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Freeman MJ, Yang Q, Cherney-Stafford L, Striker R, Foley DP, Al-Adra DP, Sanger CB. Analysis of >15 000 Solid Organ Transplant Recipients Reveals Nonanal Genitourinary HPV-related Disease as Highest Risk Predictor for Anal Squamous Intraepithelial Lesions/Anal Cancer. Transplantation 2024; 108:1605-1612. [PMID: 38383963 DOI: 10.1097/tp.0000000000004930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Solid organ transplantation is a risk predictor for virally-mediated anal squamous intraepithelial lesions and cancer (anal disease). Precancerous squamous intraepithelial lesions can be detected by screening, and treatment may prevent cancer progression. Screening recommendations are not well defined. We aim to define prevalence and describe risk predictors for anal disease in a large population of solid organ transplant recipients. METHODS Retrospective single-center cohort analysis included solid organ transplant recipients cared for between 2001 and 2022 (N = 15 362). The cohort of recipients who developed anal disease was compared with those who did not. Greedy propensity score matching was performed for organ-specific recipients, and time-to-event analysis for the development of anal disease was performed in those with genitourinary human papilloma virus (HPV) disease versus those without. RESULTS Prevalence of anal disease was 0.6% (cancer 0.2%). The average years from transplant to the diagnosis of anal disease was 11.67. Anal disease was more common in women (68.5% versus 31.5%, P < 0.001), patients who had other HPV-related genitourinary diseases (40.4% versus 0.6%, P < 0.001), who were of younger age at transplant (39.62 versus 46.58, P < 0.001), and had increased years from transplant (17.06 versus 12.57, P < 0.001). In multivariate analysis, the odds of anal disease increased by 4% each year posttransplant. History of genitourinary HPV disease (odds ratio 69.63) and female sex (odds ratio 1.96) were the most significant risk predictors for anal disease. CONCLUSIONS The prevalence of anal cancer among solid organ transplant recipients was equal to the general population (0.2%). Due to the low prevalence of overall disease, these data suggest that anal screenings in transplant recipients should be targeted to higher-risk subsets: female recipients farther out from transplant and patients with genitourinary HPV-related diseases.
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Affiliation(s)
- Matthew J Freeman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Qiuyu Yang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Linda Cherney-Stafford
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Rob Striker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David P Foley
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David P Al-Adra
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Cristina B Sanger
- Department of Surgery, W.S. Middleton Memorial Veteran's Hospital, Madison, WI
- Division of Colon and Rectal Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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2
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Junkins A, Kempf MC, Burkholder G, Ye Y, Chu DI, Wiener HW, Szychowski JM, Shrestha S. Sexual risk characteristics, social vulnerability, and anal cancer screening uptake among men living with HIV in the deep south. AIDS Care 2024; 36:762-770. [PMID: 38268443 PMCID: PMC11035097 DOI: 10.1080/09540121.2023.2299747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
ABSTRACTWithout standard guidelines, there is a critical need to examine anal cancer screening uptake in the South which has the highest HIV incidence in the U.S. We identified factors associated with screening among men living with HIV (MLHIV) at a large academic HIV outpatient clinic in Alabama. Relationships between sociodemographic, clinical, sexual risk characteristics and screening were examined using T-tests, Fisher's exact, Chi-square, and logistic regression analyses. Unadjusted and adjusted odds ratios (AOR) were computed to estimate the odds of screening. Among 1,114 men, 52% had received annual anal cytology (pap) screening. Men who were screened were more likely to have multiple sexual partners compared to men who were not screened (22.8% vs. 14.8%, p = 0.002). Among men with one partner, the youngest were almost five times more likely to be screened compared to middle-aged men (AOR = 4.93, 95% CI: 2.34-10.39). Heterosexual men had lower odds and men who reported unprotected anal sex had higher odds of screening. Our findings suggest a racial disparity, with older black MLHIV being the least likely to be screened. In the South, MLHIV who are older, black, heterosexual, or live in high social vulnerability counties may be less likely to receive annual anal cancer screening.
