Had Human Papillomavirus Research Articles

Association between HIV Serostatus and premalignant cervical lesions among women attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda: a comparative cross-sectional study

BackgroundUganda has approximately 1.2 million people aged 15–64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of premalignant cervical lesions among HIV-positive women than among HIV-negative women. Additionally, HIV-infected women are more likely to have human papilloma virus (HPV) infection progress to cancer than women not infected with HIV. We determined the prevalence of premalignant cervical lesions and their association with HIV infection among women attending a cervical cancer screening clinic at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.MethodsWe conducted a comparative cross-sectional study of 210 women aged 22–65 years living with HIV and 210 women not living with HIV who were systematically enrolled from March 2022 to May 2022. Participants were subjected to a structured interviewer-administered questionnaire to obtain their demographic and clinical data. Additionally, Papanicolaou smears were obtained for microscopy to observe premalignant cervical lesions. Multivariate logistic regression was performed to determine the association between HIV status and premalignant cervical lesions.ResultsThe overall prevalence of premalignant cervical lesions in the study population was 17% (n = 72; 95% C.I: 14.1–21.4), with 23% (n = 47; 95% C.I: 17.8–29.5) in women living with HIV and 12% (n = 25; 95% C.I: 8.2–17.1) in women not living with HIV (p < 0.003). The most common premalignant cervical lesions identified were low-grade squamous intraepithelial lesions (LSIL) in both women living with HIV (74.5%; n = 35) and women not living with HIV (80%; n = 20). HIV infection was significantly associated with premalignant lesions (aOR: 2.37, 95% CI: 1.27–4.42; p = 0.007).ConclusionPremalignant cervical lesions, particularly LSILs, were more common in HIV-positive women than in HIV-negative women, highlighting the need to strengthen the integration of cervical cancer prevention strategies into HIV care programs.

Attitude to cervical cancer screening and human papillomavirus testing experience in self-sampled Nigerian women.

Cervical cancer is a disease of major public health significance which can be prevented by adequate screening. This study assessed the level of cervical cancer knowledge, attitude to screening and human papillomavirus testing experience in women who self-sampled for cervical cancer screening. A descriptive cross-sectional study involving 790 women that had human papilloma virus (HPV) testing at the gynae-oncology unit of the Lagos State University Teaching Hospital. Participants were assessed of their cervical cancer screening knowledge, attitude and HPV testing experience. High risk HPV (hr-HPV) nucleic acid testing was funded by the Clinton Health Access Initiative. Majority (76.71%) of the respondents exhibited a high level of knowledge of cervical cancer, its causes, risk factors and prevention; and a positive experience with HPV self-sampling reported in 98.1%. hr-HPV positive rate was 13.4%. The most common reason (43%) for not having a cervical screening done was lack of a doctor's request. The most commonly known method of cervical screening by the respondents was Pap Smear test (55.31%). There is need for more education to improve the level of awareness and uptake of hr-HPV testing for cervical cancer in Lagos. Health care providers are not offering cervical cancer screening enough and this needs to be explored more in future studies.

Laryngectomy in Young Patients: A Case Series and Review of the Literature.

Background and objective The peak incidence of laryngeal cancer is seen in individuals aged over 65 years, with very few patientsunder 50 years developing advanced laryngeal cancer necessitating laryngectomy. Apart from often delayed diagnosis, this younger cohort faces a unique set of challenges related to fertility preservation, lower recruitment to clinical trials, and significant psychological impact. In light of this, this case series aimed to examine the various characteristics ofpatientsbelow the age of 50 years undergoing total laryngectomy. Methods We reviewed departmental records at the University College Hospital London, spanning a period of 10 years, to identify patients who underwent total laryngectomy under the age of 50 years. Results The group comprised a total of nine patients over the age of 10 years: five males and four females. Six (66.7%) patients were smokers, and two (22.2%) had human papillomavirus (HPV)-16-positive disease. These patients underwent a variety of operative techniques. The length of postoperative inpatient stay varied greatly, ranging from five to 44 days (mean: 23 days). Conclusion There appears to be a lower prevalence of classical risk factors in our younger cohort undergoing total laryngectomy, as well as a reduced incidence of HPV-16 and a higher proportion of females. We also bring to light the significant psychological impact that these younger patients face and highlight the key learning point that clinicians must be vigilant in investigating younger patients with suspicious symptoms, even in the absence of obvious risk factors. Although further research is needed,this series is unique in that currently there are no other papers outlining laryngectomies in apatient group aged below 50 years.

