Multiple types of human papillomavirus infection and anal precancerous lesions in HIV-infected men in Taiwan: a cross-sectional study

Abstract

ObjectivesThis study aimed to assess the relationship between infection with multiple human papillomavirus (HPV) types and abnormal anal cytology in HIV-infected men.DesignAn observational, cross-sectional study.SettingA regional referral hospital in Taiwan.ParticipantsIn total, 714 HIV-infected men were enrolled between March 2011 and June 2016. Thin preparation anal Pap smears were interpreted according to the 2001 Bethesda System. Thirty-seven types of HPV were detected by reverse line blotting, including 13 oncogenic types and 24 non-oncogenic types.Outcome measuresThe relationship between anal HPV infection and abnormal anal cytology in people of Asian ethnicity and the coverage efficacy in HPV-vaccinated HIV-infected men.ResultsOn anal cytology, 175 (24.5%) subjects had atypical squamous cells of undetermined significance (ASCUS) or higher grades of dysplasia, including 87 (49.7%) with ASCUS, 73 (41.7%) with low-grade squamous intraepithelial lesions (LSILs) and 15 (8.6%) with high-grade squamous intraepithelial lesions (HSILs). A higher proportion of subjects with those without LSIL/HSIL (93.1% vs 67.3%, P<0.0001) had multiple HPV types. The odds of having LSIL/HSIL increased with an increasing number of HPV types: the ORs ranged from 1 for no HPV types to 6.96 (95% CI 2.38 to 20.37) for more than five types (Ptrend <0.0001). Multivariate logistic regression analysis showed a significant association between LSIL/HSIL and the number of HPV genotypes present (OR 1.20; 95% CI 1.02 to 1.42, P<0.05). HPV types covered by the nonavalent HPV vaccine (types 6/11/16/18/31/33/45/52/58) were detected in 70.1% of the patients in this study.ConclusionsThe odds of having anal LSIL/HSIL are approximately seventimes greater in HIV-infected men with than withoutsix or more types of HPV. Multiple HPV types in HIV-infected patients deserves aggressive follow-up, and HPV vaccination programme require scaling up.

Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer

“…All individuals with an HSIL harbored an HR HPV infection with the exception of 1 HIV‐infected patient who was positive for possibly carcinogenic HPV‐53. These results are consistent with those reported in a recent French multicenter study of HIV‐infected MSM and in a cross‐sectional study of HIV‐infected men recruited in Taiwan …”

“…The odds of having an ASCUS 1 report increased by 41% in HIV-infected MSM and by 16% in the HIV-uninfected counterparts with a unit increase in the number of genotypes in the anal sample. Although these findings are consistent with those reported by others, 24,25,36,42 it is still unclear whether multiple infections have a role in the development of anal cancer and its precursors. Interestingly, a recent study 43 showed that multiple infections by HR types may increase the risk of HGAIN recurrence.…”

“…These results are consistent with those reported in a recent French multicenter study of HIV-infected MSM 35 and in a cross-sectional study of HIV-infected men recruited in Taiwan. 36 We also found that the detection of HPV-16/18, the most prevalent genotypes in anal cancer, 37 increased with the severity of the cytological lesions in both study groups, and there was a peak in HSILs, which were HPV-16/18positive in 50% to 67% of the cases. Interestingly, a recent meta-analysis showed that only the prevalence of HPV-16, in comparison with other HR types, increased significantly with the anal lesion grade on cytology in both HIVnegative and HIV-positive individuals.…”

Human papillomavirus infection and anal cytology in Taiwanese homosexual men with and without HIV infection

“…Our study also demonstrated that numbers of HPV genotypes (both oncogenic [OR = 1.35] and non-oncogenic [OR = 1.25], Table 2) were associated with increased risk of developing anal dysplasia. Previous reports have shown a strong association between number of HPV types and anal SILs [40]. HPV types 16 and/or 18 have been considered the most important genotypes found in anal cancer [22] and have been strongly associated with HGAINs in previous studies [13,17].…”

“…Associations between multiple oncogenic HPV infections and HGAINs have also been reported [13,17]. Briefly, persistent anal infection with multiple types of HPVs, including oncogenic HPVs, is one of the risk factors for the progression of high-grade anal intraepithelial neoplasms [40,42,43], and anal squamous intraepithelial neoplasms are known precursors of anal cancer [44][45][46]. Currently, HPV vaccines have been approved for young MSM for prevention of HGAIN in western countries [47], and this strategy could also be considered in other countries if resources are available.…”