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Affiliation(s)
- Anna Junkins
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mirjam-Colette Kempf
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Greer Burkholder
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yuanfan Ye
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel I. Chu
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Howard W. Wiener
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M. Szychowski
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sadeep Shrestha
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Cachay ER, Gilbert T, Qin H, Mathews WC. Clinical Predictors and Outcomes of Invasive Anal Cancer for People With Human Immunodeficiency Virus in an Inception Cohort. Clin Infect Dis 2024:ciae124. [PMID: 38573010 DOI: 10.1093/cid/ciae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Due to the heterogeneity of risk for invasive anal cancer (IAC) among people with human immunodeficiency virus (PWH), we investigated predictors of IAC and described outcomes among those with a cancer diagnosis. METHODS Using a longitudinal inception cohort of anal cancer screening, we evaluated risk factors and outcome probabilities for incident IAC in Cox models. Screening included anal cytology and digital anorectal examination, and, if results of either were abnormal, high-resolution anoscopy. RESULTS Between 30 November 2006 and 3 March 2021, a total of 8139 PWH received care at the University of California, San Diego, with 4105 individuals undergoing screening and subsequently followed up over a median of 5.5 years. Anal cancer developed in 33 of them. IAC was more likely to develop in patients with anal high-grade squamous intraepithelial lesions (aHSILs) on initial or subsequent follow-up cytology (hazard ratio, 4.54) and a nadir CD4 cell count ≤200/µL (2.99). The joint effect of aHSILs and nadir CD4 cell count ≤200/µL amplified the hazard of IAC by 9-fold compared with the absence of both. PWH with time-updated cytology aHSIL and CD4 cell counts ≤200/µL had 5- and 10-year probabilities of IAC of 3.40% and 4.27%, respectively. Twelve individuals with cancer died, 7 (21% of the total 33) due to cancer progression, and they had clinical stage IIIA or higher cancer at initial diagnosis. CONCLUSIONS PWH with both aHSIL and a nadir CD4 cell count ≤200/µL have the highest risk of IAC. PWH who died due to IAC progression had clinical stage IIIA cancer or higher at diagnosis, highlighting the importance of early diagnosis through high-resolution anoscopic screening.
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Affiliation(s)
- Edward R Cachay
- Department of Medicine, Owen Clinic, UC San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, California, USA
| | - Tari Gilbert
- Department of Medicine, Owen Clinic, UC San Diego, San Diego, California, USA
| | - Huifang Qin
- Department of Medicine, Owen Clinic, UC San Diego, San Diego, California, USA
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D’Souza G, Tewari SR, Troy T, Webster-Cyriaque J, Wiley DJ, Lahiri CD, Palella FJ, Gillison ML, Strickler HD, Struijk L, Waterboer T, Ho K, Kwait J, Lazar J, Weber KM, Fakhry C. Oncogenic Oral Human Papillomavirus Clearance Patterns over 10 Years. Cancer Epidemiol Biomarkers Prev 2024; 33:516-524. [PMID: 38294704 PMCID: PMC10990780 DOI: 10.1158/1055-9965.epi-23-1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/06/2023] [Accepted: 01/29/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Effective screening for oropharyngeal cancer is lacking. Four oncogenic HPV clearance definitions were explored to understand long-term natural history for persistent oncogenic oral HPV (oncHPV), the precursor of oropharyngeal cancer. METHODS Prospective multicenter cohort of participants living with/at-risk for HIV, with oral rinse and gargle samples collected every 6 to 12 months for up to 10 years and tested for oncHPV. HPV clearance definitions included 1 (clear1), 2 (clear2), 3 (clear3) consecutive negatives, or being negative at last two visits (clearlast). RESULTS Median time to clearance of oncHPV exceeded 2 years for conservative definitions (clear3: 2.38, clearlast: 2.43), but not lenient (clear1: 0.68, clear2: 1.15). By clear3, most incident infections cleared at 2, 5, 8 years (55.1%, 75.6%, 79.1%), contrary to prevalent infections (37.1%, 52.5%, 59.5%, respectively). In adjusted analysis, prevalent oncHPV, older age, male sex, and living with HIV were associated with reduced clearance. Of 1,833 subjects screened, 13.8% had prevalent oncHPV and 47.5% of those infections persisted ≥5 years, representing 6.5% of persons screened. Two men with prevalent oral HPV16 developed incident oropharyngeal cancer [IR = 1.62 per 100 person-years; 95% confidence interval (CI), 0.41-6.4]. Many with oral HPV16 persisted ≥5 years (and/or developed HPV-oropharyngeal cancer) among those with 2 (72.2%), ≥2 of first 3 (65.7%), or 3 (80.0%) consecutive positive oHPV16 tests, but not after 1 (39.4%). CONCLUSIONS In our 10-year study, most incident infections cleared quickly. However, half of prevalent oncHPV persisted ≥5 years, suggesting increased risk with persistent oncHPV at >2 visits. IMPACT We identified groups with persistent oncHPV at increased risk of oropharyngeal cancer and contextualized risk levels for those with oral HPV16 infection.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Sakshi R. Tewari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Tanya Troy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | | | - Dorothy J. Wiley