Challenges in Cervical Cancer Prevention: Real-World Scenario in India.

Satinder KaurIn spite of global falling trends, cervical cancer remains a major healthcare challenge for India, South Asia Association for Regional Cooperation region, and other low- and middle-income countries. Our survey was to document the real-world challenges that still exist in India. A total of 316 eligible and complete responses to the 21 questions were analyzed. Screening of mothers and vaccinating their daughters was considered as the most important strategy to prevent cervical cancer by 65.8% (208/316). Screening was offered to all asymptomatic eligible females by 79% (250/316). Improvement in screening rates requires promoting the national program (67.7%; 214/316), strengthening existing infrastructure (62%; 196/316), regular training of primary healthcare workers (57.6%; 182/316), and increasing awareness among schools and colleges (57.9%; 183/316). Almost all responders (93%; 294/316) wanted to have human papillomavirus (HPV) vaccination included in the national immunization schedule. Cost of vaccine was considered a major roadblock. If it became available at INR 250 per dose, 96.8% (306/316) respondents would recommend it for all eligible patients. With the impending availability of this indigenous tetravalent HPV vaccine jointly produced by Department of Biotechnology, Govt of India and Serum Institute of India, the war against cervical cancer just got easier.

Longitudinal Analysis of Swallowing Displacement Kinematics After Oropharyngeal Cancer Treatment.

Quantitative swallowing displacement kinematics evolve in patients treated for oropharyngeal squamous cell carcinoma (OPSCC). We aimed to longitudinally assess these measurements and correlate them with functional swallowing outcomes. A retrospective review was conducted on patients with OPSCC treated with definitive (chemo)radiation ([C]RT) or surgery with adjuvant (chemo)radiation (S-[C]RT) who completed at least two videofluoroscopic swallow studies (VFSS). Longitudinal analysis was accomplished via mixed-effects logistic regression for the Functional Oral Intake Scale (FOIS), and Penetration Aspiration Scale (PAS), and mixed-effects linear regression for kinematic measures. Spearman's correlation was conducted between changes in FOIS/PAS and kinematic measures. Ninety-seven patients (76 males; mean age 61) completed 245 VFSS studies. A total of 94% had human papillomavirus (HPV)/p16 positive OPSCC and 74% were T0-T2. Sixty-four patients underwent [C]RT while 33 patients underwent S-[C]RT. After treatment, posterior pharyngeal wall at hold (PPWhold) increased 3.2 standard deviation (SD) between 0 and 6 months (p < 0.001), then decreased 2.2 SD between 6 and 12 months (p < 0.001) and did not return to baseline. Hyoid-to-larynx (HL) (p=0.046) and maximal hyoid displacement (Hmax) + HL (p=0.042) increased between 6 and 12 months. Hmax (p=0.020) and Hmax + HL (p < 0.001) decreased between 12-24 months beyond baseline values. The decrease in HL and increase in PPWhold (p < 0.05) correlated with an increase in PAS. From baseline, increased pharyngeal constriction ratio correlated with decreased FOIS and PPWhold (p < 0.05). Quantitative swallowing kinematic measures can effectively track changes in swallowing physiology. Increased PPWhold and restricted hyolaryngeal movement were seen in patients with OPSCC after treatment and correlated with a change in swallowing outcome, emphasizing the need for serial VFSS monitoring and targeted intervention. 3 Laryngoscope, 133:1339-1348, 2023.

Induction chemoimmunotherapy followed by CD8+ immune cell-based patient selection for chemotherapy-free radioimmunotherapy in locally advanced head and neck cancer

PurposeThe first aim of the trial is to study feasibility of combined programmed death protein ligand 1/cytotoxic T-lymphocyte-associated protein 4 inhibition concomitant to radiotherapy. In addition, efficacy of the entire...

Utility of the High-Sensitivity Modified Glasgow Prognostic Scores for Oropharyngeal Carcinoma.

