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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky N, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Coutlée F, Burchell AN. Vaccine Effectiveness Against 12-Month Incident and Persistent Anal Human Papillomavirus Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men. J Infect Dis 2023; 228:89-100. [PMID: 36655513 PMCID: PMC10304758 DOI: 10.1093/infdis/jiad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM. METHODS We recruited GBM aged 16-30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12-13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression. RESULTS Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24-1.31) for cumulative incidence and 0.53 (95% CI, .25-1.14) for persistence. PRs were 0.23 (95% CI, .05-1.03) and 0.08 (95% CI, .01-.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03-.68) and 0.12 (95% CI, .03-.54) among participants who were sexually active for ≤5 years before vaccination. CONCLUSIONS Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.
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Affiliation(s)
- Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut National de Santé Publique du Québec, Québec, Québec, Canada
| | | | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Oo MM, Moore S, Gibbons S, Adhiambo W, Muthoga P, Siele N, Akolo M, Gebrebrhan H, Sivro A, Ball BT, Lorway RR, Severini A, Kimani J, McKinnon LR. High prevalence of vaccine-preventable anal human papillomavirus infections is associated with HIV infection among gay, bisexual, and men who have sex with men in Nairobi, Kenya. Cancer Med 2023; 12:13745-13757. [PMID: 37140209 PMCID: PMC10315852 DOI: 10.1002/cam4.6008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/16/2023] [Accepted: 04/16/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection is associated with anal cancers and is more prevalent in gay, bisexual, and men who have sex with men (gbMSM), partly due to their vulnerability to HIV infection. Baseline HPV genotype distributions and risk factors can inform the design of next-generation HPV vaccines to prevent anal cancer. METHODS A cross-sectional study was conducted among gbMSM receiving care at a HIV/STI clinic in Nairobi, Kenya. Anal swabs were genotyped using a Luminex microsphere array. Multiple logistic regression methods were used to identify risk factors for four HPV outcomes (any HPV, any HR-HPV, and 4- and 9-valent vaccine-preventable HPVs). RESULTS Among 115 gbMSM, 51 (44.3%) were HIV-infected. Overall HPV prevalence was 51.3%; 84.3% among gbMSM living with HIV and 24.6% among gbMSM without HIV (p < 0.001). One-third (32.2%) had HR-HPV and the most prevalent vaccine-preventable HR-HPV genotypes were 16, 35, 45, and 58. HPV-18 was uncommon (n = 2). The 9-valent Gardasil vaccine would have prevented 61.0% of HPV types observed in this population. In multivariate analyses, HIV status was the only significant risk factor for any HPV (adjusted odds ratio [aOR]:23.0, 95% confidence interval [95% CI]: 7.3-86.0, p < 0.001) and for HR-HPV (aOR: 8.9, 95% CI: 2.8-36.0, p < 0.001). Similar findings were obtained for vaccine-preventable HPVs. Being married to a woman significantly increased the odds of having HR-HPV infections (aOR: 8.1, 95% CI: 1.6-52.0, p = 0.016). CONCLUSIONS GbMSM living with HIV in Kenya are at higher risk of anal HPV infections including genotypes that are preventable with available vaccines. Our findings support the need for a targeted HPV vaccination campaign in this population.
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Affiliation(s)
- Myo Minn Oo
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegManitobaCanada
| | - Samantha Moore
- Institute for Global Public Health (IGPH)University of ManitobaWinnipegManitobaCanada
| | - Suzanne Gibbons
- JC Wilt Infectious Disease Research CentreNational Microbiology Laboratory, Public Health Agency of CanadaWinnipegManitobaCanada
| | - Wendy Adhiambo
- University of Nairobi Institute of Tropical and Infectious Diseases, University of NairobiNairobiKenya
| | - Peter Muthoga
- University of Nairobi Institute of Tropical and Infectious Diseases, University of NairobiNairobiKenya
| | - Naomi Siele
- University of Nairobi Institute of Tropical and Infectious Diseases, University of NairobiNairobiKenya
| | - Maureen Akolo
- University of Nairobi Institute of Tropical and Infectious Diseases, University of NairobiNairobiKenya
| | - Henok Gebrebrhan
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegManitobaCanada
| | - Aida Sivro
- JC Wilt Infectious Disease Research CentreNational Microbiology Laboratory, Public Health Agency of CanadaWinnipegManitobaCanada
- Department of Medical MicrobiologyUniversity of KwaZulu‐NatalDurbanSouth Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)DurbanSouth Africa
| | - Blake T. Ball
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegManitobaCanada
- JC Wilt Infectious Disease Research CentreNational Microbiology Laboratory, Public Health Agency of CanadaWinnipegManitobaCanada
| | - Robert R. Lorway
- Institute for Global Public Health (IGPH)University of ManitobaWinnipegManitobaCanada
| | - Alberto Severini
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegManitobaCanada
- JC Wilt Infectious Disease Research CentreNational Microbiology Laboratory, Public Health Agency of CanadaWinnipegManitobaCanada
| | - Joshua Kimani
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegManitobaCanada
- University of Nairobi Institute of Tropical and Infectious Diseases, University of NairobiNairobiKenya
| | - Lyle R. McKinnon
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegManitobaCanada
- University of Nairobi Institute of Tropical and Infectious Diseases, University of NairobiNairobiKenya
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)DurbanSouth Africa
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Sanger CB, Xu Y, Carchman E, Lawson E, Heise C, Striker R, Voils CI. Prevalence of High-Grade Anal Dysplasia and Anal Cancer in Veterans Living With HIV and CD4/CD8 Ratio as a Marker For Increased Risk: A Regional Retrospective Cohort Study. Dis Colon Rectum 2021; 64:805-811. [PMID: 34086000 PMCID: PMC8186795 DOI: 10.1097/dcr.0000000000002009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Department of Veterans Affairs cares for the largest population of patients with HIV of any healthcare system in the United States. Screening for anal dysplasia/cancer is recommended for all veterans with HIV. Exams are invasive, burdensome, and resource intensive. We currently lack markers of disease to tailor screening. OBJECTIVE The purpose of this study was to establish the prevalence of advanced anal disease (high-grade dysplasia and anal cancer) and to determine whether CD4/CD8 ratio correlates with risk. DESIGN This was a retrospective regional cohort study of veterans with HIV. SETTINGS The study was conducted at eight medical centers between 2001 and 2019. PATIENTS Patients with advanced disease were compared with patients with nonadvanced anal pathology. MAIN OUTCOME MEASURES Logistic regression modeling was used to estimate adjusted odds of disease as a function of CD4/CD8. Lowest (nadir) CD4/CD8 and nearest CD4/CD8 ratio in each cohort were evaluated. RESULTS A total of 2267 veterans were included. Fifteen percent had anal pathology (112 with advanced disease (37 cancer and 75 high-grade), 222 with nonadvanced disease). Nadir and nearest ratio were lower in patients with advanced disease versus nonadvanced (0.24 vs 0.45 (p < 0.001) and 0.50 vs 0.88 (p < 0.001)). In adjusted models, a 1-unit increase in nadir or nearest ratio conferred decreased risk of advanced disease (OR = 0.19 (95% CI, 0.07-0.53); p < 0.001; OR = 0.22 (95% CI, 0.12-0.43); p < 0.001). Using a minimum sensitivity analysis, a cutoff nadir ratio of 0.42 or nearest ratio of 0.76 could be used to risk stratify. LIMITATIONS This was a retrospective analysis with a low screening rate. CONCLUSIONS In a regional cohort of veterans with HIV, 15% were formally assessed for anal dysplasia. Advanced anal disease was present in 33% of those screened, 5% of the HIV-positive population. A strong predictor of advanced disease in this cohort is the CD4/CD8 ratio, which is a promising marker to stratify screening practices. Risk stratification using CD4/CD8 has the potential to decrease burdensome invasive examinations for low-risk patients and to intensify examinations for those at high risk. See Video Abstract at http://links.lww.com/DCR/B528. PREVALENCIA DE DISPLASIA ANAL DE ALTO GRADO Y CNCER ANAL EN VETERANOS QUE VIVEN CON EL VIH Y LA RELACIN CD / CD COMO MARCADOR DE MAYOR RIESGO UN ESTUDIO DE COHORTE REGIONAL RETROSPECTIVE ANTECEDENTES:El Departamento de Asuntos de Veteranos atiende a la población más grande de pacientes con el virus de inmunodeficiencia humana (VIH) de cualquier sistema de salud en los Estados Unidos. Se recomienda la detección de displasia / cáncer anal para todos los veteranos con VIH. Los exámenes son invasivos, onerosos y requieren muchos recursos. Actualmente carecemos de marcadores de enfermedad para adaptar la detección.OBJETIVO:Establecer la prevalencia de enfermedad anal avanzada (displasia de alto grado y cáncer anal) y determinar si la relación CD4 / CD8 se correlaciona con el riesgo.DISEÑO:Estudio de cohorte regional retrospectivo de veteranos con VIH.AJUSTE:Ocho centros médicos entre 2001-2019.PACIENTES:Se comparó a pacientes con enfermedad avanzada con pacientes con patología anal no avanzada.PRINCIPALES MEDIDAS DE RESULTADO:Se utilizó un modelo de regresión logística para estimar las probabilidades ajustadas de enfermedad en función de CD4 / CD8. Se evaluó la relación CD4 / CD8 más baja (nadir) y la relación CD4 / CD8 más cercana en cada cohorte.RESULTADOS:Se incluyeron un total de 2267 veteranos. El 15% tenía patología anal (112 enfermedad avanzada (37 cáncer, 75 de alto grado), 222 enfermedad no avanzada). El nadir y el cociente más cercano fueron menores en los pacientes con enfermedad avanzada frente a los no avanzados (0,24 frente a 0,45 (p <0,001) y 0,50 frente a 0,88 (p <0,001)), respectivamente. En modelos ajustados, el aumento de una unidad en el nadir o el cociente más cercano confirió una disminución del riesgo de enfermedad avanzada (OR 0,19 (IC del 95%: 0,07, 0,53, p <0,001)) y (OR 0,22 (IC del 95%: 0,12, 0,43, p <0,001))), respectivamente. Utilizando un análisis de sensibilidad mínima, se podría utilizar un cociente del nadir de corte de 0,42 o el cociente más cercano de 0,76 para estratificar el riesgo.LIMITACIONES:Análisis retrospectivo con una tasa de detección baja.CONCLUSIONES:En una cohorte regional de veteranos con VIH, el 15% fueron evaluados formalmente por displasia anal. La enfermedad anal avanzada estuvo presente en el 33% de los examinados, el 5% de la población VIH +. Un fuerte predictor de enfermedad avanzada en esta cohorte es la relación CD4 / CD8, que es un marcador prometedor para estratificar las prácticas de detección. La estratificación del riesgo usando CD4 / CD8 tiene el potencial de disminuir los exámenes invasivos onerosos para los pacientes de bajo riesgo e intensificar los exámenes para los de alto riesgo. Consulte Video Resumen en http://links.lww.com/DCR/B528.