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Cecile Delille Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Frank Joseph Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maura L. Gillison
- Department of Thoracic-Head and neck medical oncology, MD Anderson Cancer Center
| | - Howard D. Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Linda Struijk
- Viroclinics-DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Jason Lazar
- Department of Medical Education, SUNY Downstate Health Science University
| | | | - Carole Fakhry
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
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5
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Zhang J, Sun Y, Chen X, Ye Y, Shen W, Ye X, Lin Y, Lin Z, Tan S, Gao M, Ding Y, He N, Lin H, Liu X. Incidence, clearance, and factors associated with anal human papilloma virus infection among men with HIV. AIDS 2024; 38:9-20. [PMID: 37861684 DOI: 10.1097/qad.0000000000003755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVES This study aims to estimate the incidence and persistence/clearance of anal human papilloma virus (HPV) infection and related factors among men with HIV in Taizhou, China. DESIGN A prospective cohort study. METHODS Men with HIV were recruited and followed up from 2016 to 2021. Questionnaire surveys were used to collect social-demographic and behavioral characteristics, and anal swabs were collected for HPV Genotyping. RESULTS A total of 675 men with HIV were recruited and followed up. After an average follow-up time of 1.75 years, HPV39 (3.8/100 person-years), HPV52 (3.6/100 person-years), HPV51 (3.1/100 person-years), HPV58 (2.5/100 person-years) and HPV16 (2.4 cases/100 person-years) in the high-risk types showed the highest incidence rate. In marriage with woman [adjusted hazard ratio (aHR) = 0.44, 95% confidence interval (CI) 0.20-0.99] showed an inverse association with HPV incidence, while bisexuality or undetermined sexual orientation (aHR = 2.62, 95% CI 1.08-6.36) showed a positive association. For those infected at baseline, the top three high-risk HPV with the lowest clearance density were HPV52 (32.2/100 person-years), HPV58 (38.1/100 person-years), and HPV16 (43.5/100 person-years). Daily consumption of 1-28 g alcohol (aHR = 0.62, 95% CI 0.41-0.95) showed an inverse association with HPV clearance, while illicit drug use (aHR = 3.24, 95% CI 1.59-6.59) showed a positive association. CONCLUSION Anal HPV infection and clearance were both active in men with HIV in China. Marriage status and sexuality were associated with the incidence of HPV infection, while substance use including alcohol and illicit drug were associated with HPV clearance. More studies are needed to explore the risk factors of HPV persistence.
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Affiliation(s)
- Jing Zhang
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
- Xuhui District Center for Disease Control and Prevention, Shanghai
| | - Yu Sun
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention
| | - Yiwen Ye
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention
| | - Xiaohong Ye
- Linhai District Center for Disease Control and Prevention
| | - Yajun Lin
- Sanmen District Center for Disease Control and Prevention
| | - Zhebin Lin
- Wenlin District Center for Disease Control and Prevention
| | - Shigang Tan
- Huangyan District Center for Disease Control and Prevention, Zhejiang Province, China
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Haijiang Lin
- Taizhou City Center for Disease Control and Prevention
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
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Džundová MN, Sehnal B, Zikán M, Kocián R, Dubová O, Hubka P, Dostálek L, Kabele P, Brtnický T, Slama J. Risk Factors for the Anal and Oral Human Papillomavirus (HPV) Infections among Women with Severe Cervical Lesions: A Prospective Case-Control Study. Biomedicines 2023; 11:3183. [PMID: 38137404 PMCID: PMC10741157 DOI: 10.3390/biomedicines11123183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
The carcinogenicity of HPV infection in the anogenital and oropharyngeal regions is broadly accepted. The aim of the study was to define risk factors for anal and oral HPV infections in high-risk patients with biopsy-proven severe cervical lesions (CIN2+). Altogether immunocompetent 473 females with CIN2+ were categorized into the study group and another 245 women into the control group. The strongest risk factor for anal HPV infection was the presence of cervical HPV infection (p < 0.001). Furthermore, ten or more lifetime sexual partners (p = 0.013), a sexual non-coital contact with the anal area (p < 0.001), and actively practicing anal-penetrative intercourse (p < 0.001) were significantly associated with anal HPV. A history of genital warts in the woman (p = 0.010) and the presence of genital warts in the male partner (p = 0.029) were found statistically significant for the risk of oral HPV infection. Our data suggest that the presence of HPV infection, especially high-risk genotypes, in one anatomical site poses the greatest risk for HPV infection in another anatomical site. The cervix is the main reservoir of infection, but the risk factors for anal and oral HPV infections are dissimilar according to different anatomical distances and more complex routes of transmission.