ObjectiveThere is increasing evidence that the high-sensitivity modified Glasgow prognostic scores are inflammatory indices that can predict survival for many cancer types. However, there is limited information regarding their prognostic values in cases of head and neck cancer. This study aimed to evaluate whether the high-sensitivity modified Glasgow prognostic scores could predict outcomes among patients with oropharyngeal squamous cell carcinoma (OPC).Study DesignRetrospective study.SettingUniversity hospital.MethodsWe reviewed the records of 106 patients with histologically confirmed OPC between March 2009 and June 2020. The high-sensitivity modified Glasgow prognostic scores were calculated as 0 (C-reactive protein [CRP] concentration: ≤0.3 mg/dL), 1 (CRP concentration >0.3 mg/dL and albumin concentration ≥3.5 mg/dL), or 2 (CRP concentration >0.3 mg/dL and albumin concentration <3.5 mg/dL). Univariate and multivariable Cox proportional hazard analyses were performed for overall survival (OS) and disease-free survival (DFS).ResultsForty-four of these patients had human papillomavirus (HPV)–positive OPC, and 62 had HPV-negative OPC, and these populations were analyzed separately. The high-sensitivity modified Glasgow prognostic score was significantly associated with age, performance status, and HPV. On univariate analysis, high-sensitivity modified Glasgow prognostic score showed associations with OS and DFS in both subpopulations. Moreover, on multivariable analysis, the high-sensitivity modified Glasgow prognostic score showed associations with OS and DFS in both subpopulations. Poor performance status predicted OS in both subpopulations.ConclusionWe conclude that the high-sensitivity modified Glasgow prognostic score is useful as an independent prognostic factor in OPC.

Laryngeal cancer in two non-consanguineous people (spouses): a case report

The objective is to report a rare case of laryngeal cancer in spouses. Case report. A 59-year-old female patient was admitted to the Department of Head and Neck Tumors in December 2019 with complaints of hoarseness. In 1997, she had radiotherapy for T1N0M0 laryngeal cancer. After comprehensive examination, she was diagnosed with recurrent laryngeal cancer. The patient has undergone frontolateral laryngeal resection. A 67-year-old male patient was admitted to the Department of Head and Neck Tumors in November 2019 with T3N0M0 laryngeal cancer (diagnosed 2 months before). He has undergone extended frontolateral laryngeal resection followed by radiotherapy in the postoperative period. Discussion. Both patients had no risk factors, such as occupational hazards or smoking. However, both spouses had close relatives with cancer, what indicates their genetic predisposition to malignant tumors. The female patient was found to have human papilloma virus (HPV) in the tumor cells, whereas her spouse was HPV-negative, although rapid histology showed indirect signs of HPV, which does not exclude the elimination of HPV. Conclusion. In this rare case of laryngeal cancer diagnosed in two non-consanguineous spouses, the disease is likely to be caused by their hereditary predisposition, HPV infection, and the fact that they lived in the same socioeconomic conditions.

The changing landscape of head and neck cancer radiotherapy patients: is high-risk, prolonged feeding tube use indicative of on-treatment weight loss?

IntroductionPrecision radiotherapy relies heavily on optimal weight management. Our group previously developed a risk stratification model for patients at risk of prolonged feeding tube (FT) intervention. The study objective was to assess on‐treatment weight loss according to stratified risk of prolonged FT use.MethodsOne hundred and one (n = 101) definitive head and neck radiotherapy patients were included in this study. Patients were stratified into high risk (HRi: T‐classification ≥ 3 with level 2 Nodal disease), high‐intermediate risk (HIRi: T‐classification ≥ 3 without level 2 Nodes) and low‐intermediate risk (LIRi: T‐classification < 3 with level 2 Nodes) of prolonged FT use. Demographic variables and on‐treatment weight loss were evaluated according to risk status.ResultsOropharyngeal carcinoma (OPC) was present in a larger proportion in the LIRi cohort (HRi: 71%, HIRi: 52%, LIRi: 81%, P = 0.008). LIRi patients were more likely to have human papilloma virus (HPV)‐associated disease (88%, P = 0.001). Never/minimal smoking (P = 0.003), good performance status (P < 0.001), healthy BMI (P = 0.050) and no pre‐existing dysphagia (P < 0.001) were predominant within the LIRi prognostic group. LIRi patients lost significantly more weight in total (HRi = 4.8% vs. LIRi = 8.2%, P = 0.002; HIRi = 5.2% vs. LIRi = 8.2%, P = 0.006) and when using a FT (HRi = 4.6% vs. LIRi = 8.8%, P < 0.001; HIRi = 5.3% vs. LIRi = 8.8%, P = 0.002).ConclusionsPatients identified as low‐intermediate risk of prolonged, ≥25% FT use report significantly increased weight loss compared with patients at higher risk of FT use. This cohort is typical of the increasing number of patients presenting with HPV‐associated OPC. Results of this study suggest we should closely observe such patients throughout treatment, to ensure optimal weight maintenance, facilitating precision radiotherapy.