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Affiliation(s)
- Cristina B. Sanger
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
- William S. Middleton Memorial Veteran’s Hospital, Madison, WI
| | - Yiwei Xu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Evie Carchman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Elise Lawson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Charles Heise
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Rob Striker
- William S. Middleton Memorial Veteran’s Hospital, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Corrine I. Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
- William S. Middleton Memorial Veteran’s Hospital, Madison, WI
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Choi Y, Loutfy M, Remis RS, Liu J, Rebbapragada A, Huibner S, Brunetta J, Smith G, Reko T, Halpenny R, Kaul R, Grennan T. HPV genotyping and risk factors for anal high-risk HPV infection in men who have sex with men from Toronto, Canada. Sci Rep 2021; 11:4779. [PMID: 33637798 PMCID: PMC7910431 DOI: 10.1038/s41598-021-84079-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
Men who have sex with men (MSM) are disproportionately affected by anal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection. Currently, the nonavalent HPV vaccine provides coverage against nine HPV genotypes, including seven HR-HPV genotypes. Here, we characterize anal HR-HPV genotype distribution and associated risk factors in MSM from Toronto, Canada recruited between September 2010 and June 2012. Wilcoxon-Mann-Whitney test was used for continuous variables, Chi-square test was performed for categorical variables, and a multivariable model using logistic regression was created to assess for correlates of anal HR-HPV infection. A total of 442 MSM were recruited, with a median age of 45 (IQR 38-50) and an overall HPV prevalence of 82%. The prevalence of any HR-HPV infection was 65.3% and 50.7% in the HIV-positive and HIV-negative MSM, respectively. No participant tested positive for all genotypes covered by the nonavalent vaccine. HIV status (aOR 1.806; 95% CI 1.159-2.816), smoking (aOR 2.176; 95% CI 1.285-3.685) and the number of lifetime sexual partners (aOR 2.466; 95% CI 1.092-5.567) were independent risk factors for anal HR-HPV infection. Our findings will be useful to inform HPV vaccine rollout and HPV prevention strategies in Canadian MSM.
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Affiliation(s)
- Yoojin Choi
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada.
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Robert S Remis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Juan Liu
- Public Health Laboratory-Toronto, Public Health Ontario, Toronto, Ontario, Canada
| | | | - Sanja Huibner
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Graham Smith
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | | | | | - Rupert Kaul
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul's Hospital, Vancouver, British Columbia, Canada
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Alberts CJ, Heard I, Canestri A, Marchand L, Fléjou JF, Piroth L, Ferry T, Didelot JM, Siproudhis L, Henno S, Poizot-Martin I, Darragh TM, Clifford GM, Combes JD, Etienney I. 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. J Infect Dis 2020; 221:1488-1493. [PMID: 31754686 DOI: 10.1093/infdis/jiz623] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/21/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prospective data on the natural history of anal human papillomavirus (HPV) infection are scarce in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). METHODS We analyzed incidence and clearance of HPV-16 and HPV-18 in a French cohort of HIV-infected MSM, aged ≥35 years, followed-up annually (n = 438, 2014-2018). RESULTS Human papillomavirus-16 and HPV-18 incidence were similar (~10% incident infections at 24 months). Human papillomavirus-16 incidence was higher among high-grade versus no lesion at baseline (adjusted incidence rate ratio = 3.0; 95% confidence interval, 1.07-8.18). Human papillomavirus-16 cleared significantly slower than HPV-18 (32% versus 54% by 24 months). CONCLUSIONS In conclusion, anal HPV-16 is more persistent than HPV-18, and its incidence correlates with a prior detection of high-grade lesions.
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Affiliation(s)
| | - Isabelle Heard
- Centre National de Référence des HPV, Institut Pasteur, Paris, France
- Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Ana Canestri
- Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, AP-HP, Paris, France
| | - Lucie Marchand
- ANRS (France Recherche Nord et Sud Sida-HIV et Hépatites), Paris, France
| | - Jean-François Fléjou
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Saint-Antoine, Groupe Hospitalier Hôpitaux Universitaires Est Parisien (GH HUEP), AP-HP, Paris, France
- Faculté de Médecine Sorbonne Université, Paris, France
| | - Lionel Piroth
- Département d'Infectiologie, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon, France
- Institut National de la Sante et de la Recherche Medicale (INSERM) Centre d'Investigation Clinique (CIC) 1432, Université de Bourgogne, Dijon, France
| | - Tristan Ferry
- Département d'Infectiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Didelot
- Département d'Hépato-Gastroentérologie, CHU Saint Eloi et Université de Montpellier, Montpellier, France
| | - Laurent Siproudhis
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes, France
- INSERM U1241, University of Rennes 1, Rennes, France
- INPHY CIC 1414 University Hospital of Rennes, Pontchaillou, Rennes, France
| | - Sébastien Henno
- Service d'Anatomie et Cytologie Pathologiques, CHU Pontchaillou, Rennes, France
| | - Isabelle Poizot-Martin
- Service d'Immuno-Hématologie Clinique, Université Aix Marseille, APHM Sainte-Marguerite, Marseille, France
- INSERM U912 (Sciences économiques et sociales de la santé et traitement de l'information médicale - SESSTIM), Marseille, France
| | - Teresa M Darragh
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | | | | | - Isabelle Etienney
- Service de Proctologie Médico-Interventionnelle, Groupe Hospitalier Diaconesses Croix-Saint-Simon, Paris, France
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Strong C, Yu YF, Zou H, Ku WW, Lee CW, Ko NY. Sexual network and detection of anogenital human papillomavirus in a community cohort of men who have sex with men in Taiwan. PLoS One 2019; 14:e0216784. [PMID: 31075133 PMCID: PMC6510428 DOI: 10.1371/journal.pone.0216784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 04/29/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We examined the association between anogenital human papillomavirus (HPV) infection and sexual networks in men who have sex with men (MSM). METHODS A total of 253 MSM, 20 years of age and older, were recruited from the community in Southern Taiwan in 2015-2016. At baseline and at each follow-up visit, MSM were screened for HPV to identify 37 HPV genotypes. At the six-month follow-up, MSM were asked to fill out an egocentric network assessment and to report the last five persons with whom they had sex regarding the characteristics of sexual behavior with each network member. RESULTS A total of 182 participants (71.9%) returned for the follow-up and one third had at least one HPV type detected. A higher level of bridging network position calculated by the level of constraints in the network was significantly less likely to have HPV detection at the anal site. A high level of concurrency was associated with penile HPV detection (AOR = 3.16, 95% CI = 1.01-9.86). CONCLUSIONS Identifying network-related characteristics can advance our understanding of high-risk populations and for prioritizing HPV vaccine recommendations.
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Affiliation(s)
- Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
| | - Yi-Fang Yu
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Wen-Wei Ku
- Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Wen Lee
- Fengshan Lee Chia Wen Urologic Clinic, Kaohsiung, Taiwan
| | - Nai-Ying Ko
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, National Cheng Kung University and Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Lisboa C, Santo I, Azevedo J, Azevedo L, Pista A, Dias C, Cunha MJ. High Prevalence of Human Papillomavirus on Anal and Oral Samples from Men and Women with External Anogenital Warts: The HERCOLES Study. Acta Derm Venereol 2019; 99:557-563. [PMID: 30723872 DOI: 10.2340/00015555-3136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Human papillomavirus (HPV) infection is highly prevalent in the sexually active population. This study estimates the prevalence of HPV DNA in anal and oral samples from a cohort of men and women with incident anogenital warts. Anal and/or oral samples from 541 patients with anogenital warts were tested for 35 HPV genotypes using a PCR assay. The overall prevalence of anal HPV and oral HPV DNA was 59.9% (n = 305/509; 95% confidence interval (CI) 55.6-64.1%) and 14.5% (n = 78/538; 95% CI 11.8-17.7%), respectively. Among patients with perianal warts, the anal HPV DNA prevalence was 92.3% (95% CI 87.0-95.5%). Anal HPV DNA prevalence in patients with genital warts but no perianal warts was 55.7% (95% CI 50.6-60.7%). Both anal and oral HPV infections were more common in men who have sex with men than in heterosexual men (90.4% versus 38.5% and 20.8% versus 11.8%, respectively). Anal high risk-HPV infection was more common in women (58.8%) and in men who have sex with men (67.7%). We found that anogenital warts represent a clinical marker for both anal and oral HPV infections, including anal high risk-HPV infections, particularly among women and men who have sex with men.
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Affiliation(s)
- Carmen Lisboa
- Department of Microbiology, University of Porto, Faculty of medicine, 4200-319 Porto, Portugal.
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8
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Xu H, Ling Y, Xi Y, Ma H, Wang H, Hu HM, Liu Q, Li YM, Deng XT, Yang SX, Delwart E, Zhang W. Viral metagenomics updated the prevalence of human papillomavirus types in anogenital warts. Emerg Microbes Infect 2019; 8:1291-1299. [PMID: 31495287 PMCID: PMC6746260 DOI: 10.1080/22221751.2019.1661757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/22/2019] [Indexed: 11/01/2022]
Abstract
To investigate the composition of human papillomavirus (HPV) types in anogenital warts (AGWs), viral nucleic acid in 110 AGWs, pooled into 11 specimen pools, were subjected to viral metagenomic analysis. After finding HPV7 in AGWs, conventional PCR screening was performed for HPV7 in other 190 individual AGW specimens. Viral metagenomic results indicated that 29 different types of HPV were recovered, with HPV11 and HPV6 showing the highest proportion of sequence reads. HPV7 was detected in 7 of 11 pools, 5 of which contained abundant HPV7 sequence reads. 24 complete genomes of HPV were acquired in viral metagenomic analysis, including 5 HPV7 genomes, based on which phylogenetic analysis and pairwise sequence comparison were conducted. PCR screening for HPV7 in other 190 individual AGW specimens revealed 25 positive cases (13.16%), of which the amplified fragments were sequenced and confirmed to be HPV7 sequences. Although HPV7 was generally found in hand warts and recently also in warts in toe webs, our data suggested that the role of HPV7 in AGW should be considered in the future clinical test and vaccine development for AGWs.
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Affiliation(s)
- Hui Xu
- Department of Dermatology, the Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Yu Ling
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Yuan Xi
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Hong Ma
- Department of Dermatology, the Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Hao Wang
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Hui-Min Hu
- Department of Dermatology, the Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Qi Liu
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Yu-Mei Li
- Department of Dermatology, the Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Xu-Tao Deng
- Vitalant Research Institute, San Francisco, CA,USA
| | - Shi-Xing Yang
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Eric Delwart
- Vitalant Research Institute, San Francisco, CA,USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA,USA
| | - Wen Zhang
- Department of Microbiology, School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China
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Kreuter A, Hufbauer M, Silling S, Oellig F, Akgül B, Wieland U. Simultaneous Induction of Benign Condyloma and High-grade Anal Dysplasia Induced by Low-risk Human Papillomavirus Type 42. Acta Derm Venereol 2018; 98:616-617. [PMID: 29487947 DOI: 10.2340/00015555-2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Josefstr. 3, DE-46045 Oberhausen, Germany.
