies and prolonged ART use was associated with a 10% reduction in HR-HPV prevalence in two studies (per year: aOR=0.90, 95%CI:0.85-0.95, I 2 =0.0%). PLHIV with undetectable PVL had lower HSIL/AIN2+ prevalence compared to those without (cOR=0.84, 95%CI:0.72-0.98, I 2 =0.0%) in 16 studies, particularly if sustained for >1 year (cOR=0.62, 95%CI:0.47-0.81, I 2 =0.0%). ART was not associated with anal cancer incidence when adjusted for years living with HIV in 3 studies (aHR=1.11, 95%CI: 0.68-1.80, I 2 =0.0%), but ART users with sustained undetectable HIV PVL had 44% lower risk of anal cancer compared to those without (aHR=0.56, 95%CI:0.44-0.70, I 2 =0%) and for each 100 cells/µl increase in nadir CD4+ count, there was a 40% decrease in anal cancer incidence (cHR=0.60, 95%CI:0.46-0.78, I 2 =21.7%). INTERPRETATION: Effective ART use and early initiation at higher nadir CD4+ may reduce anal HR-HPV and anal cancer risk.
Twelve high-risk alpha human papillomavirus (HPV) genotypes cause approximately 690,000 cancer cases annually, with cervical and oropharyngeal cancer being the two most prominent types. HPV testing is performed in laboratory settings for various applications of a clinical, epidemiological, and research nature using a range of clinical specimens collected by clinicians or by individuals (self-collected specimens).
ObjectivesPatients with cancer are at higher risk for severe COVID-19 infection. COVID-19 surveillance of workers in oncological centres is crucial to assess infection burden and prevent transmission. We estimate the SARS-CoV-2 seroprevalence among healthcare workers (HCWs) of a comprehensive cancer centre in Catalonia, Spain, and analyse its association with sociodemographic characteristics, exposure factors and behaviours.DesignCross-sectional study (21 May 2020–26 June 2020).SettingA comprehensive cancer centre (Institut Català d’Oncologia) in Catalonia, Spain.ParticipantsAll HCWs (N=1969) were invited to complete an online self-administered epidemiological survey and provide a blood sample for SARS-CoV-2 antibodies detection.Primary outcome measurePrevalence (%) and 95% CIs of seropositivity together with adjusted prevalence ratios (aPR) and 95% CI were estimated.ResultsA total of 1266 HCWs filled the survey (participation rate: 64.0%) and 1238 underwent serological testing (97.8%). The median age was 43.7 years (p25–p75: 34.8–51.0 years), 76.0% were female, 52.0% were nursing or medical staff and 79.0% worked on-site during the pandemic period. SARS-CoV-2 seroprevalence was 8.9% (95% CI 7.44% to 10.63%), with no differences by age and sex. No significant differences in terms of seroprevalence were observed between onsite workers and teleworkers. Seropositivity was associated with living with a person with COVID-19 (aPR 3.86, 95% CI 2.49 to 5.98). Among on-site workers, seropositive participants were twofold more likely to be nursing or medical staff. Nursing and medical staff working in a COVID-19 area showed a higher seroprevalence than other staff (aPR 2.45, 95% CI 1.08 to 5.52).ConclusionsAt the end of the first wave of the pandemic in Spain, SARS-CoV-2 seroprevalence among Institut Català d’Oncologia HCW was lower than the reported in other Spanish hospitals. The main risk factors were sharing household with infected people and contact with COVID-19 patients and colleagues. Strengthening preventive measures and health education among HCW is fundamental.
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