Treatment of genital warts by using CO2 laser

Background: Genital wart is the most common viral sexually transmitted disease. In fact, its incidence is rising rapidly. It is approximated that 30%–50% of sexually active adult have human papillomavirus (HPV) infection, but only 1%–2% of them have apparent genital wart. Mostly, cervical dysplasia and cancer are associated with oncogenic HPV types. HPV types are classified into high-, intermediate-, and low-risk group. HPV Types 16 and 18 are considered as a high-risk group cancer-associated HPVs, whereas Types 6 and 11 concerned as a low risk and HPV types 31, 33, and 35 have an intermediate association with cancer. Objective: The objective of the study was designed to evaluate the activity of CO2 laser to treat genital warts of female Iraqi patients. Materials and Methods: Fifteen female patients with genital warts were involved in this study. Their age range from 22 to 49 years treated by CO2 laser at the Laser Medicine Research Clinics of Institute of Laser for Postgraduate Studies from July 2017 to end of July 2018. Application of topical lidocaine cream 10% for 30 min or local infiltration of 2% xylocaine had been performed. CO2 laser in chopped mode was used with a peak power: 151 watts and repeated time 35 s in D mode, pulse duration 1.3 ms. Treatments by vaporization of the warts were done in one session except one patient with a large number and multiple locations two sessions were done. Results: Three patients expressed mild pain during the procedure, but it could be tolerated by them. No edema or oozing observed during the 1st week. No postoperative infections or scars. Two cases of recurrence 2/15, (13.3%) after few months from treatment. Conclusion: CO2 laser vaporization is an effective and safe method for treatment of genital warts and can be done in the outpatient clinic.

Single-Arm Phase 2 Trial of Elective Nodal Dose Reduction for Patients With Locoregionally Advanced Squamous Cell Carcinoma of the Head and Neck

To evaluate a novel chemoradiation therapy (CRT) regimen for patients with squamous cell carcinoma of the head and neck (SCCHN) incorporating a lower intensity modulated radiation therapy dose to electively treated neck lymph nodes than is currently standard. Eligible patients had locally advanced SCCHN of the oral cavity, oropharynx, larynx, or hypopharynx. The 7-week CRT course consisted of weekly cisplatin at 35mg/m2 concurrently with sequential-boost intensity modulated radiation therapy: 36Gy to high- and low-risk planning target volumes followed by a sequential boost to the high-risk planning target volume to 70Gy. The primary endpoint was elective nodal failure. Secondary endpoints were survival, toxicity, feeding tube duration, and quality of life evaluated by the FACT-HN and QOL-RTI surveys. Between 2011 and 2014, 54 patients were enrolled, 31 (57%) of whom had human papillomavirus (HPV)-positive disease.Of the patients, 35 (65%) had stage IVa disease. The median follow-up period for survivors was 36months (range, 12-66months). Elective nodal failure did not develop in any patient. The actuarial 3-year survival rate for the entire cohort was 91% (95% confidence interval [CI] 0.79-0.96); for the HPV-negative group, 85% (95% CI 0.61-0.95); and for the HPV-positive group, 96% (95% CI 0.77-0.99). Common grade 3 toxicities were dysphagia (79%), mucositis and/or stomatitis (41%), nausea (20%), xerostomia (13%), vomiting (11%), and neutropenia (10%). The median feeding tube duration was 142days. Patient FACT-HN scores were higher at 3, 6, and 12months versus at the end of treatment (P < .0001). Total FACT-HN scores returned to pretreatment baseline by 6months. Overall QOL-RTI scores were lower from pretreatment to the end of treatment through 12months (P = .0001). This CRT regimen for patients with advanced SCCHN demonstrated the potential feasibility of reducing the elective dose to the neck, a topic that requires additional study in future clinical trials.

