Risk factors for infection by oncogenic human papillomaviruses in HIV-positive MSM patients in the ART era (2010–2016)

Hidalgo-Tenorio, Carmen; Gil-Anguita, Concepción; Ramírez-Taboada, Jessica; Esquivias, Javier; López-Ruz, Miguel Ángel; Balgahata, Omar Mohamed; Javier-Martínez, Rosario; Pasquau, Juan

doi:10.1097/md.0000000000008109

Cited by 20 publications

(20 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A co-test using anal cytology and HPV genotyping may be considered a useful tool, especially considering the increase in sensitivity when both tests are used [ 46 ]. Patients at risk of anal cancer, such as those who are HIV-positive, especially with the lower CD4 count, and MSM, would benefit with an earlier diagnosis if we considered the identification of HR-HPV infection before the emergence of the abnormal cells [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Anal HPV infection and correlates in HIV-infected patients attending a Sexually Transmitted Infection clinic in Brazil

Boldrini¹,

Volpini²,

Freitas³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

ObjectiveTo estimate the prevalence of anal HPV infection, genotype distribution, intraepithelial neoplasia (AIN) and correlates in a cohort of HIV-infected patients attending at Sexually Transmitted Infections (STI) clinic in Brazil.Study designA descriptive analysis was performed which includes, demographic, behavioral and clinical data. Anal specimens from HIV-positive men and women were collected during a regular visit and they were used for cytology and histopathology tests, as well as for HPV molecular identification.ResultsA total of 223 patients (143 females and 80 males) were enrolled in the study and, HPV was identified in 68.6% of the sample. The frequency of HR-HPV, HPV16/18 and multiple HPV infection were similar in both groups. The upstream regulatory region (URR) sequencing was carried out in 38 samples identified as HPV16-positive, and European variants were the most frequent (69.2%), followed by Africans (25.6%) and Asiatic-Americans (5.1%). Having more than 20 sexual partners was associated with multiple HPV infection (p = 0.000) while, anal sex and the first intercourse before 15 years of age was a risk factor for any HPV infection (p = 0.001). Being MSM (men who have sex with men) was a risk factor for any HPV and multiple infections (p = 0.002). The CD4 count >500 cells/mm3 was a protective factor for the HPV16/18 (p = 0.048) and multiple infections (p = 0.023), and the undetectable viral load and HAART treatment were both protective for any HPV (p = 0.010), HR-HPV (p = 0.091) and multiple infections (p = 0.006). Abnormal anoscopy was found in 23.7% (53/223) of the total number of patients, and this was significantly associated with all types of investigated HPV infections (p<0.0001).ConclusionsIn this study, anal HPV infection was common among young HIV-positive men and women, particularly in MSM. Anal cancer screening in patients at risk, such as those who are HIV-positive, and mainly those with anal HPV infection and a history of STI, will increase the likelihood of detecting anal intraepithelial neoplasia.

show abstract

Section: Discussionmentioning

confidence: 99%

Anal HPV infection and correlates in HIV-infected patients attending a Sexually Transmitted Infection clinic in Brazil

Boldrini¹,

Volpini²,

Freitas³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…0. (22, 30, 31, 36, 38, 42, 43, 86, 88, 89, 94- Nadir CD4+ ≥200 vs. <200 cells/µl (22,38,41,42,98,101) 6 0. .. Current CD4+ ≥500 vs. <500 cells/µl (23,38,43,87,89…”

Section: Hr-hpv Persistencementioning

confidence: 99%

Association of antiretroviral therapy with anal high-risk human papillomavirus, anal intraepithelial neoplasia, and anal cancer in people living with HIV: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

BACKGROUND: The effect of antiretroviral therapy (ART) on the natural history of anal HR-HPV and anal lesion progression is not well established. We reviewed the association of ART and other HIV-related factors on anal HPV infection, anal intraepithelial neoplasia (AIN), and anal cancer among people living with HIV (PLHIV). METHODS: We searched Medline and Embase for studies from 1 January 1996 to 30 October 2019 that reported the association of HIV-related exposures (ART, HIV-RNA plasma viral load [PVL] and nadir or current CD4+ cell count) with outcomes of anal HR-HPV prevalence, incidence or persistence or prevalence, incidence, progression or regression of anal histological/cytological abnormalities, or anal cancer incidence. We assessed the risk of bias of included studies using the Newcastle-Ottawa scale. We performed random-effects meta-analyses; heterogeneity was examined using I 2 statistic. FINDINGS: 122 studies were included comprising 417,006 PLHIV (19%, 44% and 5% women, men-whohave-sex-with-men; men-who-have-sex-with-women, respectively; 32% of studies did not stratify findings by gender and/or sexual orientation). PLHIV taking ART had 35% lower HR-HPV prevalence compared to ART-naïve (crude Odds Ratio[cOR]=0.65, 95%CI:0.54-0.79; I 2 =12.1%) in 18 studies and prolonged ART use was associated with a 10% reduction in HR-HPV prevalence in two studies (per year: aOR=0.90, 95%CI:0.85-0.95, I 2 =0.0%). PLHIV with undetectable PVL had lower HSIL/AIN2+ prevalence compared to those without (cOR=0.84, 95%CI:0.72-0.98, I 2 =0.0%) in 16 studies, particularly if sustained for >1 year (cOR=0.62, 95%CI:0.47-0.81, I 2 =0.0%). ART was not associated with anal cancer incidence when adjusted for years living with HIV in 3 studies (aHR=1.11, 95%CI: 0.68-1.80, I 2 =0.0%), but ART users with sustained undetectable HIV PVL had 44% lower risk of anal cancer compared to those without (aHR=0.56, 95%CI:0.44-0.70, I 2 =0%) and for each 100 cells/µl increase in nadir CD4+ count, there was a 40% decrease in anal cancer incidence (cHR=0.60, 95%CI:0.46-0.78, I 2 =21.7%). INTERPRETATION: Effective ART use and early initiation at higher nadir CD4+ may reduce anal HR-HPV and anal cancer risk.