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10
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Mboumba Bouassa RS, Mbeko Simaleko M, Camengo SP, Mossoro-Kpinde CD, Veyer D, Matta M, Robin L, Longo JDD, Grésenguet G, Péré H, Meye JF, Belec L. Unusual and unique distribution of anal high-risk human papillomavirus (HR-HPV) among men who have sex with men living in the Central African Republic. PLoS One 2018; 13:e0197845. [PMID: 29795661 PMCID: PMC5967740 DOI: 10.1371/journal.pone.0197845] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/27/2018] [Indexed: 12/05/2022] Open
Abstract
Background High-risk (HR) human papillomavirus (HPV) infection remains a great concern in relation to African men who have sex with men (MSM), especially those infected with HIV. The prevalence of HR-HPV and associated risk factors was estimated in a cross-sectional observational study covering MSM living in Bangui, Central African Republic. Methods MSM receiving care at the Centre National de Référence des Infections Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, were included. HIV serostatus and socio-demographic and behavioral characteristics were collected. HPV DNA was detected and genotyped on anal swabs using Anyplex™ II HPV28 test (Seegene, South Korea), and HSV DNA by in-house real-time PCR. Logistic regression analyses were used to determine risk factors associated with HPV outcomes. Results 42 MSM (mean age, 23.2 years; range, 14–39) including 69.1% HIV-1-positive and 30.9% HIV-negative were prospectively enrolled. The prevalence of anal HPV was 69.1%, including 82.7% of HR-HPV which were multiple in 52.0%. The most prevalent genotypes were HPV-35, HPV-58, HPV-59 and HPV-31. While, HPV-16 and HPV-18 were present in a minority of samples. Multiple HR-HPV infection was more frequent in HIV-positive MSM (41.4%) with 2.7 genotypes per anal samples than in HIV-negative (7.7%) with 1.5 genotypes per anal samples. HPV types included in the prophylactic Gardasil-9® vaccine were detected in 68.9% of specimens and HPV-58 was the most frequently detected. MSM infected by HPV-16 and HPV-18 were all infected by HIV-1. Few anal swabs (11.9%) contained HSV-2 DNA without relationship with HPV detection. Condomless receptive anal intercourse was the main risk factor to being infected with any type of HPV and condomless insertive anal intercourse was significantly less associated with HPV contamination than receptive anal intercourse (Odd ratio = 0.02). Conclusion MSM in Bangui are at-risk of HIV and HR-HPV anal infections. The unusual distribution of HPV-35 as predominant HPV suggests possible geographic specificities in the molecular epidemiology of HR-HPV in sub-Saharan Africa. Scaling up prevention strategies against HPV infection and related cancers adapted for MSM in Africa should be prioritized. Innovative interventions should be conceived for the MSM population living in Bangui.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Ecole Doctorale Régionale d’Infectiologie Tropicale de Franceville, Franceville, Gabon
- Ecole Doctorale Bio Sorbonne Paris Cité, BioSPC, Paris Descartes, Paris, France
| | - Marcel Mbeko Simaleko
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
| | - Serge Police Camengo
- Servivce de Gastro-entérologie, Hôpital de l’Amitié, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Christian Diamant Mossoro-Kpinde
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Laboratoire National de Biologie Clinique et de Santé Publique, Bangui, Central African Republic
- * E-mail:
| | - David Veyer
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Mathieu Matta
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Leman Robin
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean De Dieu Longo
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Gérard Grésenguet
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Hélène Péré
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-François Meye
- Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire d’Angondjé, Libreville et Faculté de Médecine de Libreville, Université des Sciences de la Santé, Libreville, Gabon
| | - Laurent Belec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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11
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Chikandiwa A, Kelly H, Sawadogo B, Ngou J, Pisa PT, Gibson L, Didelot MN, Meda N, Weiss HA, Segondy M, Mayaud P, Delany-Moretlwe S. Prevalence, incidence and correlates of low risk HPV infection and anogenital warts in a cohort of women living with HIV in Burkina Faso and South Africa. PLoS One 2018; 13:e0196018. [PMID: 29715305 PMCID: PMC5929550 DOI: 10.1371/journal.pone.0196018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/04/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report the prevalence and incidence of low-risk human papillomavirus infection (LR-HPV) and anogenital warts (AGW) among women living with HIV (WLHIV) in Burkina Faso (BF) and South Africa (SA), and to explore HIV-related factors associated with these outcomes. METHODS We enrolled 1238 WLHIV (BF = 615; SA = 623) aged 25-50 years and followed them at three time points (6, 12 and 16 months) after enrolment. Presence of AGW was assessed during gynaecological examination. Cervico-vaginal swabs for enrolment and month 16 follow-up visits were tested for HPV infection by Inno-LiPA® genotyping. Logistic regression was used to assess risk factors for prevalent infection or AGW. Cox regression was used to assess risk factors for incident AGW. RESULTS Women in SA were more likely than those in BF to have prevalent LR-HPV infection (BF: 27.1% vs. SA: 40.9%; p<0.001) and incident LR-HPV infection (BF: 25.8% vs. SA: 31.6%, p = 0.05). Prevalence of persistent LR-HPV was similar in the two countries (BF: 33.3% vs. SA: 30.4%; p = 0.54), as were prevalence and incidence of AGW (Prevalence: BF: 7.5% vs. SA: 5.7%; p = 0.21; Incidence: BF: 2.47 vs. SA: 2.33 per 100 person-years; p = 0.41). HPV6 was associated with incident AGW (BF: adjusted Hazard Ratio (aHR) = 4.88; 95%CI: 1.36-17.45; SA: aHR = 5.02; 95%CI: 1.40-17.99). Prevalent LR-HPV (BF: adjusted Odds Ratio [aOR = 1.86]; 95%CI: 1.01-3.41; SA: aOR = 1.75; 95%CI: 0.88-3.48); persistent LR-HPV (BF: aOR = 1.92; 95%CI: 0.44-8.44; SA: aOR = 2.81; 95%CI: 1.07-7.41) and prevalent AGW (BF: aOR = 1.53; 95%CI: 0.61-3.87; SA: aOR = 4.11; 95%CI: 1.20-14.10) were each associated with low CD4+ counts (i.e. <200 vs. >500 cells/μL). Duration of ART and HIV plasma viral load were not associated with any LR-HPV infection or AGW outcomes. CONCLUSION LR-HPV infection and AGW are common in WLHIV in sub-Saharan Africa. Type-specific HPV vaccines and effective ART with immunological reconstitution could reduce the burden of AGW in this population.
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Affiliation(s)
- Admire Chikandiwa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Kelly
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bernard Sawadogo
- Centre de Recherche Internationale pour la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Jean Ngou
- INSERM, EFS, University of Montpellier, Montpellier, France
| | - Pedro T. Pisa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lorna Gibson
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Nicolas Meda
- Centre de Recherche Internationale pour la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Helen A. Weiss
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michel Segondy
- INSERM, EFS, University of Montpellier, Montpellier, France
| | - Philippe Mayaud
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Tian T, Mijiti P, Bingxue H, Fadong Z, Ainiwaer A, Guoyao S, Zhanlin Z, Mahan Y, Xiaoqin T, Zheng G, Jianghong D. Prevalence and risk factors of anal human papillomavirus infection among HIV-negative men who have sex with men in Urumqi city of Xinjiang Uyghur Autonomous Region, China. PLoS One 2017; 12:e0187928. [PMID: 29141014 PMCID: PMC5687769 DOI: 10.1371/journal.pone.0187928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/27/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Infection with human papillomavirus (HPV) is the most common sexually transmitted infection among men who have sex with men (MSM). Study on prevalence and risk factors of anal HPV infection among HIV-negative MSM in Northwestern China was rare. METHODS We performed a cross-sectional study of HPV prevalence using anal swab specimens among HIV-negative MSM in Urumqi city of Xinjiang Uyghur Autonomous Region, China between April 1st and October 30th in 2016. Prevalence of any anal HPV infection, high-risk and low-risk HPV infection was estimated. Risk factors associated with any anal HPV infection was analyzed using univariate and multivariate logistic regression models. RESULTS Among 538 potential participants, 500(92.9%) were recruited in this study. The genotyping results of anal HPV infection were available for all. Of them, 259 (51.8%), 190 (38.0%) and 141(28.2%) were positive for at least one of the targeted 37 HPV genotypes, high-risk HPV genotypes, and any low-risk HPV genotypes. The most prevalent anal HPV genotype was HPV 6(11.8%), followed by HPV 16(11.2%), HPV 11(10.8%), HPV 51(7.0%) and HPV 18(5.4%).Among those infected with at least one of the targeted 37 anal HPV genotypes, 75(29.0%), 155(59.8%) and 191(73.7%) were infected with 2-valent, quadrivalent and 9-valent HPV vaccine-covered genotypes. Receptive anal intercourse in the past year was the only predictor of any anal HPV infection in multivariate logistic regression model. CONCLUSION Prevalence of any anal HPV infection and high-risk HPV infection among HIV-negative MSM in Urumqi city of Xinjiang is high. The majority of genotypes detected in our study were covered by quadrivalent and 9-valent HPV vaccines. Regular anal exams and early HPV vaccination among MSM may be considered in future HPV prevention programs in Xinjiang, China.
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Affiliation(s)
- Tian Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Peierdun Mijiti
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Huang Bingxue
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhang Fadong
- Surgery Department of Toutunhe District General Hospital, Urumqi, Xinjiang, China
| | - Abidan Ainiwaer
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Sang Guoyao
- Clinical Laboratory of Xinjiang Medical University First Affiliated Hospital, Urumqi, Xinjiang, China
| | - Zhang Zhanlin
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yeledan Mahan
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tuo Xiaoqin
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Gong Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Dai Jianghong
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
- * E-mail:
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13
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Sudenga SL, Nyitray AG, Torres BN, Silva R, Villa L, Lazcano-Ponce E, Abrahamsen M, Baggio ML, Salmeron J, Quiterio M, Giuliano AR. Comparison of anal HPV natural history among men by country of residence: Brazil, Mexico, and the United States. J Infect 2017; 75:35-47. [PMID: 28363585 PMCID: PMC6640845 DOI: 10.1016/j.jinf.2017.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Globally, anal cancer incidence is rare, but is increasing in some world regions. Our objective was to assess differences in anal HPV natural history in three countries. METHODS Men aged 18-70 years were recruited from the US (n = 634), Mexico (n = 665), and Brazil (n = 731). Anal specimens were collected every six-months. HPV genotyping was assessed by Linear Array. Anal HPV prevalence was compared using the Fisher's exact test. HPV infection incidence rates (IR) and 95% confidence intervals (CI) were calculated. RESULTS Any anal HPV prevalence was highest among men from Brazil (24%) compared to Mexico (15%) and the US (15%). When stratified by sexual history, the prevalence of any HPV among MSM/MSMW was 43%, 37%, and 45% and 9%, 12%, and 10% for MSW from Brazil, Mexico, and US, respectively. Any HPV incidence was significantly higher among men from Brazil compared to US men (IRR = 2.4, 95% CI = 1.7-3.4) and comparable between men from Mexico and the US (IRR = 1.2, 95% CI = 0.8-1.8). CONCLUSION Men in Brazil and Mexico often have similar, if not higher incidence of anal HPV compared to men from the U.S., and may benefit from gender neutral HPV vaccine policies.
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Affiliation(s)
- Staci L Sudenga
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA; Division of Epidemiology, Vanderbilt University, Nashville, TN, USA
| | - Alan G Nyitray
- Center for Infectious Disease, The University of Texas School of Public Health at Houston, TX, USA
| | - B Nelson Torres
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Roberto Silva
- Centro de Referência e Treinamento em DST/AIDS, São Paulo, Brazil
| | - Luisa Villa
- School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Lazcano-Ponce
- Center for Translational Investigation in Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Martha Abrahamsen
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Maria Luiza Baggio
- Center for Translational Investigation in Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA.