The impact of HPV infection on survival in a geographically defined cohort of oropharynx squamous cell carcinoma (OPSCC) patients in whom surgical treatment has been one main treatment

Conclusions: We determined that 55% of the patients with oropharynx squamous cell carcinoma (OPSCC) had human papilloma virus (HPV)-positive tumors. We demonstrated that HPV-positive patients had better 5-year disease-specific survival (DSS) than the HPV-negative counterparts. This was also primarily true for cancers originating in the tonsil or base of the tongue with T3 and/or N2 tumors. Objective: Urogenital high risk (hr) HPV is an important risk factor, and probably causative agent, for OPSCC. The study investigated these factors. Methods: We identified 232 patients with OPSCC, of which 186 lesions were from the tonsil or base of the tongue region, treated in the period 1992–2008 in Western Norway. Five-year DSS was recorded for all patients. Results: In all, 124 of 226 patients had HPV-positive tumors. All except five HPV-positive patients had HPV-16-positive tumors; 69% of the patients with tonsil or base of the tongue SCC had HPV-positive tumors, whereas 14% of remaining OPSCC patients had HPV-positive tumors. Five-year DSS with HPV-positive tumor was 77% compared with 53% with an HPV-negative tumor (p < 0.001), also valid with adjustment for age, gender, and TNM stage, but primarily determined with patients with the specific tumor sites tonsils and base of the tongue with TNM stages T3 or N2.

Transoral Robotic Surgery: A Population‐Level Analysis

(1) To determine baseline demographic, geographic, clinical, and pathologic characteristics of patients who had transoral robotic surgery (TORS) for oropharyngeal cancer. (2) To analyze margin status and unplanned readmission after TORS versus nonrobotic surgery. Retrospective database review. National Cancer Database (2010-2011). Searching the National Cancer Database for adults with oropharyngeal cancer, we identified 877 patients who had TORS and 4269 patients who had nonrobotic surgery. Outcomes of interest included likelihood of adjuvant therapy, margin status, and unplanned readmission. Statistical analysis included chi-square, t tests, and multivariate regression. From 2010 to 2011, there was a 67% increase in the use of TORS for oropharyngeal cancer. Compared with patients who had nonrobotic surgery, TORS patients were more likely to be at academic centers (80.8% vs 49.1%, P < .001), to have private insurance (62.2% vs 57.4%, P < .001), and to have human papilloma virus (HPV)-positive tumors (48.3% vs 27.1%, P < .001). TORS (odds ratio, 0.50; 95% CI, 0.39-0.63) and HPV positivity (odds ratio, 0.73; 95% CI, 0.53-0.99) were independently associated with decreased likelihood of adjuvant chemoradiation versus radiation therapy. TORS patients were less likely to have positive margins than were patients who had nonrobotic surgery (20.2% vs 31.0%, P < .001). High-volume TORS centers had lower rates of positive margins (15.8% vs 26.1%, P < .001) and unplanned readmissions (3.1% vs 6.1%, P < .03) than did low-volume centers. TORS is being rapidly adopted by academic and community cancer centers. TORS is associated with a lower rate of positive margins than nonrobotic surgery, and high-volume centers have the lowest rates of positive margins and unplanned readmissions.

Urinary cytopathologic findings in renal allograft recipients in Sudan: Trends, outcome and challenges

Urine cytology allows frequent monitoring of the intragraft events in renal transplantation and detection of infections associated with renal transplantation as a result of immunosuppression, specifically BK polyoma virus (Decoy cells). We conducted a cross-sectional study aimed to demonstrate the urinary cytomorphological changes among renal allograft recipients. We studied urine samples from 182 renal adult allograft recipients. All grafts were obtained from live donors. All the study population was under immunosuppressive drugs (Cyclosporine, Tacrolimus or azathioprine). Fourteen samples (7.6%) were collected during the first three months following transplantation. The slides of the centrifuged precipitates were stained with Papanicolaou and Diff Quick stains. The slides were screened by a cyto-screener and examined by a consultant cytopathologist for the presence of infectious agents and benign and malignant cellular changes. Of the 182 cases, 120 (65.9%) were negative for cytological changes, 45 (24.7%) showed bacterial infection, eight (4.4%) had BK polyoma virus infection (Decoy cells), four (2.2%) had human papilloma virus (HPV) infection (Koilocytosis) (Figure 1), three (1.6%) showed candida and two (1.1%) had cytomegalovirus infection. Renal transplant recipients are at a high risk for developing infections, including opportunistic infections; this is generally attributed to the immunosuppression status and epidemiologic exposure to infections. During the first posttransplantation year, 40–50% of recipients experience at least one infection. Smears consistent with bacterial infections were the most common finding in our study; they revealed polymorphs, macrophages, necrotic debris and background of bacteria. In our study, eight (4.4%) cases were diagnosed to have BK polyoma virus cytological changes (Decoy cells). Human polyoma viruses are members of the Papova virus family, which have a double strand DNA-genome. Recently, BK virus has been recognized as a cause of severe renal allograft dysfunction and potential graft loss, which are characterized by the presence of Decoy cells that were reported to present in 10–19.7% of urine samples from renal transplant (RT) patients.

