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More Than Half in HIV Patient Series Carry High-Risk Human Papillomavirus
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12th European AIDS Conference, November 11-13, 2009, Cologne, Germany
Mark Mascolini
Sixty percent of 205 consecutive HIV-infected outpatients in a Roman clinic had detectable high-risk human papillomavirus (HPV), an anal cancer precursor [1]. AIDS at the first study visit made high-risk HPV infection more likely. Only high-risk HPV independently predicted cytologic or histologic changes.
HPV-induced anal cancer ranks as a growing threat to HIV-infected people despite suppressive antiretroviral therapy [2]. To analyze details of HPV-related anal cancer risk factors, researchers at Catholic University and San Gallicano Hospital in Rome performed anoscopy, HPV tests, and cytological exams on 205 consecutive outpatients with HIV. Patients with dysplasia or lesions were biopsied. The investigators re-examined some study participants a median of 1 year after the initial exam.
Of the 205 study participants, 166 (81%) were men, 92 (45%) were gay men, and almost half reported having receptive anal intercourse. Thirty-five people (17%) reported between 11 and 100 episodes of receptive anal intercourse, and 39 (19%) had more than 100 such episodes. The study group included 187 people (92%) taking antiretrovirals and 164 (80%) with a viral load below 400 copies. Median age was 44 years (interquartile range 39 to 48) and median CD4 count 534. So this middle-aged population had relatively well controlled HIV infection.
The cohort included 144 people (70%) with any type of HPV and 124 (60%) with a high-risk HPV genotype, usually types 6, 16, and 18. Among people with high-risk HPV, 59% carried multiple high-risk genotypes. HPV expressed the E6/E7 oncogenes in 66 of 90 people (73%) with high-risk HPV, and 37 of these 66 (56%) had multiple HPV genotypes. Nineteen people had cytologic or histologic alterations, including 2 with carcinoma, 3 with atypical squamous cell of undetermined significance (ASCUS), and 14 with anal intraepithelial neoplasia (AIN)-1 dysplasia.
Among 59 people who returned for follow-up a median of 1 year later, 10 of 20 who did not initially have high-risk HPV did have high-risk HPV at follow-up. Among 39 of these 55 with initial high-risk HPV, 8 (20.5%) reverted to high-risk HPV-negative status at follow-up. Among 51 people with anal cytology analyzed after a median 1 year of follow-up, 7 of 41 with normal initial cytology (17%) had altered cytology at follow-up, and 1 of 10 with initial altered cytology had a worse cytologic status at follow-up.
Multivariate analysis pinpointed only one factor that predicted high-risk HPV infection: AIDS at the initial visit raised the risk 2.76 times, but that heightened risk fell just short of statistical significance (95% confidence interval [CI] 0.92 to 8.32, P = 0.072). Antiretroviral treatment lowered the risk of cytologic or histologic alterations 56% (odds ratio 0.44), but that association lacked statistical significance (95% CI 0.12 to 1.60, P = 0.21). High-risk HPV emerged as the only independent predictor of cytologic or histologic changes, raising the risk almost 10 times (odds ratio 9.85, 95% CI 1.27 to 76.1, P = 0.03).
Andrea De Luca of Catholic University, who presented the data, noted that some of the high-risk HPV genotypes detected in this population are not included in the current HPV vaccine. He stressed that high-risk HPV is not only a problem of gay men with HIV, since only 45% of this study group picked up HIV through gay sex.
References
1. De Luca A, D'Onghia S, Farina S, et al. Frequent detection of multiple, oncogene-expressing high-risk HPV types in anal swabs from HIV-infected individuals: predictors and association with anal dysplasia. 12th European AIDS Conference. November 11-13, 2009. Cologne, Germany. Abstract PS3/2.
2. Palefsky J. Human papillomavirus-related disease in people with HIV. Curr Opin HIV AIDS. 2009;4:52-56.
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