Abstract
BackgroundAn association between HPV infection and progression to anal squamous intraepithelial lesions (ASIL) has been established, specifically in high-risk populations such as HIV-infected men. In this population, anal cancer is one of the most common non-AIDS-defining malignancies.MethodsA cross-sectional study to detect anal lesions and HPV infection was performed. Anal mucosa samples were collected from 56 HIV-infected men from Cuba. The cytological diagnosis was done according to Bethesda 2001 System. HPV DNA detection was determined by qPCR for six high-risk HPV types and end point PCR for low-risk HPV types (6 and 11). The end point PCR with nucleotide sequencing technique was achieved to detect other genotypes of HPV not included in the qPCR in those samples negative for HPV- 6 and 11 or negative for the six genotypes identified in the qPCR.ResultsCytological diagnosis identified 53 of 56 (95%) men with abnormal anal cytology. Among those, 26% (14/53) had atypical squamous cells of undetermined significance (ASC-US), 4% (2/53) had atypical squamous cells of undetermined significance cannot exclude high-grade lesions (ASC-H), 64% (34/53) had low-grade squamous intraepithelial lesions (LSIL), and 6% (3/53) had high-grade squamous intraepithelial lesions (HSIL). HPV DNA was detected in 89% (50/56) of men and 79% had at least one of the high-risk HPV types. HPV- 16 was the most common genotype (52%), while HPV-18 was the most frequently detected genotype in men with HSIL. We found statistically significant differences in the HPV viral loads with respect to the cytology results (p = 0.0006) and that the practice of receptive anal sex was a risk factor for anal HPV infection (p = 0.032).ConclusionThis study shows a high prevalence of ASIL and high-risk HPV infections in the study group and is the first study showing the distribution of HPV genotypes in HIV infected Cuban men with abnormal anal cytology. This information may be of importance for local decision makers to improve prevention strategies, including the introduction of HPV vaccine in Cuba.
Highlights
An association between human papillomavirus (HPV) infection and progression to anal squamous intraepithelial lesions (ASIL) has been established, in high-risk populations such as human immunodeficiency virus (HIV)-infected men
The end point PCR with nucleotide sequencing technique was achieved to detect other genotypes of HPV not included in the Quantitative real time polymerase chain reaction (qPCR) in those samples negative for HPV- 6 and 11 or negative for the six genotypes identified in the qPCR
In this study we found for the first time in Cuba, a high prevalence of high-risk HPV (HR-HPV) infection in anal mucosa of HIV infected men
Summary
An association between HPV infection and progression to anal squamous intraepithelial lesions (ASIL) has been established, in high-risk populations such as HIV-infected men. In this population, anal cancer is one of the most common non-AIDS-defining malignancies. While anal carcinoma is rare in the general population [1], it is one of the most common non-AIDS-defining malignancies in the era of combination antiretroviral therapy [2] It is more frequent among individuals with human immunodeficiency virus (HIV) infection, in men who have sex with men (MSM) [3]. Screening of anal precancerous lesions in HIV-infected MSM has been suggested to be important for cancer prevention [10]
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