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Affiliation(s)
- F Bouscarat
- Service de dermatologie, hôpital Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| | - F Pelletier
- Service de dermatologie, maladies sexuellement transmissibles, allergologie et explorations, hôpital Jean-Minjoz, CHRU, 2, boulevard Fleming, 25030 Besançon, France
| | - S Fouéré
- 41, boulevard Henri-IV, 75004 Paris, France
| | - M Janier
- Centre clinique et biologique des MST, hôpital Saint-Louis, 42, rue Bichat, 75010 Paris, France
| | - A Bertolloti
- Service de dermatologie, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - F Aubin
- Service de dermatologie, maladies sexuellement transmissibles, allergologie et explorations, hôpital Jean-Minjoz, CHRU, 2, boulevard Fleming, 25030 Besançon, France
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15
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Nicol AF, Brunette LL, Nuovo GJ, Grinsztejn B, Friedman RK, Veloso VG, Cunha CB, Coutinho JR, Vianna-Andrade C, Oliveira NS, Woodham AW, DA Silva DM, Kast WM. Secretory Leukocyte Protease Inhibitor Expression and High-Risk HPV Infection in Anal Lesions of HIV-Positive Patients. J Acquir Immune Defic Syndr 2016; 73:27-33. [PMID: 27149102 PMCID: PMC4981526 DOI: 10.1097/qai.0000000000001049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate secretory leukocyte protease inhibitor (SLPI) expression in anal biopsies from HIV-positive (HIV+) individuals, and compare that to anal intraepithelial neoplasia (AIN) diagnoses and human papillomavirus (HPV) status. DESIGN This is a cross-sectional study of a cohort of 54 HIV+ (31 males and 23 females) from an AIDS clinic in Rio de Janeiro, Brazil. METHODS The study material consisted of anorectal tissue biopsies obtained from HIV+ subjects, which were used to construct tissue microarray paraffin blocks for immunohistochemical analysis of SLPI expression. Biopsies were evaluated by an expert pathologist and classified as low-grade AIN1, high-grade AIN2/3, or normal squamous epithelium. In addition, DNA from the biopsies was extracted and analyzed for the presence of low- or high-risk HPV DNA. RESULTS Histologically, normal squamous epithelium from the anorectal region showed strong positive SLPI staining in 17/20 (85%) samples. In comparison, 9/17 (53%) dysplastic squamous epithelial samples from AIN1 patients showed strong SLPI staining, and only 5/17 (29%) samples from AIN2/3 patients exhibited strong SPLI staining, which both were significantly fewer than those from normal tissue (P = 0.005). Furthermore, there was a significantly higher proportion of samples in which oncogenic high-risk HPV genotypes were detected in low SLPI-expressing tissues than that in tissues with high SLPI expression (P = 0.040). CONCLUSIONS Taken together these results suggest that low SLPI expression is associated with high-risk HPV infections in the development of AIN.
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Affiliation(s)
- Alcina F Nicol
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laurie L Brunette
- Norris Comprehensive Cancer Center, Departments of Obstetrics & Gynecology and Molecular Microbiology & Immunology, University of Southern California, Los Angeles, California, USA
| | - Gerard J Nuovo
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Beatriz Grinsztejn
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ruth K Friedman
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdiléa G Veloso
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cynthia B Cunha
- LabClin DST/AIDS, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - José R Coutinho
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cecilia Vianna-Andrade
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Nathalia S Oliveira
- Laboratory of Interdisciplinary Medical Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Andrew W Woodham
- Norris Comprehensive Cancer Center, Departments of Obstetrics & Gynecology and Molecular Microbiology & Immunology, University of Southern California, Los Angeles, California, USA
| | - Diane M DA Silva
- Norris Comprehensive Cancer Center, Departments of Obstetrics & Gynecology and Molecular Microbiology & Immunology, University of Southern California, Los Angeles, California, USA
| | - W Martin Kast
- Norris Comprehensive Cancer Center, Departments of Obstetrics & Gynecology and Molecular Microbiology & Immunology, University of Southern California, Los Angeles, California, USA
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16
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Lee CH, Lee SH, Lee S, Cho H, Kim KH, Lee JE, Jung EJ, Lee SJ, Kim EJ, Kim KH, Moon E, Cho HJ. Anal Human Papillomavirus Infection among HIV-Infected Men in Korea. PLoS One 2016; 11:e0161460. [PMID: 27548632 PMCID: PMC4993367 DOI: 10.1371/journal.pone.0161460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/05/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Little is known about the epidemiology on human papillomavirus (HPV) infection among HIV-infected men in Korea. The objective of this study was to determine the prevalence, genotype distribution and risk factors associated with anal HPV infection among HIV-infected men in Korea. METHODS A single-center cross-sectional study was conducted with HIV-infected men in Korea. Participants completed a detailed sexual behavior risk factor questionnaire. Anal samples were collected for cytology and HPV genotyping. Factors associated with anal HPV infection were assessed using multivariable logistic regression, stratifying by sexual behaviour. RESULTS A total of 201 HIV-infected men were included in the study: 133 were from men who have sex with men (MSM) and 68 from men who have sex with women (MSW). Any anal HPV infection was detected in 82.7% of HIV-infected MSM and in 51.5% of HIV- infected MSW (P < 0.001). High-risk HPV (HR-HPV) prevalence was higher among MSM (47.4%) than MSW (25.0%; P = 0.002). The HR-HPV types identified most frequently were HPV 16 (11%), HPV 18 (9.9%), and HPV 58 (5%) in MSM, and HPV 58(11%) and HPV 16 (8.9%) in MSW. Prevalence of any HPV types in 9-valent vaccine types was higher among MSM than MSW (47.4% vs 22.1%. P = 0.001). Abnormal anal cytology was more commonly detected in MSM than MSW (42.9% vs.19.1%, P < 0.001). In HIV-infected MSM, higher number of lifetime male sex partners was significantly associated with any anal HPV infection, but age was a significant risk factor associated with anal HR-HPV infection. CONCLUSION Anal HPV infection was highly prevalent in HIV-infected MSM in Korea, and also commonly found in HIV-infected MSW. In HIV-infected MSM, the significant risk factor for being infected with any HPV infection was lifetime number of male sexual partners, and with anal oncogenic HPV infection was age.
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Affiliation(s)
- Chang Hun Lee
- Department of Pathology, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
- * E-mail:
| | - Shinwon Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Heerim Cho
- Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kye-Hyung Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jung Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun ju Jung
- Department of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Su jin Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan Pusan National University Hospital, Geongsangnam-do, Korea
| | - Eun Jung Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan Pusan National University Hospital, Geongsangnam-do, Korea
| | - Ki Hyung Kim
- Department of Obstetrics & Gynecology, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Hong Je Cho
- Department of Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
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17
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Renzi A, Giordano P, Renzi G, Landolfi V, Del Genio A, Weiss EG. Buschke-Lowenstein Tumor Successful Treatment by Surgical Excision Alone: A Case Report. Surg Innov 2016; 13:69-72. [PMID: 16708158 DOI: 10.1177/155335060601300111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perianal giant condyloma acuminatum is a rare variant of condyloma acuminata and often represents a therapeutic challenge. We report a case successfully treated with surgical excision alone.
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Affiliation(s)
- Adolfo Renzi
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA
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18
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Zhao L, Fang F, Carey F, Wang QQ. A case of condyloma acuminata with giant and multiple lesions on the vulva and breast: successfully treated with surgical operations. Int J STD AIDS 2016; 15:199-201. [PMID: 15038869 DOI: 10.1258/095646204322916678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of a 24-year-old female patient with a history of giant and multiple lesions of condylomata acuminata on the vulva and breasts which were treated by surgical excision.
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Affiliation(s)
- Liang Zhao
- Department of Dermatological Surgery, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, 12 Jiang-wang-miao Road, Nanjing 210042, Jiangsu Province, China.
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Ruanpeng D, Chariyalertsak S, Kaewpoowat Q, Supindham T, Settakorn J, Sukpan K, Utaipat U, Miura T, Kosashunhanan N, Saokhieo P, Songsupa R, Wongthanee A. Cytological Anal Squamous Intraepithelial Lesions Associated with Anal High-Risk Human Papillomavirus Infections among Men Who Have Sex with Men in Northern Thailand. PLoS One 2016; 11:e0156280. [PMID: 27227684 PMCID: PMC4882004 DOI: 10.1371/journal.pone.0156280] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 05/11/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anal cancer, one of human papillomavirus (HPV) related malignancies, has increased in recent decades, particularly among men who have sex with men (MSM) and HIV-infected (HIV+) persons. We aimed to explore the prevalence of anal squamous intraepithelial lesions (ASIL) using Papanicolau (Pap) screening among MSM in northern Thailand and its associated factors. METHODS Two hundreds MSM aged ≥18 years reporting receptive anal intercourse in the prior 6 months were recruited from July 2012 through January 2013. Medical history and behavioral data were collected by staff interview and computer-assisted self interview. Anal Pap smear, HPV genotyping, and HIV testing were performed. Two pathologists blinded to HPV and HIV status reported cytologic results by Bethesda classification. RESULTS Mean age was 27.2 years (range 18-54). Overall, 86 (43.0%) had ASIL: 28 (14.2%) with atypical cells of undetermined significance (ASCUS), 1 (0.5%) with atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H), 56 (28.4%) with low-grade squamous intraepithelial lesion (LSIL), and 1 (0.5%) with high-grade squamous intraepithelial lesion (HSIL). ASIL was associated by univariate analysis (p ≤0.05) with older age, gender identity other than bisexual (i.e., gay men and transgender women), rectal douching, anal symptoms, genital warts, HIV positivity, and high-risk-HPV infection. However, on multiple logistic regression ASIL was associated only with high-risk HPV type (p = 0.002) and HIV infection (p = 0.01). CONCLUSIONS ASIL is quite common in high-risk MSM in northern Thailand and is associated with high-risk HPV types and HIV infection. Routine anal Pap screening should be considered, given the high frequency of ASIL, particularly in the HIV+. High resolution anoscopy (HRA), not done here, should be to confirm PAP smears whose sensitivity and specificity are quite variable. Timely HPV vaccination should be considered for this population.
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Affiliation(s)
- Darin Ruanpeng
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
| | - Quanhathai Kaewpoowat
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Taweewat Supindham
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Jongkolnee Settakorn
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kornkanok Sukpan
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Utaiwan Utaipat
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Toshiyuki Miura
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | | | - Pongpun Saokhieo
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Radchanok Songsupa
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Antika Wongthanee
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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20
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Handisurya A, Lázár S, Papay P, Primas C, Haitel A, Horvat R, Tanew A, Vogelsang H, Kirnbauer R. Anogenital Human Papillomavirus Prevalence is Unaffected by Therapeutic Tumour Necrosis Factor-alpha Inhibition. Acta Derm Venereol 2016; 96:494-8. [PMID: 26581127 DOI: 10.2340/00015555-2298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients receiving tumour necrosis factor alpha (TNF-α) inhibitors are at increased risk of exacerbation of (myco-)bacterial and some viral infections. However, information on anogenital human papillomavirus (HPV) infection in these patients is sparse or conflicting. In this study 222 patients with psoriasis or inflammatory bowel disease (IBD), who received either anti-TNF-α inhibitors or alternatives (purine-, folic acid analogues, phototherapy, fumaric ester, mesalazine) continuously for at least 6 months, were evaluated for the presence of anogenital HPV-induced lesions, mucosal HPV DNA, and serological status of mucosal low-risk HPV6 and high-risk HPV16/HPV18. Hallmarks of anogenital HPV infection were more frequently detected in patients with psoriasis than in those with IBD. HPV-induced lesions, viral DNA, and seroprevalence were not elevated in participants with psoriasis or IBD, who received TNF-α inhibitors for a mean duration of 31.4 months (range 6-96 months) compared with recipients of alternative or no treatment. TNF-α blockade for a mean period of 31.4 months does not increase detectable anogenital HPV infection or disease.