show abstract

“…Besides a previous investigation in our cohort (16), only one study has been published [7] on the prevalence of HPV genotypes in HIV+ MSM according to biopsy results, and it only examined HPV genotypes in individuals with pathological cytology and anoscopy, limiting the information provided [7].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the ACTG trial on the quadrivalent HPV vaccine in seropositive adults was suspended for lack of efficacy [15]. Finally, many HIV+MSM are already HIV-infected, and they are generally over the maximum age (26 years) recommended for vaccination [16].…”

mentioning

confidence: 99%

ART is key to clearing oncogenic HPV genotypes (HR-HPV) in anal mucosa of HIV-positive MSM

et al. 2019

Self Cite

View full text Add to dashboard Cite

BackgroundAnal squamous cell carcinoma (ASCC) is one of the most frequent non-AIDS-defining neoplasias in HIV patients, mainly in MSM, and it has been associated with chronic infection with high-risk human papilloma virus (HR-HPV). Our main objective was to determine HR-HPV clearance and acquisition rates and related factors and their relationship with the incidence of HSILs and ASCC in anal mucosa of HIV+ MSM. Patients and methodsThe study included consecutive HIV-infected MSM between May 2010 and December 2018. Data were gathered at baseline and annually on their sexual behavior, CD4 and CD8 levels, plasma HIV viral load, and results of anal cytology, HPV PCR, and high-resolution anoscopy. ResultsOut of the 405 patients studied, 34.9% of patients cleared oncogenic genotypes (IQR: 37-69) within 49 months, and 42.9% acquired new genotypes within 36 months (IQR:12-60). In multivariate analysis, clearance was only significantly influenced by the duration of antiretroviral therapy (ART) (OR: 1.016, 95% CI 1.003-1.030). The incidence of HSILs was 30.86/ 1,000 patient-years and that of ASCC was 81.22/100,000 patient-years; these incidences were not influenced by the acquisition (acquired: 14.9% vs. non-acquired: 10.4%; p = 0.238) or clearance (cleared 11.4% vs. non-cleared: 13.2%; p = 0.662) rates of these viruses. ConclusionsThe duration of ART appears to positively affect oncogenic genotype clearance in the anal mucosa of HIV+ MSM, although this clearance does not affect the incidence of HSILs or ASCC. The reduction in HSIL+ rate observed in our patients may be attributable to the bundle of measures adopted at our center. Competing interests: The authors have declared that no competing interests exist. 30-50 yrs, n (%) 244 (60.2) >50 yrs n (%) 38 (9.4) Retired, n (%), 95% CI 6 (1.5) Educational level No studies 40 (9.9) Primary studies 129 (31.9) Secondary studies 230 (56.7) University studies 22 (5.4) (3-7.5) Origin Europe 387 (95.6) Central America 17 (4.2) qHPV vaccine (2012-2014), n (%), 95% CI 66 (16.3) Age at first sexual intercourse, median (IQR) 18 (16-20) Number of lifetime male sex partners, median (IQR) 50 (15-150) Number of male sex partners during previous 12 months, (IQR) 1(1-7) Habitual use of condoms, n (%), 95%CI 294 (72.6) (68.2-77.4) Total number of sexual partners during follow-up, median (P25-P75) 54.5(20-154) History of anal/genital warts, n (%), (95%CI) 128 (31.6), (27.1-36.1) Anal/genital warts at baseline, n (%), (95%CI) 93 Time since HIV diagnosis (months), median (IQR) 25 (8-84)CD4 at diagnosis of HIV (cel/uL), (± SD) 448± 298.17 HIV viral load at diagnosis of HIV (log), mean (IQR) 4.61 (4.07-5.12) CD4 nadir (cells/uL), (± SD) 367.93±233.85 CD4 nadir < 200 cells/uL, n(%), 95% CI 97 (23.9), (20-28.5) CD4 cell count at baseline (cells/uL), (± SD) 689.64± 475.03 CD8 cell count at baseline (cells/uL), (± SD) 981.5±531.5 CD4 /CD8 ratio, mean, (± SD) 0.77±0.70 HIV viral load at baseline (log), median, IQR 0 (0-1.72) Undetectable: < 50 HIV RNA copies/mL of plasma n (%) 348 (85.9) History of AIDS ...

show abstract

Risk factors for infection by oncogenic human papillomaviruses in HIV-positive MSM patients in the ART era (2010–2016)

Cited by 20 publications

References 25 publications

Anal HPV infection and correlates in HIV-infected patients attending a Sexually Transmitted Infection clinic in Brazil

Anal HPV infection and correlates in HIV-infected patients attending a Sexually Transmitted Infection clinic in Brazil

Association of antiretroviral therapy with anal high-risk human papillomavirus, anal intraepithelial neoplasia, and anal cancer in people living with HIV: a systematic review and meta-analysis

ART is key to clearing oncogenic HPV genotypes (HR-HPV) in anal mucosa of HIV-positive MSM

Contact Info

Product

Resources

About