HPV-Genotype Distribution and Oncogene Expression in HIV-Positive Adults and the Underlying Risk Factors for Anal, Oral and Genital Malignancy: An Atlantic Canada Prospective Cohort Study

Abstract

BACKGROUND:Human Papillomavirus (HPV) is the most common sexually transmitted agent. These small DNA viruses target the basal cells of the epithelium. While the HPV family is comprised of more than 100 genotypes, only about 40 or so types are associated with human anogenital infections. Infection s with oncogenic HPV 53,66,6 8,73,18,31,33,35,39,45 ,51,52,56,58,59) OBJECTIVES:Primary: To determine the prevalence and distribution of high risk (HR) oncogenic HPV-types in HIV-positive adult s in Atlantic Canada.Secondary: To correlate the prevalence of HR HPV genotyp es with underl ying pre-malign ant lesions and maligna ncy through a cross-sectiona l study.To corre late pre-ma lignant lesions and malignancy with patient s' demographics and underlying risk factor s.This thesis is part of a larger prospective cohort study designed to follow consenting persons with Hl'V infection in Atlantic Canada over a 3-year period subsequent to baseline screening in year one. The data in this thesis are limited to that obtained at baseline in all four Atlantic Provinces during the first year of the study. All Hlv-positive adults treated through the participating infectious disease clinics were approached by the clinic physicians or nurses to request participation in the study. Atlantic Canada has approximately 800 routinely followed HlV-positive adults and we expected to enroll approximately 400 of them. This study was approved by ethic committees of all participating institutions as well as the Public Health Agency of Canada, the funding agency for the study.Recruitment commenced in June, 2009. All procedures were performed after obtaining informed consent. Consenting participants were required to comp lete a confidential questionnaire to obtain demographic and risk factor data. Participants' identifiers were retained to permit questionnaire data to be correlated with HPV related disease outcomes. SurePath (Becton Dickinson) liquid cytology medium was used in the collection of oropharyngeal and anal swab specimens from all males and females, and an additional cervical specimen was obtained from females. All specimens were tested for cytologic abnormalities , HPV DNA and genotyping . The study cohort will be followed up with the above protocol for a period of 3 years. These results will be subsequently used to assess any HPV related disease outcome and genotypic specific information. Consent also gives access to patients' medical files for information on viral load, CD4+T cell count and treatment regimens in order to correlate these factors with disease outcome.The study analysis is based on a total of 300 patients; of these 91.7% were males. The population and gender distribution among the provinces were: Nova Scotia, Halifax (NSH) -total 150 patients, of these 142 (94.7%) were males; New Brunswick, Moncton (NBM) -total 90 patients, of these 85 (94.4%) were males; Newfoundland and Labrador, St. John's (NLSJ) -total 44 patients, of these 34 (77.3%) were males; and New Brunswick, Saint John (NBSJ) -total 16 patients, of ...