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21
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Sasaki A, Nakajima T, Egashira H, Takeda K, Tokoro S, Ichita C, Masuda S, Uojima H, Koizumi K, Kinbara T, Sakamoto T, Saito Y, Kako M. Condyloma acuminatum of the anal canal, treated with endoscopic submucosal dissection. World J Gastroenterol 2016; 22:2636-2641. [PMID: 26937152 PMCID: PMC4768210 DOI: 10.3748/wjg.v22.i8.2636] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/19/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papilloma virus infection. Not all individuals develop persistent, progressive disease, but careful follow up is required with moderate-to-severe dysplasia to prevent progression to malignancy. Standard therapies include surgical treatments (trans-anal resection and trans-anal endoscopic microsurgery) and immunotherapeutic and topical methods (topical imiquimod); however, local recurrence remains a considerable problem. Here, we report a case with superficial CA of the anal canal, treated with endoscopic submucosal dissection (ESD). A 28-year-old man presented with a chief complaint of hematochezia. Digital exam did not detect a tumor. Screening colonoscopy revealed 10-mm long, whitish condyles extending from the anal canal to the lower rectum. The lesion covered almost the whole circumference, and only a small amount of normal mucosa remained. Magnifying endoscopy with narrow band imaging showed brownish hairpin-shaped, coiled capillaries. Although histopathological diagnosis by biopsy revealed CA, accurate histological differentiation between CA, papilloma, and squamous cell carcinoma can be difficult with a small specimen. Therefore, we performed diagnostic ESD, which provides a complete specimen for precise histopathological evaluation. The pathological diagnosis was CA, with moderate dysplasia (anal intraepithelial neoplasia 2). There was no recurrence at 16 mo after the initial ESD. Compared to surgical treatment, endoscopic diagnosis and resection could be performed simultaneously and the tumor margin observed clearly with a magnifying chromocolonoscopy, resulting in less recurrence. These findings suggest that endoscopic resection may be an alternative method for CA that prevents recurrence.
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22
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Nagata N, Watanabe K, Nishijima T, Tadokoro K, Watanabe K, Shimbo T, Niikura R, Sekine K, Akiyama J, Teruya K, Gatanaga H, Kikuchi Y, Uemura N, Oka S. Prevalence of Anal Human Papillomavirus Infection and Risk Factors among HIV-positive Patients in Tokyo, Japan. PLoS One 2015; 10:e0137434. [PMID: 26368294 PMCID: PMC4569050 DOI: 10.1371/journal.pone.0137434] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/17/2015] [Indexed: 12/13/2022] Open
Abstract
Background Oncogenic human papillomavirus (HPV) infection, particularly multiple HPV types, is recognized as a necessary cause of anal cancer. However, a limited number of studies have reported the prevalence of anal HPV infection in Asia. We determined the prevalence, genotypes, and risk factors for anal HPV infection in Japanese HIV-positive men who have sex with men (MSM), heterosexual men, and women. Methods This cross-sectional study included 421 HIV-positive patients. At enrollment, we collected data on smoking, alcohol, co-morbidities, drugs, CD4 cell counts, HIV RNA levels, highly active anti-retroviral therapy (HAART) duration, sexually transmitted infections (STIs), and serological screening (syphilis, hepatitis B virus, Chlamydia trachomatis, Entamoeba histolytica). Anal swabs were collected for oncogenic HPV genotyping. Results Oncogenic HPV rate was 75.9% in MSM, 20.6% in heterosexual men, and 19.2% in women. HPV 16/18 types were detected in 34.9% of MSM, 17.7% of heterosexual men, and 11.5% of women. Multiple oncogenic HPV (≥2 oncogenic types) rate was 54.6% in MSM, 8.8% in heterosexual men, and 0% in women. In univariate analysis, younger age, male sex, MSM, CD4 <100, HIV viral load >50,000, no administration of HAART, and having ≥2 sexually transmitted infections (STIs) were significantly associated with oncogenic HPV infection, whereas higher smoking index and corticosteroid use were marginally associated with oncogenic HPV infection. In multivariate analysis, younger age (OR, 0.98 [0.96–0.99]), MSM (OR, 5.85 [2.33–14.71]), CD4 <100 (OR, 2.24 [1.00–5.01]), and having ≥2 STIs (OR, 2.81 [1.72–4.61]) were independently associated with oncogenic HPV infection. These 4 variables were also significant risk factors for multiple oncogenic HPV infection. Conclusions Among Japanese HIV-infected patients, approximately two-thirds of MSM, one-fifth of heterosexual men, and one-fifth of women have anal oncogenic HPV infection. Younger age, MSM, ≥2 STIs, and immunosuppression confer a higher risk of infection with oncogenic HPV and multiple oncogenic types.
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Affiliation(s)
- Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | - Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Nishijima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Koji Watanabe
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Ryota Niikura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsunori Sekine
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junichi Akiyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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23
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Supindham T, Chariyalertsak S, Utaipat U, Miura T, Ruanpeng D, Chotirosniramit N, Kosashunhanan N, Sugandhavesa P, Saokhieo P, Songsupa R, Siriaunkgul S, Wongthanee A. High Prevalence and Genotype Diversity of Anal HPV Infection among MSM in Northern Thailand. PLoS One 2015; 10:e0124499. [PMID: 25932915 PMCID: PMC4416722 DOI: 10.1371/journal.pone.0124499] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/02/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HPV infection is common and may cause cancer among men who have sex with men (MSM). Anal HPV infection (HPV+) was found in 85% of HIV-positive (HIV+) and 59% of HIV-negative (HIV-) MSM in Bangkok, central Thailand. As little is known about HPV in this group in northern Thailand, we studied MSM subgroups comprised of gay men (GM), bisexual men (BM), and transgender women (TGW). METHODS From July 2012 through January 2013, 85 (42.5% of 200) GM, 30 (15%) BM, and 85 (42.5%) TGW who practiced receptive anal intercourse were recruited after informed consent, followed by self-assisted computer interview, HIV testing, and anal swabs for HPV genotyping. RESULTS Of 197 adequate specimens, the overall prevalence of any HPV was 157 (80%). Prevalence was 89% (76/85) in GM, 48% (14/29) in BM, and 81% (67/83) in TGW. The most common high-risk types were HPV16 (27% of 197), HPV58 (23%), and HPV51 (18%). Prevalence of high-risk types was 74% in 85 GM, 35% in 29 BM, and 71% in 83 TGW. Prevalence of any HPV type, or high-risk type, was 100% and 94%, respectively, among 48 HIV+ MSM, 70% and 54% among 120 HIV- MSM. Of the 197 specimens, 36% (70) had HPV types 16 and/or 18 in the bivalent vaccine, compared to 48% (95) with ≥1 of types 16/18/06/11 in the quadrivalent, 56% (111) for 16/18/31/33/45/52/58 in the 7-valent, and 64% (126) for 16/18/31/33/45/52/58/06/11 in the 9-valent. HIV+, GM, and TGW were independently associated with HPV infection. CONCLUSIONS We found higher rates of both any HPV and high-risk types than previous studies. Among the heretofore unstudied TGW, their equivalent HPV rates were comparable to GM. Current and investigational HPV vaccines could substantially protect GM, BM, and TGW from the serious consequences of HPV infection especially among HIV + MSM.
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Affiliation(s)
- Taweewat Supindham
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
| | - Utaiwan Utaipat
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Toshiyuki Miura
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Darin Ruanpeng
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Pongpun Saokhieo
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Radchanok Songsupa
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sumalee Siriaunkgul
- Depart of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Antika Wongthanee
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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Hood JE, Gottlieb GS, Kiviat NB, Sow PS, Toure M, Feng Q, Hawes SE. The association between HPV, intraepithelial lesions and HIV-1 shedding in anogenital specimens in two contrasting populations: Senegalese women and American MSM. Int J STD AIDS 2015; 27:353-62. [PMID: 25914409 DOI: 10.1177/0956462415580691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/15/2015] [Indexed: 11/15/2022]
Abstract
In light of observational evidence showing an association between human papillomavirus (HPV) and HIV acquisition risk, the potential of HPV vaccination as a HIV prevention strategy is being considered. However, the relationship between HPV and HIV infectiousness is unclear. In this analysis, the relationship between HPV and anogenital HIV shedding (a proxy for transmissibility) was assessed in two diverse populations: HIV-infected Senegalese women and American men who have sex with men (MSM). Data from two longitudinal studies with similar protocols were analysed. In both studies, anogenital specimens underwent cytologic, HPV DNA, and HIV-1 RNA testing. Analyses utilised multivariable generalised estimating equations that controlled for age, hormonal contraceptive use (women only), plasma viral load, CD4 count and treatment status. Among Senegalese women, cervical lesions were significantly associated with the detection of HIV RNA (aRR = 1.16 [1.05, 1.28]) and log10 cervicovaginal fluids viral load (adjusted β = 0.56 [0.12, 1.01]). No association was detected between HPV (of any type) and cervicovaginal HIV shedding (aRRDetection = 0.90 [0.77, 1.06]; βQuantity = -0.31 [-0.78, 0.16]). Among MSM, having multiple HPV infections (versus no HPV infection) was associated with anal HIV shedding (aRRDetection = 1.05 [1.01, 1.09]; βQuantity = 0.11 [0.01, 0.21]). Anal lesions were not associated with anal HIV shedding (aRRLESIONS = 0.99 [0.96, 1.03], βLESIONS = -0.05 [-0.13, 0.03]). Although HPV and intraepithelial lesions were associated with anogenital HIV shedding in crude analyses, the measures of effect were attenuated in adjusted analyses. Our data suggest that the prevention of HPV through vaccination is unlikely to substantially affect HIV infectiousness among persons living with HIV.
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Affiliation(s)
- Julia E Hood
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nancy B Kiviat
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Papa Salif Sow
- Department of Infectious Diseases, University of Dakar, Dakar, Senegal
| | - Macoumba Toure
- Department of Infectious Diseases, University of Dakar, Dakar, Senegal
| | - Qinghua Feng
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA
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25
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Porbunderwala SJ, Stanley JD, Lorenzo-Rivero S. Management of severe perianal herpes. Am Surg 2015; 81:E136-E137. [PMID: 25760195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Steven J Porbunderwala
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee, USA
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Assi R, Hashim PW, Reddy VB, Einarsdottir H, Longo WE. Sexually transmitted infections of the anus and rectum. World J Gastroenterol 2014; 20:15262-15268. [PMID: 25386074 PMCID: PMC4223259 DOI: 10.3748/wjg.v20.i41.15262] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/22/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
Sexually transmitted infections (STIs) represent a significant public health concern. Several STIs, once thought to be on the verge of extinction, have recently reemerged. This change is thought to be partially related to an increase in STIs of the anus and rectum. Importantly, the global human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) epidemic has contributed to the emergence of particular anorectal lesions that require specialized approaches. In this report, we review common anorectal STIs that are frequently referred to colorectal surgeons in the United States. Epidemiology, clinical presentation, and management are summarized, including the latest treatment recommendations. The particularity of anorectal diseases in HIV/AIDS is addressed, along with recent trends in anal cytology and human papillomavirus vaccination.