Management of the Unknown Primary in the Era of HPV and Robotics

Objectives: A subset of patients with squamous cell carcinoma of the head and neck present with a cervical metastasis from an unknown primary site. Currently, many of these patients have human papillomavirus (HPV) positive tumors, making the oropharynx the most likely primary site. Objectives: 1) Develop a minimally invasive approach to identify and definitively treat patients initially diagnosed with carcinoma of unknown primary (CUP) using transoral robotic surgery (TORS). Additionally, we anticipate that this aggressive approach will yield the primary lesion in a higher subset of patients. Methods: A retrospective chart review study was conducted to evaluate a novel minimally-invasive management approach using TORS to assess the primary site. Results: We identified 12 patients with CUP of the head and neck that had undergone this approach from December 2011 to April 2012. Ten patients were classified as HPV positive using p16 staining as surrogate marker. The primary site was identified in 10 of 12 patients (83%), the majority of which was found to be the base of tongue. Conclusions: We have developed a minimally invasive surgical approach using TORS for the diagnosis and subsequent management of the patient with CUP. Using this algorithm, we are able to move from frozen section directly to an en bloc definitive resection in many patients. Our results show a significant rate of primary tumor identification using a robotic-assisted approach and support the rationale for further investigation of this technique.

Detection of Immunoglobulin G against E7 of Human Papillomavirus in Non-Small-Cell Lung Cancer

Background. A significant number of non-small-cell lung cancers (NSCLC) have human papillomavirus (HPV) DNA integrated in their genome. This study sought to further establish HPV's possible etiologic link to NSCLC by evaluating an immune response to HPV's oncogene, E7, in patients with NSCLC. Patients and Methods. Antibodies (IgG) in serum against E7 for HPV 16 and 18 in 100 patients with NSCLC were examined by enzyme-linked immunosorbent assay (ELISA). Results. Sixteen NSCLC patients were found to have a high titration of IgG for HPV oncogenic E7 protein. 23.5% of adenocarcinomas (AC,) and 15.4% of squamous cell carcinomas (SCC) were positive for IgG against HPV E7. HPV-18 (11%) had a slightly higher frequency than HPV-16 (6%). Of the six positive cases for HPV-16, 3 were AC, 2 SCC, and 1 NOS (not otherwise specified). For the 11 HPV-18 positives, 7 were AC, and 4 SCC. The one case with IgG against HPV 16 and 18 was AC. One case had high cross-reactive levels against E7 of HPV 16 and 18. Two (28%) of 7 patients who reported never smoking were positive for HPV, and 12 (13.6%) of 88 smokers were HPV positive. Conclusions. The study detected high levels of IgG against E7 in 16% of NSCLC patients. This adds evidence to a potential role of HPV in the pathogenesis of NSCLC.

The evaluation of older patients with cervical cancer

ObjectiveThe number of elderly patients being diagnosed with cervical cancer is increasing, and the outcome of cervical cancer related to age is controversial. We conducted a retrospective analysis in patients treated for advanced cervical cancer in order to investigate patient characteristics and prognosis of older patients.MethodsMedical records were collected of 159 patients with cervical cancer who had been treated with radiotherapy or combined radiotherapy and chemotherapy from January 2007 to January 2009. The patients were divided into two age groups: (1) patients ≥65 years old, and (2) patients <65 years old. There were 52 women in group 1, 107 in group 2. Prognosis, patient characteristics, treatment, and toxicities were evaluated.ResultsWith a median follow-up of 36.5 months, local control for groups 1 and 2 was 88.5% and 79.4%, respectively. Disease-free survival for the two groups was 71.2% and 67.3%; overall survival was 73.1% and 72.9%. As shown by univariate analyses, there was no statistically significant difference between the two groups (P > 0.05). Seventy-six patients had human papillomavirus (HPV) at diagnosis (twelve women ≥65 years, 64 women ≤65 years; P = 0.000). Forty-two women tested positive for HPV 16, while 32 women tested positive for HPV 18 respectively. Pelvic and/or paraaortic lymph-node metastasis was found in 25 patients (eight in group 1, 17 in group 2; P = 0.960) on computed tomography scan. Of the 159 patients analyzed, sixteen patients (16/52) in group 1 received concurrent chemotherapy, while 96 (96/107) in group 2 completed that treatment.ConclusionsCervical cancer has the same prognosis in old and young women. Age may not be an independent increased risk of death in women with cervical cancer, and the age-group is at lower risk for virulent HPV strands (HPV 16/18) compared to younger patients. Treatment recommendations were implemented less often for older patients. Radiotherapy remained the most common treatment chosen for elderly patients. This confirms that there is a stronger need to pay attention to the elderly patient.

