High prevalence of human papillomavirus infection in the anus, penis and mouth in HIV-positive men

Sirera, Guillem; Videla, Sebastià; Piñol, Marta; Cañadas, MariPaz; Llatjós, Mariona; Ballesteros, A; García-Cuyás, Francisco; Castellà, Eva; Guerola, Rosa; Tural, Cristina; Rey-Joly, Celestino; Clotet, Bonaventura

doi:10.1097/01.aids.0000226963.10342.f4

Cited by 66 publications

(56 citation statements)

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“…Nine of these 14 (64%) were found to have detectable anal HPV DNA, while seven of the 14 (50%) had an HR-HPV type detected, which probably represents persistence of infection. Larger international studies have reported a similar prevalence of HR-HPV infection, with persistence of HR-HPV infection in 50−70% of MSM and a higher persistence rate in HIV-infected subjects [21][22][23].HIV infection was positively associated with detection of HPV DNA (P = 0.04) and HR-HPV DNA (47% vs. 36% in HIV-negative individuals; P = 0.146) in our study. The high prevalence of HPV infection in HIV-infected subjects may be driven by an increased persistence of HPV infection as a consequence of compromised immunity and/or by a high incidence of new infections as a consequence of sexual behaviour.…”

supporting

confidence: 78%

Prevalence of human papillomavirus in men who have sex with men in the era of an effective vaccine; a call to act

et al. 2014

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ObjectivesThe incidence of human papillomavirus (HPV)-associated anal cancer is increasing. Men who have sex with men (MSM), particularly those coinfected with HIV, are disproportionately affected. Documenting the molecular epidemiology of HPV infection is important in guiding policy makers in formulating universal and/or targeted vaccine guidelines. MethodsA prospective cohort study was conducted. HIV-positive and HIV-negative MSM > 18 years old were invited to participate. Provider-performed anal swabs were collected and anal HPV infection was detected using consensus primer solution phase polymerase chain reaction (PCR) followed by type-specific PCR for high-risk (HR)-HPV types 16, 18 and 31. Between-group differences were analysed using χ 2 tests and Wilcoxon rank tests. ResultsOne hundred and ninety-four MSM [mean (standard deviation (SD)) age 36 (10) years; 51% HIV-positive) were recruited. The median number of sexual contacts in the preceding 12 months was 4 (interquartile range 2-10). HIV-positive subjects had a mean (SD) CD4 count of 557 (217) cells/μL, and 84% were on highly active antiretroviral therapy (HAART). Thirty-one samples were B-globin negative and thus excluded from further analysis. A total of 113 subjects (69%) had detectable HPV DNA. Sixty-eight subjects (42%) had an HR-HPV type detected. HR HPV type 16 was detected in 44 samples (27%), HR-HPV type 18 in 26 samples (16%) and HR-HPV type 31 in 14 samples (23%). Twenty-eight subjects (17%) had more than one type of HR-HPV type detected. When HPV and HR-HPV were stratified by age, those > 35 years had a higher prevalence (P = 0.001 and P = 0.028, respectively). HIV-positive subjects were more likely than HIV-negative subjects to have any detectable HPV (77% vs. 61%, respectively; P = 0.04), to have HR-HPV type 18 or 31 (P = 0.05 and P = 0.006, respectively) and to be infected with more than one HR-HPV type (31% vs. 3%, respectively; P < 0.001). Within the HIV-positive group, the prevalence of HPV was higher in those not on HAART (P = 0.041), although it did not differ when stratified by CD4 count. ConclusionsThe identified prevalence of anal HPV infection was high. Emerging patterns of HPV-related disease strengthen the call for universal vaccination of boys and girls with consideration of catch-up and targeted vaccination of high-risk groups such as MSM and those with HIV infection. Following the introduction of screening programmes in the developed world, the incidence of cervical cancer has decreased; however, the incidences of HPV-associated anal and oropharyngeal cancers have increased dramatically in the past decade [3]. Noncervical HPV-associated cancers, while individually relatively rare, now collectively parallel the burden of cervical cancers in developed countries. HR-HPV is now thought to cause over 5% of all cancers world-wide [4].Certain 'at-risk' groups such as men who have sex with men (MSM), particularly those with HIV infection, are disproportionately affected. The incidence of anal cancer is 1−2/100 000 in the general pop...