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Abstract
BACKGROUND 30% of people with anogenital warts (AGW) have spontaneous regression of lesions but there is no way to determine whether a specific lesion will remain. There are a wide range of options available for treating people with AGW and selection is based on clinician's experience, patient preferences and adverse effects. The imiquimod could offer the advantages of patient-applied therapies without incurring the limitations of provider-administered treatments. OBJECTIVES To assess the effectiveness and safety of imiquimod for the treatment of AGW in non-immunocompromised adults. SEARCH METHODS We searched the Cochrane Sexually Transmitted Infections Group Specialized Register (15 April 2014), CENTRAL (1991 to 15 April 2014), MEDLINE (1946 to 15 April 2014), EMBASE (1947 to 15 April 2014), LILACS (1982 to 15 April 2014), World Health Organization International Clinical Trials Registry (ICTRP) (15 April 2014), ClinicalTrials.gov (15 April 2014), Web of Science (2001 to 15 April 2014) and OpenGrey (15 April 2014). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing the use of imiquimod with placebo, any other patient-applied or any other provider-administered treatment (excluding interferon and 5-fluorouracil which are assessed in other Cochrane Reviews) for the treatment of AGW in non-immunocompromised adults. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We resolved any disagreements through consensus. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS Ten RCTs (1734 participants) met our inclusion criteria of which six were funded by industry. We judged the risk of bias of the included trials as high. Six trials (1294 participants) compared the use of imiquimod versus placebo. There was very low quality evidence that imiquimod was superior to placebo in achieving complete and partial regression (RR 4.03, 95% CI 2.03 to 7.99; RR 2.56, 95% CI 2.05 to 3.20, respectively). When compared with placebo, the effects of imiquimod on recurrence (RR 2.76, 95% CI 0.70 to 10.91), appearance of new warts (RR 0.76, 95% CI 0.58 to 1.00) and frequency of systemic adverse reactions (RR 0.91, 95% CI 0.63 to 1.32) were imprecise. We downgraded the quality of evidence to low or very low. There was low quality evidence that imiquimod led to more local adverse reactions (RR 1.73, 95% CI 1.18 to 2.53) and pain (RR 11.84, 95% CI 3.36 to 41.63).Two trials (105 participants) compared the use of imiquimod versus any other patient-applied treatment (podophyllotoxin and podophyllin). The estimated effects of imiquimod on complete regression (RR 1.09, 95% CI 0.80 to 1.48), partial regression (RR 0.77, 95% CI 0.40 to 1.47), recurrence (RR 0.49, 95% CI 0.21 to 1.11) or the presence of local adverse reactions (RR 1.24, 95% CI 1.00 to 1.54) were imprecise (very low quality evidence). There was low quality evidence that systemic adverse reactions were less frequent with imiquimod (RR 0.30, 95% CI 0.09 to 0.98).Finally, two trials (335 participants) compared imiquimod with any other provider-administered treatment (ablative methods and cryotherapy). There was very low quality of evidence that imiquimod did not have a lower frequency of complete regression (RR 0.84, 95% CI 0.56 to 1.28). There was very low quality evidence that imiquimod led to a lower rate of recurrence during six-month follow-up (RR 0.24, 95% CI 0.10 to 0.56) but this did not translate in to a lower recurrence from six to 12 months (RR 0.71, 95% CI 0.40 to 1.25; very low quality evidence). There was very low quality evidence that imiquimod was associated with less pain (RR 0.30, 95% CI 0.17 to 0.54) and fewer local reactions (RR 0.55, 95% CI 0.40 to 0.74). AUTHORS' CONCLUSIONS The benefits and harms of imiquimod compared with placebo should be regarded with caution due to the risk of bias, imprecision and inconsistency for many of the outcomes we assessed in this Cochrane Review. The evidence for many of the outcomes that show imiquimod and patient-applied treatment (podophyllotoxin or podophyllin) confer similar benefits but fewer systematic reactions with the Imiquimod, is of low or very low quality. The quality of evidence for the outcomes assessing imiquimod and other provider-administered treatment were of very low quality.
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Affiliation(s)
- Carlos F Grillo‐Ardila
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics & Gynecology and Clinical Research InstituteCarrera 30 No 45‐03BogotaColombia
| | - Edith Angel‐Müller
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics & GynecologyCra 30 # 45‐03BogotaColombia
| | - Luis C Salazar‐Díaz
- Faculty of Medicine, Universidad Nacional de ColombiaClinical Research InstituteBogotaColombia
| | - Hernando G Gaitán
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics & Gynecology and Clinical Research InstituteCarrera 30 No 45‐03BogotaColombia
| | - Ariel I Ruiz‐Parra
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics & Gynecology and Clinical Research InstituteCarrera 30 No 45‐03BogotaColombia
| | - Anne Lethaby
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand1142
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Mlakar B, Kocjan BJ, Hošnjak L, Fujs Komloš K, Milošević M, Poljak M. Betapapillomaviruses in the anal canal of HIV positive and HIV negative men who have sex with men. J Clin Virol 2014; 61:237-41. [PMID: 25097015 DOI: 10.1016/j.jcv.2014.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Betapapillomaviruses (β-PV) are etiologically associated with epidermodysplasia verruciformis and a proportion of skin precancerous lesions and cancer, mainly in immunocompromised individuals. OBJECTIVES The prevalence and persistence of anal β-PV infection and β-PV type distribution were determined in a cohort of men who have sex with men (MSM). A correlation with HIV-1 infection status and selected demographic and behavioral risk factors were additionally established. STUDY DESIGN A total of 181 anal swabs (135 initial and 46 follow-up swabs) obtained from 135 Slovenian MSMs (17.0% HIV-1 positive) were tested for the presence of 25 different β-PV types using Diassay RHA Kit Skin (beta) HPV assay and, if negative, with an in-house nested M(a)/H(a) PCR. RESULTS β-PVs were detected in 88/135 (65.2%) initial anal swabs. Infection with multiple β-PV types was found in 26 samples; the number of β-PVs ranged from 2 to 9. A total of 29 distinct β-PVs were detected: HPV-36 and HPV-38 were the most prevalent, followed by HPV-23, HPV-24, and HPV-93. HIV-1 positive status, promiscuity and use of alkyl nitrites were significantly associated with a higher prevalence of anal β-PV infection. Three partial DNA sequences suggesting putative new HPV types were identified. CONCLUSION To the best of our knowledge, this is the first study to investigate and characterize β-PV infections in the anal region. We showed that anal β-PV infection is highly prevalent in the MSM population and that β-PVs can establish persistent infection in the anal region for up to 4.8 years.
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Affiliation(s)
- Boštjan Mlakar
- Department of Surgery, Rožna dolina Surgical Centre, Ljubljana, Slovenia; Department of Proctology, Surgical Centre Zdrav Splet, Maribor, Slovenia
| | - Boštjan J Kocjan
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lea Hošnjak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kristina Fujs Komloš
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miloš Milošević
- Slovenj Gradec General Hospital, Department of General and Abdominal Surgery, Slovenj Gradec, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Swedish KA, Goldstone SE. Prevention of anal condyloma with quadrivalent human papillomavirus vaccination of older men who have sex with men. PLoS One 2014; 9:e93393. [PMID: 24714693 PMCID: PMC3979673 DOI: 10.1371/journal.pone.0093393] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/03/2014] [Indexed: 11/24/2022] Open
Abstract
Background The quadrivalent human papillomavirus vaccine (qHPV) is FDA-approved for use in males 9 to 26 years old to prevent anogenital condyloma. The objective of this study is to determine if qHPV is effective at preventing anal condyloma among men who have sex with men (MSM) aged 26 years and older. Methods This post-hoc analysis of a nonconcurrent cohort study evaluated 210 patients without history of anal condyloma and 103 patients with previously-treated anal condyloma recurrence-free for at least 12 months prior to vaccination/time zero. We determined the rate of anal condyloma development in vaccinated versus unvaccinated patients. Results 313 patients with mean age 42 years were followed for median 981 days. During 773.6 person-years follow-up, condyloma developed in 10 (8.6%) vaccinated patients (incidence of 3.7 per 100 person-years) and 37 (18.8%) unvaccinated patients (incidence 7.3 per 100 person-years; p = 0.05). Multivariable hazards ratio showed that qHPV was associated with decreased risk of anal condyloma development (HR 0.45; 95% CI 0.22–0.92; p = 0.03). History of anal condyloma was associated with increased risk of anal condyloma development (HR 2.28; 95% CI 1.28–4.05; p = 0.005), as was infection with oncogenic HPV (HR 3.87; 95% CI 1.66–9.03; p = 0.002). Conclusions Among MSM 26 years of age and older with and without history of anal condyloma, qHPV reduces the risk of anal condyloma development. A randomized controlled trial is needed to confirm these findings in this age group.
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Affiliation(s)
- Kristin A. Swedish
- Department of Internal Medicine, Montefiore Medical Center, Bronx, New York, United States of America
| | - Stephen E. Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
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Abstract
Although human papillomavirus (HPV) infections are common in HIV-infected adults, little is known about children. Our objective was to examine the prevalence of and risks for HPV of the oral mucosal and external genital areas in nonsexually active (NSA) perinatally (P) HIV+ children and compare with HIV-exposed but uninfected (HEU) children. A convenience sample attending a pediatric clinic were enrolled. Samples for HPV were obtained from the oral and anogenital areas and tested for one of 37 HPV types. The mean age of the 48 PHIV+ children was 14.3±3.9 years vs. 6.2±4.8 for the 52 HEU (p<0.001). Of the 23 PHIV+ girls, 30.4% had anogenital and 17% had oral HPV, and of the 27 HEU girls, 2 (7.4%) anogenital and 0 had oral HPV. Of the boys, 4/23 (17.4%) and 1/25 (4%) PHIV+ had anogenital and oral HPV, respectively, and 3/24 (12.5%) and 1/25 (4%) HEU had anogenital and oral HPV, respectively. Rates of HPV did not differ by age among the PHIV+, whereas older HEU were more likely to have HPV than younger HEU (p=0.07). This large age gap precluded statistical comparison by HIV status. The presence of HPV in NSA PHIV+ children may have implications regarding HPV vaccination efficacy.
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Affiliation(s)
- Anna-Barbara Moscicki
- 1 Division of Adolescent Medicine, Department of Pediatrics, University of California San Francisco , San Francisco, California
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Abstract
Based on a growing need for unified terminology to describe the pathologic and clinical spectrum of lesions, the American Society for Colposcopy and Cervical Pathology and the College of American Pathologists Pathology and Laboratory Quality Center convened the Lower Anogenital Squamous Terminology (LAST) Project to reassess and harmonize the terminology used to describe human papillomavirus-associated squamous lesions of the lower anogenital tract as manifested in a variety of end organs. The distinction between cancer precursors and those without malignant potential leads to consistency in the interpretation of management guidelines and the therapeutic options.
