Anal human papillomavirus infection in HIV-positive men and women at two opportunistic infections clinics in Harare, Zimbabwe

Simbarashe Chinyowa,Marshall Munjoma,Rudo Makunike-Mutasa,Godfrey I Muguti,Joel M Palefsky,Zvavahera M Chirenje

doi:10.1186/s12889-018-6170-6

Abstract

BackgroundHIV-infected individuals are at increased risk of anal cancer; in the majority of cases this is linked to human papillomavirus (HPV) infection. Anal cancer screening is not routinely offered in Zimbabwe.MethodsA cross-sectional study was performed on 152 patients (88 females; 64 males) attending Opportunistic Infection Clinics at 2 tertiary hospitals between November 2014 and June 2015. Demographic data, immunological parameters and behavioural characteristics were collected. An anal swab was collected from each patient for HPV genotype testing. HPV testing was performed using MY09/MY11 PCR, followed by typing using the dot blot method.ResultsThe mean age was 39.6 years (range, 18–69 years). Median CD4 count was 375 cells/μL. 96% were on antiretroviral therapy. Only one patient identified as a man who has sex with men. Of 122 samples tested for HPV, 54 were positive (44%). HPV was three times more common in females (60%) than males (20%). Being HPV-positive was associated with history of perianal warts, history of cervical intraepithelial neoplasia and having more than ten lifetime sexual partners. The most commonly detected high-risk HPV genotypes were HPV-58 (13%), HPV-31 (11%) and HPV-16 (9%). Nine patients harboured multiple high-risk HPV types. The two most commonly detected low-risk genotypes were HPV-11 (17%) and HPV-53 (11%).ConclusionOverall anal HPV prevalence was 44% in this mostly heterosexual HIV-positive population. Oncogenic HPV types accounted for almost half of infections, supporting the need for surveillance of anal cancer in this population.

Highlights

Anal cancer is rare in the general population but is significantly more prevalent in high-risk groups such as men who have sex with men (MSM) and those infected with human immunodeficiency virus (HIV)
Patients visit the Opportunistic Infections Clinics (OIC) for HIV testing and counselling services, routine follow up of HIV disease, and fulfilment of prescribed antiretroviral drugs. 85% of patients enrolled at the OIC are on highly active antiretroviral therapy (HAART)
Overall human papillomavirus (HPV)-16 was found at a prevalence of 4% which is important because HPV-16 is one of the most consistent genotypes associated with anal cancer [11]

Summary

Introduction

Anal cancer is rare in the general population but is significantly more prevalent in high-risk groups such as men who have sex with men (MSM) and those infected with human immunodeficiency virus (HIV). In up to 90% of cases anal cancer is linked to human papillomavirus (HPV) infection [1]. There are numerous HPV genotypes and anal cancer in this population is most strongly linked to persistent HPV-16 and HPV-18 infection [3]. Data from other high-risk groups, in particular, African heterosexual males and females are relatively scant [4].The patterns of HPV infection, HPV clearance or progression to anal squamous intraepithelial lesions and cancer in this latter group are yet to be fully elucidated. HIV-infected individuals are at increased risk of anal cancer; in the majority of cases this is linked to human papillomavirus (HPV) infection.

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Discussion

Conclusion