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Affiliation(s)
- Monika Nipčová Džundová
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Borek Sehnal
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Michal Zikán
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Roman Kocián
- Department of Gynecology, Obstetrics and Neonatology, General University Hospital, 1st Faculty of Medicine, Charles University, 12808 Prague, Czech Republic; (R.K.); (L.D.); (J.S.)
| | - Olga Dubová
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Petr Hubka
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Lukáš Dostálek
- Department of Gynecology, Obstetrics and Neonatology, General University Hospital, 1st Faculty of Medicine, Charles University, 12808 Prague, Czech Republic; (R.K.); (L.D.); (J.S.)
| | - Pavel Kabele
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Tomáš Brtnický
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Jiri Slama
- Department of Gynecology, Obstetrics and Neonatology, General University Hospital, 1st Faculty of Medicine, Charles University, 12808 Prague, Czech Republic; (R.K.); (L.D.); (J.S.)
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Wei F, Alberts CJ, Albuquerque A, Clifford GM. Impact of Human Papillomavirus Vaccine Against Anal Human Papillomavirus Infection, Anal Intraepithelial Neoplasia, and Recurrence of Anal Intraepithelial Neoplasia: A Systematic Review and Meta-analysis. J Infect Dis 2023; 228:1496-1504. [PMID: 37257044 DOI: 10.1093/infdis/jiad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND We sought to summarize human papillomavirus (HPV) vaccine efficacy/effectiveness (VE) against anal HPV infection and anal intraepithelial neoplasia (AIN). METHODS We performed literature review and meta-analysis to estimate VE, stratified by age and analytic population (per-protocol efficacy [PPE] or intention-to-treat [ITT] population in clinical trials, or all participants in real-world studies). RESULTS We identified 6 clinical trials and 8 real-world studies. In participants vaccinated at age ≤26 years (mainly human immunodeficiency virus [HIV]-negative individuals), significant VE against incident/prevalent anal HPV infection was reported in clinical trials, with a higher estimate in PPE (2 studies with 2390 participants; VE, 84% [95% confidence interval (CI), 77%-90%]; I2 = 0%) than ITT (2 studies with 4885 participants; 55%, 39%-67%; I2 = 46%) populations or in real-world studies (4 studies with 2375 participants; 77%, 40%-91%; I2 = 81%). HPV vaccination at age ≤26 years was associated with significant VE in preventing persistent anal HPV infection and AIN. No significant VE against anal HPV infection or AIN was found in persons vaccinated at age >26 years (mainly people living with HIV). CONCLUSIONS There is strong evidence for high VE against anal HPV infection and AIN in HIV-negative individuals vaccinated at age ≤26 years. However, the lower impact in ITT than in PPE populations and the lack of significant effect in people living with HIV aged >26 years indicates that vaccines have the higher impact in populations with less sexual exposure to anal HPV.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Andreia Albuquerque
- Gastroenterology Department, Fernando Pessoa Teaching Hospital, São Cosme, Portugal
- Precancerous Lesions and Early Cancer Management Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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8
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Prétet JL, Baraquin A, Barret AS, Bercot B, Rahib D, Lydié N, Pépin-Puget L, Lepiller Q. Anal and oropharyngeal HPV distribution in HIV-negative multipartner MSM using self-sampling kits for HIV and sexually transmitted infection screening. J Med Virol 2023; 95:e29068. [PMID: 37654019 DOI: 10.1002/jmv.29068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/28/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
Men who have sex with men (MSM) are at high risk of sexually transmitted infections, among which HPV infections are particularly prominent. We took advantage of the MémoDépistages study to evaluate HPV distribution at anal and oropharyngeal sites in HIV-negative multipartner MSM. HPV DNA was detected in 82% (n = 344) of anal and 11% (n = 45) of oropharyngeal self-collected samples taken from 421 participants. Multiple HPV types were detected in 70% of anal samples, and single HPV types in 91% of oropharyngeal samples. HPV16 was the most frequent type detected in the anus, followed by HPV6, HPV51, and HPV52. HPV6, HPV16, and HPV11 were the most prevalent types in the oropharynx. HPV targeted by the nonavalent vaccine was detected in 71% and 50% of HPV-positive anal and oropharyngeal samples, respectively. The main risk factor associated with HPV detection was frequenting gay meeting places, living in large cities, and having an anal Chlamydia trachomatis/Neisseria gonorrhoeae infection. In this cohort of highly sexually active MSM, HPV detection was highly frequent and rendered them at high risk of precancerous and cancerous lesions. Universal vaccination against HPV before sexual debut is an important public health strategy to prevent HPV-associated cancers in this highly vulnerable population of HIV-negative MSM.
