Natural History of Anal Squamous Intraepithelial Lesions in HIV-Positive Men with Normal Baseline Cytology

Revollo, Boris; Videla, Sebastián; Sirera, Guillem; Cuyàs, Francesc García; Parés, David; Corral, Javier; Clotet, Bonaventura; Llibre, Josep M

doi:10.1089/apc.2019.0186

Cited by 8 publications

(13 citation statements)

References 26 publications

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“…This finding is a result of a high incidence of mucosal HPV in the control tissue and a relatively low incidence of HPV among patients with conjunctival CIN and SCC in African studies. Evidence from other anatomical regions, such as the anus, uterine cervix and oral cavity, shows a higher prevalence of HPV in apparently normal mucosa of HIV‐positive compared to HIV‐negative individuals (Choudhury et al 2016; Lin et al 2018; Liu et al 2018; Revollo et al 2019; Mendez‐Martinez et al 2020). Interestingly, in the anal region, the fraction of invasive carcinomas that are attributable to HPV16, is higher in HIV‐negative than in HIV‐positive individuals (Lin et al 2018).…”

Section: Discussionmentioning

confidence: 99%

Human papillomavirus infection plays a role in conjunctival squamous cell carcinoma: a systematic review and meta‐analysis of observational studies

Ramberg

Møller-Hansen

Toft

et al. 2020

Acta Ophthalmologica

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Purpose We aimed to study the prevalence of human papillomavirus (HPV) in conjunctival intraepithelial neoplasia and carcinoma. Furthermore, we aimed to explore whether geographical differences or different detection modalities are associated with the conflicting information regarding HPV and the development of the disease. Methods We searched the MEDLINE, EMBASE and Scopus databases for studies reporting on HPV and conjunctival intraepithelial neoplasia or carcinoma. The pooled prevalence proportions, odds ratio (OR) and corresponding 95% confidence intervals were calculated assuming a random‐effects model. Subgroup analyses and meta‐regression explored possible sources of heterogeneity. Results A total of 39 studies were included in the systematic review. The pooled prevalence of HPV in conjunctival intraepithelial neoplasia and carcinoma was 26%, with HPV16, 18, and 33 being the most frequently reported genotypes. Human papillomavirus (HPV) infection was associated with an increased risk of conjunctival intraepithelial neoplasia and carcinoma (OR 8.4, 95% confidence interval (CI) 3.7–19.1); lower in studies from African countries (OR 1.7, 95% CI 0.9–3.5) than other countries (OR 16.1, 95% CI 5.8–44.3), p = 0.013. Conclusion Human papillomavirus infection increases the odds of conjunctival intraepithelial neoplasia and carcinoma by 8.4 compared to healthy conjunctival mucosa or other ocular surface diseases. There seem to be geographical differences regarding HPV in conjunctival intraepithelial neoplasia and carcinoma. HPV16 was the most prevalent genotype, followed by HPV18 and HPV33, meaning that most of the HPV‐related conjunctival intraepithelial neoplasia and carcinoma may be prevented by the HPV vaccines that are currently available.

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Section: Discussionmentioning

confidence: 99%

Human papillomavirus infection plays a role in conjunctival squamous cell carcinoma: a systematic review and meta‐analysis of observational studies

Ramberg

Møller-Hansen

Toft

et al. 2020

Acta Ophthalmologica

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“…4 HIV-positive men and women are at a higher risk of anal cancer than the general population, but the risk is highest among HIV-positive gay and bisexual men (GBM). [4][5][6] Most anal SCC, and its precursor high-grade squamous intraepithelial lesion (HSIL), is associated with HPV genotypes with high oncogenic potential [high-risk HPV (HRHPV)]. 7,8 Anal wart is defined as a papillary proliferation with low-grade cytopathic features of HPV infection.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Association of Perianal and Intra-Anal Warts with Composite High-Grade Squamous Intraepithelial Lesions Among Gay and Bisexual Men: Baseline Data from the Study of the Prevention of Anal Cancer