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confidence: 78%

Prevalence of human papillomavirus in men who have sex with men in the era of an effective vaccine; a call to act

et al. 2014

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“…Anal cytology exams of our group of patients evidenced abnormalities in just 47.6% of the individuals with a lesion at anuscopy, and no HSIL was observed with cytology. The prevalence of abnormal cytology in HIV-positive men varies; whereas Moscicki et al and Wilkin et al found prevalence rates of 41.2% [9] and 48% [21], similar to what we found, Sirena et al reported 75% abnormal cytologies [30].…”

Section: Discussionsupporting

confidence: 90%

“…Sexual behavior apparently contributed to the high frequency of HPVmediated anal lesions in this group. These behaviors are among the main risk factors for acquisition of co-infection, namely receptive anal intercourse and a large number of sexual partners [11,20,[24][25][26][27]; this is the main route of transmission of HPV and HIV [3,24,25] and is an important risk factor for AIN [3,4,[28][29][30]. Surprisingly, 19% of the patients with an abnormal anal examination were heterosexuals.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic methods for prevention of anal cancer and characteristics of anal lesions caused by HPV in men with HIV/AIDS

Pereira¹,

Lacerda²,

Barros³

2008

Braz J Infect Dis

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Abnormalities found with anuscopy under colposcopic vision, anal cytology and anal biopsy were evaluated in 21 men with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) at the Federal University of Pernambuco Hospital in Brazil. Mean age was 38.4 ± 6.0 years, and mean time of HIV infection was 8.3 ± 5.1 years; 95.2% of the patients had been on highly active antiretroviral therapy (HAART) for an average of 6.6 ± 4.5 years. Mean CD4+ cell count was 482.2 ± 173.75 cells/mm 3 , and 80.9% presented a HIV viral load of < 5,000 copies/mL. Reported sexual preference was 52.4% homosexuals, 28.6% bisexuals, and 19.0%heterosexuals; 81% reported having had receptive anal intercourse and 61.9% reported more than 10 sexual partners of the same sex. Results of anuscopy under colposcopic vision revealed 17 (81.0%) low-grade lesions and/or condylomata or micropapillae and four (19.0%) high-grade lesions with or without condylomata. Among the 21 anal cytology examinations, seven (33.3%) revealed low-grade squamous intraepithelial lesions (LSIL); three (14.3%) presented atypical squamous cells of undetermined significance (ASCUS) and 11 (52.4%) were normal. Seventeen patients were submitted to anal biopsy with the following findings: three patients (17.6%) with normal epithelium, one (5.9%) with infection by HPV, three (17.6%) with condylomatas, two (11.8%) with AIN 1, four (23.6%) with AIN 2, three (17.6%) with AIN 3, and one (5.9%) with PAIN 2. Anuscopy under colposcopic vision was found to be useful for detecting anal lesions and for guiding anal biopsies. Anal cytology was less useful, as it underestimated the frequency of lesions.

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“…In a study of HIVinfected men, a high prevalence of high-risk HPV types (16 and 18) was found in the anus, penis and mouth (78%, 36% and 30%, respectively), without evidence of pathology in these areas. 82 The relative risk of penile cancer in HIV-positive patients is four times higher than that in HIV-negative men. 75 HIV-infected homosexual men have a substantially increased risk of HPV-induced anal cancer and anal intraepithelial neoplasia, and a moderately increased risk of penile cancer.…”

Section: Testicular Tumorsmentioning

confidence: 99%

Urologic complications of HIV and AIDS

2009

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High prevalence of human papillomavirus infection in the anus, penis and mouth in HIV-positive men

Cited by 66 publications

References 14 publications

Prevalence of human papillomavirus in men who have sex with men in the era of an effective vaccine; a call to act

Prevalence of human papillomavirus in men who have sex with men in the era of an effective vaccine; a call to act

Diagnostic methods for prevention of anal cancer and characteristics of anal lesions caused by HPV in men with HIV/AIDS

Urologic complications of HIV and AIDS

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