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Affiliation(s)
- Jean-Luc Prétet
- Université de Franche-Comté, Carcinogenèse associée aux HPV, Besançon, France
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
| | - Alice Baraquin
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
| | | | - Béatrice Bercot
- Laboratoire associé au Centre National de Référence des IST bactériennes, Service de Bactériologie, Hôpital St Louis, APHP, Paris, France
- Université Paris Cité, IAME UMR1137, Paris, France
| | | | | | - Line Pépin-Puget
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
| | - Quentin Lepiller
- Université de Franche-Comté, Carcinogenèse associée aux HPV, Besançon, France
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
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9
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Albuquerque A. Anal Intraepithelial Neoplasia and Anal Squamous Cell Carcinoma: Updates From the Last 3 Years. J Low Genit Tract Dis 2023; 27:252-254. [PMID: 37166025 DOI: 10.1097/lgt.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
ABSTRACT In the last 3 years, new and relevant information has been published on anal cancer and anal precancerous lesions epidemiology, screening, treatment, and vaccination. This information will likely change prevention and treatment strategies for these patients in the upcoming years.
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Affiliation(s)
- Andreia Albuquerque
- Gastroenterology Department, Fernando Pessoa Teaching Hospital, Portugal, Precancerous lesions and early cancer management research group RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
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10
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Clifford GM, Wei F. Prevention of Human Papillomavirus-Related Anal Cancer in Women Living With Human Immunodeficiency Virus. J Infect Dis 2023; 227:929-931. [PMID: 36196561 DOI: 10.1093/infdis/jiac399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gary M Clifford
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Feixue Wei
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
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Benevolo M, Latini A, Rollo F, Giuliani M, Giglio A, Giuliani E, Cristaudo A, Morrone A, Donà MG. Incidence of abnormal anal cytology in HIV-infected and HIV-uninfected men who have sex with men. Cancer Cytopathol 2022; 131:262-270. [PMID: 36582010 DOI: 10.1002/cncy.22675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Anal cytology is used in the prevention of anal cancer, which disproportionally affects men who have sex with men (MSM). Data on the incidence of cytologic abnormalities in these individuals are scant. METHODS MSM with baseline negative anal cytology and at least one further adequate cytology were included. Incidence rate for positive atypical squamous cells of undetermined significance (ASC-US+) was calculated. Kaplan-Meier curves were compared by log-rank test according to HIV status, baseline high-risk human papillomavirus (HPV) (high-risk HPV-negative, HPV16-positive, other high-risk HPV-positive [non-HPV16]) and high-risk HPV persistence (positive from baseline to the first ASC-US+ or last visit for those who remained cytologically negative). Cox univariate and multivariate analyses were performed. RESULTS A total of 250 MSM were included: 52/153 (34.0%) HIV-uninfected MSM had an ASC-US+ report at follow-up (incidence: 13.1 × 100 person-years; 95% CI, 9.8-17.2); 48/97 (49.5%) HIV-infected MSM developed cytologic abnormalities (incidence: 16.0 × 100 person-years; 95% CI, 11.8-21.2). ASC-US+ incidence in HIV-uninfected and HIV-infected MSM did not differ significantly (p = .32). Kaplan-Meier curves did not differ significantly according to baseline high-risk HPV. Differences were significant between those with and without persistent high-risk HPVs, both among HIV-uninfected (p = .03) and HIV-infected MSM (p = .008). Age (adjusted hazard ratio [aHR], 0.98; 95% CI, 0.96-0.99), high-risk HPV persistence (aHR, 1.57; 95% CI, 1.02-2.39), and condomless receptive anal sex (aHR, 1.99; 95% CI, 1.31-3.03) were predictors for incident ASC-US+. CONCLUSIONS Despite the limited number of subjects, in our study HIV-uninfected and HIV-infected MSM have a similar ASC-US+ incidence. Occurrence of ASC-US+ was significantly affected by age, high-risk HPV persistence, and condomless receptive anal sex. The assessment of HPV persistence might identify those MSM at higher risk for anal lesions.
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Affiliation(s)
- Maria Benevolo
- Pathology Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Francesca Rollo
- Pathology Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Amalia Giglio
- Microbiology and Clinical Pathology Department, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Eugenia Giuliani
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Antonio Cristaudo
- Department of Dermatology, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
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