Goddard

Templeton

Petoumenos

et al. 2020

AIDS Patient Care and STDs

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Human papillomavirus (HPV) causes anal warts and anal squamous cell carcinoma (SCC). A higher incidence of anal cancer has been found among individuals previously diagnosed with anogenital warts. We aimed to investigate the association between anal warts and the presumed anal SCC precursor high-grade squamous intraepithelial lesion (HSIL), among participants in the Study of the Prevention of Anal Cancer (SPANC). SPANC was a longitudinal study of anal HPV infections and related lesions among gay and bisexual men (GBM) age 35 years and older, in Sydney, Australia. Anal cytology and high-resolution anoscopy were performed. Logistic regression was used to investigate the association between clinically diagnosed anal warts and intra-anal composite-HSIL (cytology and/or histology) at the baseline visit. The prevalence of HSIL within biopsies from intra-anal warts was calculated. Laser capture microdissection (LCM) and HPV-genotyping was performed on HSIL lesions. Among 616 participants at study entry, 165 (26.8%) and 51 (8.3%) had intra-anal and perianal warts, respectively. Warts were associated with composite-HSIL, even after adjustment for HIV status, age, lifetime receptive anal intercourse partner number, and smoking (perianal: aOR 2.13, 95% CI 1.17-3.87, p = 0.013; intra-anal: aOR 1.69, 95% CI 1.16-2.46, p = 0.006). HSIL was detected in 24 (14.5%) of 165 biopsies from intra-anal warts. Of 17 HSIL lesions, 16 (94.1%) had high-risk HPV detected by LCM. Anal warts were common. Prevalent anal warts were associated with composite-HSIL. HSIL may be detected within biopsies of intra-anal warts. Anal warts may be a useful addition to risk stratification for HSIL among GBM.

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“…Such observations support the synergistic role of HIV in anal squamous oncogenesis and validate current guidelines of screening all HIV-positive RAI engaging individuals and MSM in particular at regular intervals. [ 1 2 3 42 43 ]…”

Section: Discussionmentioning

confidence: 99%

Transgenders are the most vulnerable amongst individuals engaging in receptive anal intercourse

Wadhwa

Arora

Pandhi

et al. 2021

Journal of Family Medicine and Primary Care

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Background: In India, sexuality not confirming to hetero-conjugal and peno-vaginal norm is abhorred and discriminated against. Individuals engaging in Receptive Anal Intercourse (RAI) are marginalized. Reappraisal of their sexual health conditions is likely to promote inclusive health care. Methods: Eighty-five consenting adults with RAI history were recruited from a tertiary care hospital in Delhi. Clinico-demographic data was noted and anal cytology samples were reported by Bethesda 2014 terminology. Results: There were 29 transgenders (TGs), 51 males (31 bisexual) and five females. Fifty-four subjects were Human Immunodeficiency Virus (HIV) infected (22 TGs, 31 males (17 bisexual) and one female) and 52 were receiving anti-retroviral treatment (ART). Thirty-one subjects had anal warts (6 TGs, 20 males, five females). Anal cytology revealed squamous intra-epithelial lesions (SIL) in 20 (5 TGs, 13 males, two females). TGs had significantly risker sexual practices than homosexual males, bisexual males and females, with consistently earlier age of first RAI exposure and frequent childhood (≤16 years) RAI experience compared to homosexual males, bisexual males and females, even after stratification by HIV status, warts and SIL. Conclusions: TGs had the highest sexual health risk profile including higher frequency of HIV infection compared to other subjects with RAI history. Bisexuality was common; their risk profile was variably lower than homosexual males. Mindfulness of above is likely to help overcome barriers to health care access and promote compassionate approach at all levels including primary care physicians.

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Natural History of Anal Squamous Intraepithelial Lesions in HIV-Positive Men with Normal Baseline Cytology

Cited by 8 publications

References 26 publications

Human papillomavirus infection plays a role in conjunctival squamous cell carcinoma: a systematic review and meta‐analysis of observational studies

Human papillomavirus infection plays a role in conjunctival squamous cell carcinoma: a systematic review and meta‐analysis of observational studies

Prevalence and Association of Perianal and Intra-Anal Warts with Composite High-Grade Squamous Intraepithelial Lesions Among Gay and Bisexual Men: Baseline Data from the Study of the Prevention of Anal Cancer

Transgenders are the most vulnerable amongst individuals engaging in receptive anal intercourse

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