Incidence and Clearance of Anal Human Papillomavirus (HPV)-16 and HPV-18 Infection, and Their Determinants, Among Human Immunodeficiency Virus-Infected Men Who Have Sex With Men in France

Alberts, Catharina J.; Heard, Isabelle; Canestri, Ana; Marchand, Lucie; Fléjou, Jean‐François; Piroth, Lionel; Ferry, Tristan; Didelot, Jean-Michel; Siproudhis, L.; Henno, Sébastien; Poizot‐Martin, Isabelle; Darragh, Teresa M.; Clifford, Gary M.; Combes, Jean‐Damien; Etienney, Isabelle; Arvieux, Cédric; Costes-Martineau, Valérie; Grande, Jean Del; Falguières, Michaël; Fischer, Hugues; Flejou, JF; Hoyau, N; Landon, M; Laude, Hélène; Breton, F. Le; Lesage, Anne; Lion, A; Maincent, G; Njatonirina, H; Patey, O.; Sanchez, V Petrov; Pialoux, Vincent; Zaegel-Faucher, Olivia; Ressiot, E.; Radenne, Sylvie; Reynes, Jacques; Tamalet, Catherine; Tattevin, Pierre

doi:10.1093/infdis/jiz623

Cited by 16 publications

(15 citation statements)

References 14 publications

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“…More specifically, 8/10 (80%) patients with previously documented “other” HR‐HPV were negative on follow‐up; only two such patients with HR‐HPV 16/18 were identified. This correlates with previously published literature that describes HR‐HPV 16/18 is either slow to clear or does not clear 12‐14 . Further, a recent study prospectively examined the natural history of anal HPV infections and noted that HPV 16 was frequently associated with high‐grade lesions and was slow to clear 12 .…”

Section: Discussionsupporting

confidence: 87%

“…This correlates with previously published literature that describes HR-HPV 16/18 is either slow to clear or does not clear. [12][13][14] Further, a recent study prospectively examined the natural history of anal HPV infections and noted that HPV 16 was frequently associated with high-grade lesions and was slow to clear. 12 Such data, as well as those in our study, may further identify patients at greater risk and improve triage.…”

Section: T a B L E 1 Correlation Between Asc-h And Asc-us And Hr-hpv Test Results In Comparison To Nilmmentioning

confidence: 99%

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Anal cytology and high‐risk human papilloma virus testing in atypical squamous categories: Value of concurrent testing in management of high‐risk population

Cimic

Saqi

2021

Diagnostic Cytopathology

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Anal squamous cell carcinoma is relatively rare, but its incidence and mortality have been increasing worldwide. While anal cytology is a sensitive cancer screening modality, its specificity is low, and data for concurrent high‐risk human papilloma virus (HR‐HPV) testing are limited. At our institution, anal cancer screening consists of combined anal cytology and high‐risk human papilloma virus (HR‐HPV) testing on all specimens. The aims of the study were to correlate results of atypical cytological diagnoses [atypical squamous cells of undetermined significance (ASCUS) and atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC‐H)] with HR‐HPV testing and determine if co‐testing may potentially influence management. A retrospective search over 24‐months was performed for anal cytology specimens with diagnoses of ASCUS and ASC‐H. Corresponding HR‐HPV (HPV 16/18 and Other‐31/33/35/39/45/51/52/56/58/59/66/68) results were retrieved, and concordance/discordance was recorded. Cytology results were correlated with anal biopsy diagnoses, when available. A total of 139 patients, including 127 with ASCUS and 12 with ASC‐H, were identified. Of the ASCUS cases, 90/127 (70.9%) had HR‐HPV, and a squamous intraepithelial lesion (SIL) was evident in 20/39 (51.2%) of biopsies. All 12/12 (100%) ASC‐H were associated with HR‐HPV and 3/6 (50%) biopsies had a SIL. Our study supports use of concurrent cytology and HR‐HPV for anal cancer screening cytology. Co‐testing improves specificity of atypical cytology diagnoses and can identify patients requiring further intervention.

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Section: Discussionsupporting

confidence: 87%

Section: T a B L E 1 Correlation Between Asc-h And Asc-us And Hr-hpv Test Results In Comparison To Nilmmentioning

confidence: 99%

Anal cytology and high‐risk human papilloma virus testing in atypical squamous categories: Value of concurrent testing in management of high‐risk population

Cimic

Saqi

2021

Diagnostic Cytopathology

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“…This finding of a relationship between HSIL-positivity and poor immunological status is consistent with previous observations that prolonged antiretroviral treatment [ 21 – 23 ] and a high CD4 count, regardless of CD4 nadir [ 24 ], are protective factors against HSIL. A recent prospective study observed a similar incidence of HPV-16 and -18 genotypes in the anal mucosa of French HIV+MSM, but HPV-16 was more persistent and therefore more closely correlated with the presence of HSIL [ 25 ]. In a retrospective study of “alpha-human papillomavirus” in the anal mucosa of German HIV+ patients, the presence of HSIL and simultaneous infection was associated with high- and low-risk genotypes [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments

