Coinfection of Epstein-Barr virus, cytomegalovirus, herpes simplex virus, human papillomavirus and anal intraepithelial neoplasia in HIV patients in Amazon, Brazil

Abstract

OBJECTIVE: The prevention of anal cancer is a goal of worldwide Aids support centers. Despite the efforts that have been made and progress in the antiretroviral therapy, effective disease control remains elusive. Difficulty in preventing anal cancer may result from the ineffectiveness of highly active antiretroviral therapy on the human papillomavirus (HPV) since the coinfection with HIV and HPV appears to increase the risk of HPV-infected cells, becoming cancerous. METHODS: We evaluated 69 HIV-positive and 30 HIV-negative male patients who underwent cytological evaluation by RT-PCR for the presence of HPV, Epstein-Barr virus, cytomegalovirus and herpes virus types (HSV) 1 and 2, and histopathology analysis of the anal canal. RESULTS: The prevalence of anal intraepithelial neoplasia was 35% and it was restricted to HIV-positive patients. Patients infected with high-risk HPV and with fewer than 50 TCD4 cells/µL showed an anal intraepithelial neoplasia rate of 85.7% compared to those with TCD4 cells >200 cells/µL (p<0.01). The rate of viral coinfection was 16.9% of the sexual transmitted diseases cases and it was correlated with HIV-1 viral load of more than 10.001 copies/mL (p=0.017). The rate of AIN in coinfected patients was 36.4% (p=0.047). CONCLUSIONS: In this study, at the main institution for the treatment of HIV/AIDS in the Amazon region of Brazil, anal coinfection with HPV, cytomegalovirus, HSV-1, HSV-2 and Epstein-Barr virus occurred only in HIV-positive patients and it was directly influenced by the viral load of HIV-1. In this study, anal viral coinfection showed no additional risk for the development of anal intraepithelial neoplasia.<br>OBJETIVO: A prevenção do câncer anal tem sido aplicada pelos centros de apoio a pacientes com Aids em todo o mundo. Apesar dos esforços empregados, o eficaz controle da doença permanece distante. A dificuldade na prevenção do câncer anal pode resultar, em parte, da ineficácia da ação da terapia antirretroviral sobre o papilomavírus humano (HPV), pois a coinfecção com HIV e HPV parece aumentar o risco das células infectadas pelo HPV em tornarem-se cancerosas. MÉTODOS: Foram avaliados 69 HIV-positivos e 30 pacientes HIV-negativos do sexo masculino, que foram submetidos à avaliação citológica anal por real time-PCR para a presença de HPV, vírus Epstein-Barr, citomegalovírus e herpes vírus tipos (HSV) 1 e 2 além da análise histopatológica de fragmento de mucosa do canal anal. RESULTADOS: A prevalência de neoplasia intraepitelial anal foi de 35% e foi restrita a pacientes HIV-positivos. Os pacientes infectados com o HPV de alto risco e com contagem inferior a 50 células TCD4/µL mostraram taxa de neoplasia intraepitelial anal de 85,7%. A diferença foi significativa quando comparado a pacientes com células TCD4 >200 células/µL (p<0,01). A taxa de coinfecção viral foi de 16,9% dos casos de doenças sexualmente transmissíveis e diretamente correlacionada à carga viral HIV-1 superior a 10,001 cópias/mL (p=0,017). A taxa de neoplasia intraepitelial anal em pacientes coinfectados f...

Prevalence and anatomical sites of human papillomavirus, Epstein-Barr virus and herpes simplex virus infections in men who have sex with men, Khon Kaen, Thailand

“…For example, high-risk HPV/HSV-2 co-infections were present in the anorectum of 55% of Brazilian MSM. Corresponding values for other combinations in that study were 27% (high-risk HPV/low-risk HPV/EBV), 9% (high-risk HPV/low-risk HPV/HSV2/EBV) and 9% (high-risk HPV/low-risk HPV/HSV-1/HSV-2/EBV) [ 11 ]. HPV and HSV co-infections were found in 4.3% of oral samples from Finnish males [ 50 ].…”

“…Most studies of HSV infection in MSM have reported only seroprevalence (82.5–90%) [ 47 , 48 ]. However, a few studies have reported prevalence of HSV DNA in the anorectum (ranging from 7.0 to 16.9%), oropharynx (0–7.2%) and urethra (2.3–49.5%) among MSM [ 11 , 34 , 49 – 51 ]. Consistent with previous studies, we found very low prevalence of HSV in all three sites (Fig.…”

“…Our report is the first to find that EBV infection is present in anorectal, oropharyngeal and urethral sites of northeast Thai MSM at higher prevalence than are HPV and HSV. A previous study found high-risk HPV at higher prevalence (90.8%) in the anorectal canal than low-risk-HPV (73.8%), HSV-1 (7.7%), HSV-2 (16.9%) and EBV (7.7%) among HIV-positive Brazilian men [ 11 ]. This agreed with a Swedish study of anal cell samples, which found higher HPV infection (76%) among HIV-infected and uninfected MSM than EBV (18.7%) and HSV (9.4%) [ 30 ].…”

“…[ 9 ]. It seems likely to be a co-factor in HPV-associated cancers such as anal and penile cancers [ 10 , 11 ]. Moreover, EBV infection is associated with HPV integration into the host genome, which is a relevant process in cervical cancer progression [ 12 ].…”

Doenças sexualmente transmissíveis atendidas em unidade primária de saúde no Nordeste do Brasil

“…As DST podem causar infertilidade 5 , câncer cervical 6 , anal 7 e de pênis 8 . Ademais, podem aumentar o risco de infecção pelo HIV 9 .…”