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Affiliation(s)
- Tomas Nuño
- The Clinical Outcomes and Comparative Effectiveness Research Fellowship Program, The Arizona Cancer Center, Center of Excellence in Women's Health, University of Arizona, Tucson, AZ 85724-5024, USA
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Zhang X, Yu J, Li M, Sun X, Han Q, Li M, Zhou F, Li X, Yang Y, Xiao D, Ruan Y, Jin Q, Gao L. Prevalence and related risk behaviors of HIV, syphilis, and anal HPV infection among men who have sex with men from Beijing, China. AIDS Behav 2013; 17:1129-36. [PMID: 22076229 DOI: 10.1007/s10461-011-0085-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Specific risk behaviors related to different sexually transmitted infections have not been widely evaluated among men who have sex with men in China. In the present study, a total of 302 MSM were recruited from Beijing with a prevalence of HIV, syphilis, and anal HPV infection as 9.9, 19.2 and 71.4%, respectively. Lower education level was observed to be related to higher infection rate of HIV and syphilis. "Ever found sexual partners in gay venues" was significantly associated with HIV infection as well. "Taking anilinction as regular sexual behavior" was observed to be a significant predictor for anal HPV infection.
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Affiliation(s)
- Xiangjun Zhang
- Xicheng District Center for Disease Prevention and Control, Beijing, 100029, China
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Fujs Komloš K, Košorok P, Kocjan BJ, Poljak M. Genetic diversity of HPV-6 in concurrent multiple anogenital warts. Acta Dermatovenerol Alp Pannonica Adriat 2013; 22:31-33. [PMID: 23674183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Anogenital warts (AGW) are the most common benign tumors in the anogenital area. They are etiologically associated with alpha human papillomaviruses (HPV), in more than 90% of cases with HPV-6 and HPV-11. AGW frequently displays a multifocal and multicentric appearance. However, it is not clear whether the occurrence of multiple AGW in a particular patient is a consequence of infection with single or multiple HPV genomic variants of a given HPV genotype. METHODS Forty-five HPV-6 isolates from fresh-frozen AGW tissue specimens, obtained from 18 patients with concurrent multiple AGW, were included. The entire HPV-6 L1, E5a, E5b ORFs, and LCR genomic region was sequenced. RESULTS Fourteen different HPV-6 L1-LCR-E5a-E5b genomic variants were identified among 18 patients with concurrent multiple AGW. In 17 out of 18 patients, a single identical HPV-6 L1-E5a-E5b-LCR genomic variant was identified in all concurrent multiple AGW collected in an individual patient. Co-infection with two different HPV-6 genomic variants was identified in one patient. DISCUSSION The presence of an identical HPV genomic variant in all concurrently present multiple AGW within an individual patient supports the hypothesis that the occurrence of multiple concurrent AGW is a consequence of infection with a single HPV-6 genomic variant, rather than infection with multiple genomic variants of HPV-6.
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Affiliation(s)
- Kristina Fujs Komloš
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, SI-1105 Ljubljana, Slovenia
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Sehnal B, Driák D, Neumannová H, Kolařík D, Menzlová E, Sláma J. [Prevalence of anal human papillomavirus infection among women and its relation to cervical HPV infection]. Ceska Gynekol 2012; 77:210-214. [PMID: 22779720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To summarize current knowledge of prevalence, duration and clearance of anal HPV infection among women and its relation to cervical HPV infection. DESIGN Review article. SETTING Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Institute for the Care of Mother and Child, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague. RESULTS The infection of human papillomavirus (HPV) is strongly associated with the development of anal cancer. Anal HPV infection is common and most anal HPV infections are transient. Women with cervical HPV infection, cervical dysplasia and cervical cancer are at the increased risk. Concurrent anal and cervical HPV infection is most prevalent among the youngest women. By contrast, the prevalence of anal infection alone remains relatively steady in all age groups. Compared with cervical infections, the overall distribution of HPV genotypes in the anus are more heterogeneous and include a greater proportion of nononcogenic types. A high degree of genotype-specific concordance is observed among concurrent anal and cervical infections, indicating a common source of infection. Tobacco smoking delays clearance of anal HPV. CONCLUSION The high degree of genotype-specific concordance suggests that the cervix may be primary source and may serve as reservoir of HPV infection, too. Any type of sexual contact may be a route of transmission, history of anal intercourse is not a condition. The women with HPV related disease of low genital tract form high-risk group for acquisition of anal HPV infection and development of anal carcinoma.
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Affiliation(s)
- B Sehnal
- Gynekologicko-porodnicka klinika, Univerzity Karlovy.
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Hernandez BY, Ka'opua LS, Scanlan L, Ching JA, Kamemoto LE, Thompson PJ, Zhu X, Shvetsov YB, Tofaeono J, Williams VT. Cervical and anal human papillomavirus infection in adult women in American Samoa. Asia Pac J Public Health 2012; 25:19-31. [PMID: 22652246 DOI: 10.1177/1010539511410867] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The prevalence of cervical and anal human papillomavirus (HPV) and risk factors associated with infections were evaluated in a cross-sectional study of 211 adult women in American Samoa. Overall, 53% of women reported ever having a Pap smear. Cervical and anal HPV was detected in 10% and 16% of women, respectively; 4% of women had concurrent cervical and anal HPV. The most common cervical genotypes were HPV 6, HPV 16, and HPV 53. Cutaneous HPV types were detected in 40% of anal infections. Cervical HPV infection was associated with anal HPV (age-adjusted odds ratio = 3.32, 1.10-10.00). After age adjustment, cervical HPV was associated with being unmarried, postsecondary education, hot running water at home, multiple sexual partners, nulliparity, condom use, and other contraceptive methods. In multivariate analyses, only age remained associated with cervical HPV and anal HPV. Cervical and anal HPV was more prevalent among younger women; only anal HPV was detected in older women.
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Palefsky JM, Giuliano AR, Goldstone S, Moreira ED, Aranda C, Jessen H, Hillman R, Ferris D, Coutlee F, Stoler MH, Marshall JB, Radley D, Vuocolo S, Haupt RM, Guris D, Garner EIO. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med 2011; 365:1576-85. [PMID: 22029979 DOI: 10.1056/nejmoa1010971] [Citation(s) in RCA: 599] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The rate of anal cancer is increasing among both women and men, particularly men who have sex with men. Caused by infection with human papillomavirus (HPV), primarily HPV type 16 or 18, anal cancer is preceded by high-grade anal intraepithelial neoplasia (grade 2 or 3). We studied the safety and efficacy of quadrivalent HPV vaccine (qHPV) against anal intraepithelial neoplasia associated with HPV-6, 11, 16, or 18 infection in men who have sex with men. METHODS In a substudy of a larger double-blind study, we randomly assigned 602 healthy men who have sex with men, 16 to 26 years of age, to receive either qHPV or placebo. The primary efficacy objective was prevention of anal intraepithelial neoplasia or anal cancer related to infection with HPV-6, 11, 16, or 18. Efficacy analyses were performed in intention-to-treat and per-protocol efficacy populations. The rates of adverse events were documented. RESULTS Efficacy of the qHPV vaccine against anal intraepithelial neoplasia associated with HPV-6, 11, 16, or 18 was 50.3% (95% confidence interval [CI], 25.7 to 67.2) in the intention-to-treat population and 77.5% (95% CI, 39.6 to 93.3) in the per-protocol efficacy population; the corresponding efficacies against anal intraepithelial neoplasia associated with HPV of any type were 25.7% (95% CI, -1.1 to 45.6) and 54.9% (95% CI, 8.4 to 79.1), respectively. Rates of anal intraepithelial neoplasia per 100 person-years were 17.5 in the placebo group and 13.0 in the vaccine group in the intention-to-treat population and 8.9 in the placebo group and 4.0 in the vaccine group in the per-protocol efficacy population. The rate of grade 2 or 3 anal intraepithelial neoplasia related to infection with HPV-6, 11, 16, or 18 was reduced by 54.2% (95% CI, 18.0 to 75.3) in the intention-to-treat population and by 74.9% (95% CI, 8.8 to 95.4) in the per-protocol efficacy population. The corresponding risks of persistent anal infection with HPV-6, 11, 16, or 18 were reduced by 59.4% (95% CI, 43.0 to 71.4) and 94.9% (95% CI, 80.4 to 99.4), respectively. No vaccine-related serious adverse events were reported. CONCLUSIONS Use of the qHPV vaccine reduced the rates of anal intraepithelial neoplasia, including of grade 2 or 3, among men who have sex with men. The vaccine had a favorable safety profile and may help to reduce the risk of anal cancer. (Funded by Merck and the National Institutes of Health; ClinicalTrials.gov number, NCT00090285.).
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Affiliation(s)
- Joel M Palefsky
- Department of Medicine, University of California at San Francisco, Box 0654, San Francisco, CA 94143, USA.
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Altinay-Kirli E, Güçer S, Karnak I. Perianal giant condyloma acuminata in an infant: an alarming lesion for a pediatric surgeon. Turk J Pediatr 2011; 53:333-336. [PMID: 21980819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Condyloma acuminatum (CA), which is a large cauliflower-like tumor, has been linked to human papilloma virus (HPV) types associated with skin warts. It is an uncommon condition in children, and there is no consensus regarding the optimal treatment. HPV may be acquired via sexual transmission, vertical transmission or extragenital contact. We report herein a 1.5-year-old girl with perianal giant CA, which developed due to extragenital contact and consisted of HPV types 6 and 18, to emphasize the effectiveness of surgical excision.
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Affiliation(s)
- Elif Altinay-Kirli
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Abstract
Background Anal HPV infection, which contributes to the development of anal warts and anal cancer, is well known to be common among men who have sex with men (MSM), especially among those HIV positives. However, HIV and anal HPV co-infection among MSM has not been addressed in China. Methods A cross-sectional study was conducted in Beijing and Tianjin, China. Study participants were recruited using multiple methods with the collaboration of local volunteer organizations. Blood and anal swabs were collected for HIV-1 serological test and HPV genotyping. Results A total of 602 MSM were recruited and laboratory data were available for 578 of them (96.0%). HIV and anal HPV prevalence were 8.5% and 62.1%, respectively. And 48 MSM (8.3%) were found to be co-infected. The HPV genotypes identified most frequently were HPV06 (19.6%), HPV16 (13.0%), HPV52 (8.5%) and HPV11 (7.6%). Different modes of HPV genotypes distribution were observed with respect to HIV status. A strong dose-response relationship was found between HIV seropositivity and multiplicity of HPV genotypes (p<0.001), which is consistent with the observation that anal HPV infection was an independent predictor for HIV infection. Conclusions A high prevalence of HIV and anal HPV co-infection was observed in the MSM community in Beijing and Tianjin, China. Anal HPV infection was found to be independently associated with increased HIV seropositivity, which suggests the application of HPV vaccine might be a potential strategy to reduce the acquisition of HIV infection though controlling the prevalence of HPV.
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Affiliation(s)
- Lei Gao
- State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (GL); (JQ)
| | - Feng Zhou
- State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangwei Li
- State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Yang
- State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qi Jin
- State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (GL); (JQ)
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Lebwohl MG, Rosen T, Stockfleth E. The role of human papillomavirus in common skin conditions: current viewpoints and therapeutic options. Cutis 2010; 86:1-12. [PMID: 21214125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A direct causal relationship between human papillomavirus (HPV) infection and cervical neoplasia is well-accepted, but the specific role of HPV in the pathogenesis of other cutaneous disorders is less clear. This article explores the role of HPV in 2 common disorders associated with considerable morbidity: external genital and perianal warts (EGWs) and actinic keratosis (AK). Because the potential role of HPV in the pathogenesis of EGW and AK may have implications that influence management, the available topical pharmacotherapy for each disorder also is reviewed. External genital and perianal warts represent a possible phenotypic expression of HPV infection and results from hyperkeratosis and hyperplasia of keratinocytes. The cell cycle disruption caused by low-risk anogenital HPV subtypes (eg, HPV-6, HPV-11) is similar to high-risk HPV subtypes, except low-risk HPV E6 and E7 proteins likely bind regulatory proteins with less affinity. Although UV light clearly has a primary causal role in the development of AK, new data suggest that HPV infection, particularly with 3-HPV subtypes, may serve as a cocarcinogen. By impairing normal DNA repair and apoptotic mechanisms, HPV may set the stage for later UV-induced transformation. It also has been suggested that HPV may increase the severity of AK lesions and contribute to their recurrence following therapy.
