Human papillomavirus infection and anal dysplasia in renal transplant recipients

Patel, Heena; Silver, Andrew; Levine, Tanya; Gr, Williams; Northover, John

doi:10.1002/bjs.7218

Cited by 46 publications

(25 citation statements)

References 17 publications

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“…9 ients. 18 The prevalence of anal cytologic atypia is very high compared with those observed in immunocompetent women using conventional cytology. 16,17 In the anus, cellular atypia was detected in eight cases (24.9%).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of high‐risk HPV and atypia in liquid‐based cytology of cervical and intra‐anal specimens from kidney‐transplanted women

Eleutério

Cavalcante

Gonçalves

et al. 2019

Diagnostic Cytopathology

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Background: There is a high frequency of human papillomavirus (HPV)-induced lesions in cervix and anus of immunosuppressed patients. However, few studies have evaluated these lesions in kidney-transplanted women.Methods: This cross-sectional study examined 31 kidney-transplanted women receiving immunosuppressive therapy at the General Hospital of Fortaleza in Brazil. Cervical and anal samples were collected and preserved in order to perform liquid-based cytology and a real-time polymerase chain reaction assay detecting high-risk HPV. Results: The patients' ages ranged from 31 to 70 years (mean: 42.6 ± 10.4). The age of sexual debut varied from 14 to 30 years (mean: 19.7 ± 3.8). Cervical cytology was diagnosed as atypical in 25.8% of cases (atypical squamous cells of undetermined significance [ASC-US] in 2 [6.2%], atypical squamous cells, but unable to exclude a high-grade squamous intraepithelial lesion in 1 [3.1%], low-grade squamous intraepithelial lesion [LSIL] in 4 [12.4%], and squamous cell carcinoma in 1 [3.1%]). Anal cytology was atypical in 35.4% of cases (ASC-US in 1 [3.2%]and LSIL in 7 [21.7%]). The presence of cervical HPV was confirmed in 22.5% of patients, and anal HPV was found in 48.8% of the cases. The relative risk of atypical anal cytology in cases of atypical cervical cytology was 4.37 (1. 35-14.20). High-risk cervical HPV did not significantly increase the risk of having atypical anal cytology. However, for HPV in the anus, this was associated with a relative risk of 10.18 (1.45-71.54).Conclusion: High-risk HPV and atypical cytology are very common in the cervix and anus of kidney-transplanted women. Furthermore, the presence of HPV in an anal sample correlates with an increased risk of atypical anal cytology. HPV tests could be useful tools for identifying patients who require anal cytology.

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Section: Discussionmentioning

confidence: 99%

Prevalence of high‐risk HPV and atypia in liquid‐based cytology of cervical and intra‐anal specimens from kidney‐transplanted women

Eleutério

Cavalcante

Gonçalves

et al. 2019

Diagnostic Cytopathology

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“…Data are also limited in the transplant population. Among renal transplant recipients, using anal cytology to assess disease, AIN was found in only 6% of patients [79], but this may represent an underestimate of the true prevalence of disease given the limited sensitivity of cytology for detection of AIN.…”

Section: Natural History Of Hpv Infections In the Anus In Men And mentioning

confidence: 99%

Updating the Natural History of Human Papillomavirus and Anogenital Cancers

Moscicki

Schiffman

Burchell

et al. 2012

Vaccine

325

282

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This chapter addresses the natural history of anogenital human papillomavirus (HPV) infection. Cervical infections are the best understood HPV infection. Cervical HPV persistence is the known necessary event for the development of cervical cancer. New infections appearing at any age are benign unless they persist. Several long-term natural history studies have now shed light on the very low risk of cervical intraepithelial neoplasia (CIN) 3+ in women past the peak of HPV acquisition (e.g., 30 or older) who are HPV-negative or clear their HPV. Although data on transmission of HPV are finally emerging, rates of transmission between heterosexual couples vary widely among studies. Factors that affect the calculations of these rates include a) intervals between testing points, b) rates of concordance or discordance at baseline, and c) difficulty in defining established infections versus contamination. Both cervix to anus and anus to cervix autoinoculation in the same woman appears to be quite common. Whether either site serves as a long-term reservoir is unknown. Studies show that anal infections in women and in men who have sex with men are quite common with cumulative rates up to 70–90%. Similarly, clearance of anal HPV is also common, with few individuals showing persistence unless they are human immunodeficiency virus (HIV)-infected. HIV strongly influences the development of anal intraepithelial neoplasia (AIN). The few studies on the natural history of AIN in HIV-infected men suggest that high-grade AIN is a precursor to invasive anal cancer. Although no natural history studies of AIN are available in women, women with other HPV-associated lesions, including CIN3+ and vulvar cancer, have higher rates of anal cancer. Data on the natural history of HPV of the male genitalia are also emerging, although penile intraepithelial neoplasia is poorly understood. Cumulative rates of HPV are extremely high in men and risks are associated with sexual behavior. Unlike women, prevalence rates are steady across all ages, suggesting that men do not develop protection against reinfection.

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“…No gender distribution was reported. Another study reported anal cytology in 108 patients (40 women and 68 men) with a mean age of 52 at time of transplant 59 . On cytology, 4 had ASC, 2 had LSIL, 4 (3.7%) had HSIL.…”

Section: Anal Hpv Infection and Disease In Womenmentioning

confidence: 99%

Screening for Anal Cancer in Women

Moscicki

Darragh

Berry-Lawhorn

et al. 2015

Journal of Lower Genital Tract Disease

128

122

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Objective The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV) and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goal was to summarize the literature on anal cancer, HSIL and HPV infection in women, and provide screening recommendations in women. Methods A group of experts convened by the ASCCP and the International Anal Neoplasia Society reviewed the literature on anal HPV infection, anal SIL and anal cancer in women. Results Anal HPV infection is common in women but is relatively transient in most. The risk of anal HSIL and cancer varies considerably by risk group, with HIV-infected women and those with a history of lower genital tract neoplasia (LGTN) at highest risk compared with the general population. Conclusions While there are no data yet to demonstrate that identification and treatment of anal HSIL leads to reduced risk of anal cancer, women in groups at the highest risk should be queried for anal cancer symptoms and have digital anorectal examinations to detect anal cancers. HIV-infected women and women with LGTN, may be considered for screening with anal cytology with triage to treatment if HSIL is diagnosed. Healthy women with no known risk factors or anal cancer symptoms do not need to be routinely screened for anal cancer or anal HSIL.

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Human papillomavirus infection and anal dysplasia in renal transplant recipients

Abstract: Anal dysplasia was related to immunosuppression and patient factors in this cohort.

Cited by 46 publications

References 17 publications

Prevalence of high‐risk HPV and atypia in liquid‐based cytology of cervical and intra‐anal specimens from kidney‐transplanted women

Prevalence of high‐risk HPV and atypia in liquid‐based cytology of cervical and intra‐anal specimens from kidney‐transplanted women

Updating the Natural History of Human Papillomavirus and Anogenital Cancers

Screening for Anal Cancer in Women

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