Abstract
BackgroundA study including 166 subjects was performed to investigate the frequency and persistence over a 6-month interval of concurrent oral and anal Human Papillomavirus (HPV) infections in Human Immunodeficiency Virus (HIV)-infected men who have sex with men (MSM).MethodsPatients with no previously documented HPV-related anogenital lesion/disease were recruited to participate in a longitudinal study. Polymerase chain reaction (PCR) was performed to detect HPV from oral and anal swabs and to detect Human Herpes Virus 8 (HHV-8) DNA in saliva on 2 separate specimen series, one collected at baseline and the other collected 6 months later. A multivariate logistic analysis was performed using anal HPV infection as the dependent variable versus a set of covariates: age, HIV plasma viral load, CD4+ count, hepatitis B virus (HBV) serology, hepatitis C virus (HCV) serology, syphilis serology and HHV-8 viral shedding. A stepwise elimination of covariates with a p-value > 0.1 was performed.ResultsThe overall prevalence of HPV did not vary significantly between the baseline and the follow-up, either in the oral (20.1 and 21.3%, respectively) or the anal specimens (88.6 and 86.3%). The prevalence of high-risk (HR) genotypes among the HPV-positive specimens was similar in the oral and anal infections (mean values 24.3% and 20.9%). Among 68 patients with either a HR, low-risk (LR) or undetermined genotype at baseline, 75% had persistent HPV and the persistence rates were 71.4% in HR infections and 76.7% in LR infections. There was a lack of genotype concordance between oral and anal HPV samples. The prevalence of HR HPV in anus appeared to be higher in the younger patients, peaking (> 25%) in the 43-50 years age group. A decrease of the high level of anal prevalence of all genotypes of HPV in the patients > 50 years was evident. HHV-8 oral shedding was positively related to HPV anal infection (p = 0.0046). A significant correlation was found between the persistence of HHV-8 shedding and HIV viral load by logistic bivariate analysis (Odds Ratio of HHV-8 persistence for 1-log increase of HIV viral load = 1.725 ± 0.397, p = 0.018).ConclusionsA high prevalence of HPV infection was found in our cohort of HIV-infected MSM, with a negative correlation between anal HPV infection and CD4 cell count.
Highlights
A study including 166 subjects was performed to investigate the frequency and persistence over a 6month interval of concurrent oral and anal Human Papillomavirus (HPV) infections in Human Immunodeficiency Virus (HIV)-infected men who have sex with men (MSM)
41 oral swabs were not able to be evaluated by Polymerase chain reaction (PCR) due to inadequate sampling revealed by the inability to detect beta-globin in the DNA sample
In the present longitudinal study conducted among HIV-infected MSM, we have found a high prevalence of HPV infection in the anal area, both at initial screening (88.6%) and follow-up (86.3%)
Summary
A study including 166 subjects was performed to investigate the frequency and persistence over a 6month interval of concurrent oral and anal Human Papillomavirus (HPV) infections in Human Immunodeficiency Virus (HIV)-infected men who have sex with men (MSM). Human papillomavirus infections are among the most common sexually transmitted infections worldwide, representing a significant health problem due to their high prevalence and transmissibility. The incidence of anal cancer is high among women with a history of cervical dysplasia and cervical cancer, HIV-positive individuals, Men who have sex with Men (MSM) and transplant recipients [1]. Several studies have found high rates of anal HPV infections in HIV-infected patients [6,7,8,9]. MSM living with HIV are susceptible to HPV infection, often involving multiple strains of HPV
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