et al. 2021

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Background The objective of this study in MSM living with HIV was to determine the incidence of HSIL and ASCC, related factors, and the response to treatment. Patients and methods Data were gathered in 405 consecutive HIV-infected MSM (May 2010-December 2018) at baseline and annually on: sexual behavior, anal cytology, and HPV PCR and/or high-resolution anoscopy results. They could choose mucosectomy with electric scalpel (from May 2010) or self-administration of 5% imiquimod 3 times weekly for 16 weeks (from November 2013). A multivariate logistic regression model was developed for ≥HSIL-related factors using a step-wise approach to select variables, with a significance level of 0.05 for entry and 0.10 for exit, applying the Hosmer-Lemeshow test to assess the goodness of fit. Results The study included 405 patients with a mean age of 36.2 years; 56.7% had bachelor´s degree, and 52.8% were smokers. They had a mean of 1 (IQR 1–7) sexual partner in the previous 12 months, median time since HIV diagnosis of 2 years, and mean CD4 nadir of 367.9 cells/uL; 86.7% were receiving ART, the mean CD4 level was 689.6 cells/uL, mean CD4/CD8 ratio was 0.77, and 85.9% of patients were undetectable. Incidence rates were 30.86/1,000 patient-years for ≥high squamous intraepithelial lesion (HSIL) and 81.22/100,000 for anal squamous cell carcinoma (ASCC). The ≥HSIL incidence significantly decreased from 42.9% (9/21) in 2010 to 4.1% (10/254) in 2018 (p = 0.034). ≥HSIL risk factors were infection with HPV 11 (OR 3.81; 95%CI 1.76–8.24), HPV 16 (OR 2.69, 95%CI 1.22–5.99), HPV 18 (OR 2.73, 95%CI 1.01–7.36), HPV 53 (OR 2.97, 95%CI 1.002–8.79); HPV 61 (OR 11.88, 95%CI 3.67–38.53); HPV 68 (OR 2.44, CI 95% 1.03–5.8); low CD4 nadir (OR1.002; 95%CI 1–1.004) and history of AIDS (OR 2.373, CI 95% 1.009–5.577). Among HSIL-positive patients, the response rate was higher after imiquimod than after surgical excision (96.7% vs 73.3%, p = 0.009) and there were fewer re-treatments (2.7% vs 23.4%, p = 0.02) and adverse events (2.7% vs 100%, p = 0.046); none developed ASCC. Conclusions HSIL screening and treatment programs reduce the incidence of HSIL, which is related to chronic HPV infection and poor immunological status. Self-administration of 5% imiquimod as first-line treatment of HSIL is more effective than surgery in HIV+ MSM.

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“…An evaluation of dosage efficacy is not possible, as we do not collect information on the exact amount of gel used. While biannual4 46–48 and annual49–53 anal HPV sampling in longitudinal studies is common, that length of follow-up will not give sufficient detail to evaluate the study’s objectives. In an ideal research setting, HPV status would be ascertained daily to have a more precise measurement of the time of HPV acquisition; however, to minimise burden on the patient, the current schedule was deemed optimal.…”

Section: Discussionmentioning

confidence: 99%

Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV): design and methods for a randomised controlled trial

et al. 2020

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IntroductionGay, bisexual and other men who have sex with men (gbMSM) have an increased risk of human papillomavirus (HPV) infection and HPV-associated diseases, such as anal cancer and anogenital warts. A carrageenan-based lubricant could prevent HPV infection, thereby reducing the disease burden in this population. This paper describes the protocol for the Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV) study, an ongoing randomised controlled trial (RCT), evaluating efficacy of a carrageenan-based personal lubricant in reducing type-specific anal HPV incidence and prevalence among sexually active gbMSM, efficacy by HIV status, safety and tolerability of the gel and participant adherence to the intervention.Methods and analysisThe study is a double-blinded, placebo-controlled RCT. Volunteer gbMSM 18 years and older are randomly assigned 1:1 to receive the treatment (a self-applied anal microbicide gel with carrageenan) or placebo (a self-applied placebo gel). At each visit, computerised questionnaires are used to collect data on sociodemographic and clinical variables, lifestyle, sexual behaviour and the gels’ safety and tolerability. At baseline and each follow-up visit (months 1, 2, 3, 6, 9 and 12), nurses collect anal specimens tested for 36 HPV types (linear array assay). HIV status is determined at baseline and 12 months. The primary outcome is incidence of type-specific anal HPV infection(s) undetected at baseline. Secondary outcomes are prevalence of type-specific anal HPV infection, safety, tolerability and adherence. We aim to recruit 380 participants to attain the study’s objectives. Data will be analysed using intention-to-treat and per-protocol approaches with subgroup analyses by HIV status.Ethics and disseminationEthics approval was obtained by the Research Ethics Boards of McGill University, the McGill University Health Centre, Concordia University and Centre Hospitalier de l’Université de Montréal. Trial results will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberNCT02354144.

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Incidence and Clearance of Anal Human Papillomavirus (HPV)-16 and HPV-18 Infection, and Their Determinants, Among Human Immunodeficiency Virus-Infected Men Who Have Sex With Men in France

Cited by 16 publications

References 14 publications

Anal cytology and high‐risk human papilloma virus testing in atypical squamous categories: Value of concurrent testing in management of high‐risk population

Anal cytology and high‐risk human papilloma virus testing in atypical squamous categories: Value of concurrent testing in management of high‐risk population

Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments

Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV): design and methods for a randomised controlled trial

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