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Affiliation(s)
- Mark G Lebwohl
- Department of Dermatology, Mt. Sinai School of Medicine, New York, New York, USA
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Gingelmaier A, Weissenbacher T, Kost B, Kaestner R, Sovric M, Mylonas I, Friese K, Bergauer F. Anal cytology as a screening tool for early detection of anal dysplasia in HIV-infected women. Anticancer Res 2010; 30:1719-1723. [PMID: 20592367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND AIM HIV-infected patients show a high rate of anal dysplasia and anal carcinoma but there is no gold standard for early detection. Therefore, the objectives of this prospective study were: a) evaluation of an anal screening using anal/perianal cytology; b) in case of a positive result to investigate its relation to immune status, clinical symptoms of HIV infection and antiretroviral therapy. PATIENTS AND METHODS In every HIV-infected woman visiting our gynaecological outpatient clinic, an anal and perianal swab for anal cytology was taken. One experienced cytologist examined all specimens. Relevant details of the HIV-related history such as CDC classification, CD4 count, viral load, actual antiretroviral therapy etc. were documented. RESULTS Altogether, 104 HIV-infected women were enrolled on this study. The results of 13 (13.5%) anal cytologies were classified as suspicious for low-grade or high-grade anal dysplasia and 6 of these were confirmed in an anal biopsy. A total of 9 out of 13 also had a cervical dysplasia and 12 were positive for high-risk HPV at the cervix. Ten of these women had already experienced clinical symptoms of their HIV infection and 8 showed a nadir of the CD4 count below 200 cells/microl. All but one took a highly active antiretroviral therapy. CONCLUSION In this pilot study, anal screening using anal cytology showed 13.5% suspected anal dysplasia in HIV-infected women. All performed biopsies revealed the presence of a high-grade anal lesion. The majority of these women already had an advanced disease and/or immune defect related to their HIV infection. In summary, we found anal cytology to be a useful tool to early detect anal dysplasia of high-risk patients such as HIV-infected women. How far this screening method contributes to the prevention of anal cancer has to be evaluated in further investigations.
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Affiliation(s)
- Andrea Gingelmaier
- Department of Obstetrics and Gynecology, Downtown Campus, Ludwig Maximilians University, Munich, Germany.
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Wolf R, Wolf D, Davidovici B. Mothers with anogenital HPV should avoid breastfeeding: myth or...? Skinmed 2010; 8:177-178. [PMID: 21137626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Ronni Wolf
- Dermatology Unit, Kaplan Medical Center, Rechovot, affiliated with the Hebrew University--Hadassah Medical School, Jerusalem, Israel.
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Delbello A, Colli C, Martínez TDR, Trevisan G. Anal canal and rectal condylomatosis: exhaustive proctological examination and STD patients. Acta Dermatovenerol Alp Pannonica Adriat 2010; 19:13-16. [PMID: 20372768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Infection of the anorectal area with some subtypes of HPV virus results in local involvement that appears as warty, papillary, condylomatous lesions. Patients exposed to high-risk HPV types, such as HPV-16, -18, and -31, are at risk for developing high-grade dysplasias or carcinomas. We reviewed 15 years (1991 - 2006) of patient records from our proctological unit and STD center and found 1,122 patients affected by anorectal condylomatosis. This study supports the importance of an exhaustive proctological examination in patients suffering from condylomatosis of the genital area, especially of the perianal zone, and in patients examined in the STD clinic, even for other reasons. An unknown anorectal condylomatosis is a frequent cause of relapse of anogenital warts. Anal warts should be examined by proctoscopy to assess the full extent of the lesions and prevent possible complications.
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Affiliation(s)
- A Delbello
- Coloproctology Unit, Sanatorio Triestino, Trieste, Italy
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HPV infection screening is important for HIV MSM. HIV & HPV connection studied. AIDS Alert 2009; 24:113-4. [PMID: 20034136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Park IU, Ogilvie JW, Anderson KE, Li ZZ, Darrah L, Madoff R, Downs L. Anal human papillomavirus infection and abnormal anal cytology in women with genital neoplasia. Gynecol Oncol 2009; 114:399-403. [PMID: 19501896 DOI: 10.1016/j.ygyno.2009.05.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 05/07/2009] [Accepted: 05/08/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Describe the type-specific prevalence of anal HPV infection in women with lower genital tract intraepithelial neoplasia and cancer. Describe the prevalence of abnormal anal cytology and identify risk factors for anal HPV infection and abnormal anal cytology in this population. METHODS We performed a cross-sectional study of women attending 2 university-based colposcopy clinics with high-grade lower genital tract intraepithelial neoplasia or cancer. Participants received anal HPV testing/typing, anal cytology and completed a questionnaire detailing medical history and sexual behavior. RESULTS Of the 102 women enrolled, 92 (90%) had adequate beta-globin for analysis of HPV DNA status, and 47/92 women (51%) had detectable anal HPV. Of the 15 HPV types identified, 9 (60%) were oncogenic types and 6 (40%) were non-oncogenic or undetermined risk types. Overall, 9 women (9%) had abnormal anal cytology, and 7 of those had corresponding anal intraepithelial neoplasia grade I (AIN I). Women with vulvar disease had the highest proportion of abnormal anal cytology (21%) compared to women with cervical disease alone (7%), but this difference was not statistically significant (p=0.10). Neither anal HPV infection nor abnormal cytology was significantly associated with anal sex practices, smoking or number of sexual partners. CONCLUSIONS Anal infection with high-risk HPV types is common in women with high-grade genital neoplasia, but was not associated with known risk factors for genital HPV infection. Other unidentified risk factors may play a role in the anal HPV infection in this population. Abnormal anal cytology was rare and larger studies are needed to identify risk factors associated with abnormal cytology and anal intraepithelial neoplasia in this population.
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Affiliation(s)
- Ina U Park
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis MN, USA.
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Diamantis ML, Bartlett BL, Tyring SK. Safety, efficacy & recurrence rates of imiquimod cream 5% for treatment of anogenital warts. Skin Therapy Lett 2009; 14:1-5. [PMID: 19609471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Imiquimod 5% cream (Aldara, Graceway Pharmaceuticals) is an immune response modifier used for the topical treatment of anogenital warts in non-HIV-infected patients. Several randomized controlled trials have demonstrated that imiquimod 5% cream is a safe and efficacious treatment. Current data regarding efficacy shows that complete clearance of warts occurred in up to 50% of patients treated with imiquimod 5% cream applied once-daily, 3 times per week for up to 16 weeks. Recurrence rates ranged from up to 19% at 3 months to 23% at 6 months. Imiquimod 5% cream showed an acceptable safety profile; local inflammatory reactions were the most frequent adverse effects, with local erythema being the most common.
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Affiliation(s)
- M L Diamantis
- The University of Texas Medical School at Houston, Houston, TX, USA
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Abstract
The objective of this study was to investigate the possible relationship between the presence of anogenital warts (AGW) in children and the sexual abuse as mode of transmission. Our series includes 8 patients with AGW who were treated in our hospital during the year 2007. A complete physical examination was carried out, including colposcopy or anoscopy, and samples were taken for histopathological examination and human papiloma virus (HPV) subtyping. We considered perinatal transmission as a possible route in two cases. Although sexual abuse was definitively confirmed in only one case, we observed some findings in four cases that led us to consider the possibility of sexual abuse. We did not consider the possibility of heteroinoculation or autoinoculation from common warts in any case. Our results have demonstrated the difficulty in assessing with certainty the source of HPV contamination in children with AGW.
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Affiliation(s)
- J Mataix Díaz
- Servicio de Dermatología, Hospital General Universitario de Alicante, Centro de Salud Los Angeles, Alicante, España.
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Dianzani C, Pierangeli A, Avola A, Borzomati D, Persichetti P, Degener AM. Intra-anal condyloma: surgical or topical treatment? Dermatol Online J 2008; 14:8. [PMID: 19265621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Human Papillomavirus infections are the strongest risk factors for genital cancer and are the causative agents of anogenital warts. Although the viral types associated with condylomata usually do not cause carcinoma, in women with a history of these lesions there is an increased risk of intraepithelial neoplasia and cancer. Generally the lesions are not life-threatening, but they provoke significant morbidity, are difficult to treat, and are a source of psychosocial stress. Thus, condylomata represent not only a health problem for the patient but also an economic burden for the society. Considering the individual episodes of care, men experience a longer duration of the lesions and incur greater costs than women. We report a case of a male patient with external and intra-anal condyloma resistant to laser therapy. Initially, surgical intervention appeared required because of florid and intra-anal growth. HPV DNA testing and sequencing revealed the presence of HPV 6. After initial discomfort, the lesions were successfully cleared with topical imiquimod 5 percent cream therapy.
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Affiliation(s)
- Caterina Dianzani
- Department of Dermatology, "Campus Biomedico," University of Rome, Italy.
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Anderson J, Hoy J, Hillman R, Gittleson C, Hartel G, Medley G, Basser R. Abnormal anal cytology in high-risk human papilloma virus infection in HIV-infected Australians. Sex Transm Infect 2008; 84:94-6. [PMID: 17881414 DOI: 10.1136/sti.2007.027250] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the prevalence of abnormal anal cytology and high-risk human papilloma virus (HPV)-type infection in HIV-infected people with a CD4 cell count >300 cells/microl. METHODS The clinic-based patient population included 126 HIV-infected people: 124 men who have sex with men, and two women (median age 45 years; CD4 cell count >300 cells/microl). Anal cytology swabs were placed into liquid-based medium for HPV typing by Hybrid Capture-2 assay and cytological assessment, by a single cytopathologist. RESULTS 106 (84%) participants were infected with high-risk HPV; 17 (14%) had no high-risk types of HPV detected; three (2%) had no HPV assay result because of an inadequate sample. Sixteen (13%) participants had cytological evidence of high-grade squamous intraepithelial (HGSIL) changes, 100% of whom had high-risk HPV types detected, and 13 (10%) had atypical squamous cells of undetermined significance with possible high-grade changes (ASCUS-H), 92% of whom had high-risk HPV types detected. Low-grade changes (LSIL) were detected in 24 (19%) participants, 96% of whom had high-risk HPV types, 32 (25%) had ASCUS with 88% high-risk HPV types, 30 (24%) had normal cytology with 73% high-risk HPV types, and 11 (9%) samples were inadequate for cytological assessment. The odds ratio of participants with high-risk HPV having abnormal anal cytology on anal swab was 5.03 (95% CI 1.45 to 17.39). DISCUSSION High-risk HPV types are common in this HIV+ population with a CD4 cell count >300 cells/microl. The presence of high-risk HPV types was associated with abnormal anal cytology such as HGSIL and ASCUS-H.
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Affiliation(s)
- J Anderson
- Carlton Clinic, 88 Rathdowne St, Carlton, Melbourne, Vic 3053, Australia
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