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

Neide Aparecida Tosato Boldrini,Paulo Roberto Merçon De Vargas,Carlos Musso,Lays Paula Bondi Volpini,Angelica Espinosa Miranda,Liliana Cruz Spano,Luciana Bueno De Freitas,Maria Lina Tornesello

doi:10.1371/journal.pone.0199058

Neide Aparecida Tosato Boldrini, Paulo Roberto Merçon De Vargas + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0199058

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Journal: PloS one	Publication Date: Jul 5, 2018
Citations: 16	License type: CC BY 4.0

Affiliation: Universidade Federal do Espírito Santo

Abstract

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

Highlights

Human papillomavirus (HPV) is a common sexually transmitted infection (STI)that can be categorized into two groups, low risk (LR-HPV) and high risk (HR-HPV) with respect to their risk of progression to malignancy [1]
The frequency of HR-HPV, HPV16/18 and multiple HPV infection were similar in both groups
The CD4 count >500 cells/mm3 was a protective factor for the HPV16/18 (p = 0.048) and multiple infections (p = 0.023), and the undetectable viral load and HAART treatment were both protective for any HPV (p = 0.010), HR-HPV (p = 0.091) and multiple infections (p = 0.006)

Summary

Introduction

Human papillomavirus (HPV) is a common sexually transmitted infection (STI)that can be categorized into two groups, low risk (LR-HPV) and high risk (HR-HPV) with respect to their risk of progression to malignancy [1]. Most sexually active individuals will acquire at least one genotype of anogenital HPV infection at some time during their lifetime [3], but there are some risk and behavioral factors that could increase the infection frequency or persistence of the virus [4]. Several co-infections, such as multiple HR-HPV or HIV coinfection could have a role in the higher probability of the progression of lesions [6]. The rate of anal cancer has been increasing over the years in patients at higher risk for persistence of HPV virus such as women with previous cervical lesions and in patients with some grade of immunosuppression, as transplanted and HIV positive [13,14,15,16]

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