Malakoplakia of the esophagus caused by human papillomavirus infection

Malakoplakia is a rare granulomatous disease probably caused by infection and characterized histologically by Michaelis-Gutmann bodies. We report a more rarely seen case esophageal malakoplakia in a 54-year-old woman. She presented with coughing while eating and drinking. Gastroscopy showed yellow nodules in the esophagus, and endoscopic ultrasonography showed a space-occupying lesion in the substratum of the esophageal mucosa. All findings highly resembled esophageal cancer. Histopathological examination finally indentified this space-occupying lesion as malakoplakia and not cancer. Immunohistochemistry showed that she had human papillomavirus (HPV) infection in the esophagus, which indicates that infection was responsible for the malakoplakia. This is believed to be the first case of malakoplakia in the esophagus, and more importantly, we established that HPV infection was the initiator of esophageal malakoplakia.

Male sex workers in Moscow, Russia: a pilot study of demographics, substance use patterns, and prevalence of HIV-1 and sexually transmitted infections

The Russian federation has been undergoing a concentrated epidemic of HIV-1 with high rates of infection among injecting drug users. Less is known about the relative risk and contribution to the country's HIV epidemic by other at-risk populations including sex workers and men who have sex with men. The goals of this project were to explore demographic characteristics, substance use patterns, and estimate the prevalence of sexually transmitted infections (STIs) and high-risk behaviors among male sex workers (MSW) in Moscow and to assess the feasibility of prospective cohort recruitment and retention among this population. Research design was a longitudinal study of 50 men with a six-month follow-up period. Participants were recruited through venue-based and snowball sampling methods. Results revealed an HIV prevalence at baseline of 16%; one MSW seroconverted during the follow-up period, yielding an incidence estimate of 4.8/100PY (95%CI 0.0–11.2). Twenty-four percentage were diagnosed with at least one STI: 12% had syphilis; 8% had Human Papilloma Virus (HPV); and 4% had Herpes Simplex Virus (HSV)-2. Three (6%) of the study participants had evidence of previous Hepatitis C Virus (HCV) exposure at baseline. Retention rates were poor with higher retention significantly associated with older men (OR: 13.1, 95% CI 3.3–52.5). This was the first study to evaluate baseline demographics, substance use patterns, and prevalence of infectious disease among MSW in Moscow. Identification and recruitment of this population appears to be feasible, but retention a challenge. While the sample size in the current study was small, the results also suggested that this is a population at considerable high risk for HIV. MSW in Moscow may be an important at-risk population in the Russian HIV epidemic and further research is urgently required to address their needs and explore prevention strategies.

Vulvar cancer in young women: demographic features and outcome evaluation

The objective of the study was to identify prognostic and environmental factors associated with vulvar carcinoma in young women. This study was a review of patients younger than 45 years who were diagnosed with vulvar squamous cell carcinoma between 1994 and 2006. Fifty-six patients were identified. Median age was 38 years and median follow-up was 25.3 months. Fifty-eight percent of patients presented with stage I disease; 77% smoked tobacco. Of patients with advanced disease, 53.3% were smokers, 40% had human papillomavirus (HPV) exposure, 46.7% had a history of vulvar intraepithelial neoplasia (VIN), and 6.7% were immunocompromised. Symptoms were present for more than 12 months in 47%, but symptom duration did not correlate with stage (P = .42) or positive lymph nodes (P = .28). Disease recurred in 10.7% and 5.4% died of disease. Young women with vulvar cancer tend to have early-stage disease, smoke, have a history of HPV, and have VIN. Many of the factors that place these patients at continuous risk are modifiable.