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Yancheva-Petrova N, Grozdeva R, Ivanov D, Strashimirov D. HPV-associated oropharyngeal carcinomas in patients living with HIV on long-term antiretroviral therapy: Case reports. Int J STD AIDS 2024; 35:654-657. [PMID: 38604991 DOI: 10.1177/09564624241244830] [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] [Indexed: 04/13/2024]
Abstract
In the 1970s, human papillomaviruses (HPV) were ascertained as the aetiologic agents of cervical carcinoma. Subsequently, an association with HPV was established in other epithelial tumours, including squamous cell carcinoma of the head and neck (HNSCC). HPV has demonstrated a high potential for inducing oropharyngeal tumours, with HPV-16 infection posing a significant oncogenic risk. People living with HIV (PLWH) are identified as being at a higher risk of HPV infection and the subsequent development of HPV-associated tumours of the oropharynx. We present two patients under the care of the Department of AIDS with long-term HIV infections who were newly diagnosed with HPV-associated carcinomas of the tonsils. Both patients had been on antiretroviral therapy (ART) for over 15 years, achieving optimal viral suppression for more than 10 years. Chemotherapy and radiation therapy were employed in the treatment of the carcinomas. Throughout the neoplastic disease treatment, both patients maintained optimal viral suppression for HIV. The presented cases underscore the fact that despite achieving long-term optimal viral suppression of HIV, people living with HIV remain susceptible to the development of HPV-associated neoplasms.
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Affiliation(s)
- Nina Yancheva-Petrova
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University - Sofia, Sofia, Bulgaria
- Department of AIDS, Specialized Hospital for Infectious and Parasitic Diseases "Prof. Ivan Kirov"- Sofia, Sofia, Bulgaria
| | - Rusina Grozdeva
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University - Sofia, Sofia, Bulgaria
- Department of AIDS, Specialized Hospital for Infectious and Parasitic Diseases "Prof. Ivan Kirov"- Sofia, Sofia, Bulgaria
| | - Daniel Ivanov
- Department of AIDS, Specialized Hospital for Infectious and Parasitic Diseases "Prof. Ivan Kirov"- Sofia, Sofia, Bulgaria
| | - Dimitar Strashimirov
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University - Sofia, Sofia, Bulgaria
- Department of AIDS, Specialized Hospital for Infectious and Parasitic Diseases "Prof. Ivan Kirov"- Sofia, Sofia, Bulgaria
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Wijesekera A, Weeramange CE, Vasani S, Kenny L, Knowland E, Seneviratne J, Punyadeera C. Surveillance of human papillomavirus through salivary diagnostics - A roadmap to early detection of oropharyngeal cancer in men. Tumour Virus Res 2024; 17:200278. [PMID: 38442788 PMCID: PMC10937231 DOI: 10.1016/j.tvr.2024.200278] [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: 02/19/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted disease. Certain strains have the potential to cause malignancy in multiple anatomical sites if not cleared by the immune system. In most infected people, HPV is cleared within two years. However, HPV may persist in susceptible individuals with certain risk factors, eventually leading to malignancy. New evidence suggests that over 75% of all oropharyngeal cancers (OPC) are directly attributable to HPV. It is estimated that prophylactic HPV vaccination alone may take at least 25 years to have a significant impact on reducing the incidence of OPC. The temporal link between detection of oral HPV, persistence of the infection and the subsequent development of OPC have been well established. Moreover, men have threefold higher risk than women for acquiring HPV-OPC. This comprehensive review focuses on OPC development in men, highlighting the risk factors associated with malignant transformation of HPV-OPC. Current evidence is insufficient to determine whether early identification of at-risk demographics, screening, and prompt diagnosis result in improved outcomes. Hitherto, the effectiveness of an oral HPV screening program in this regard has not been investigated. Nevertheless, the potential to emulate the success of the cervical screening program remains a very real possibility.
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Affiliation(s)
- Akila Wijesekera
- Griffith Institute for Drug Discovery, School of Environment and Science, Griffith University, Queensland, Australia; Royal Brisbane and Women's Hospital, Queensland, Australia.
| | - Chameera Ekanayake Weeramange
- Griffith Institute for Drug Discovery, School of Environment and Science, Griffith University, Queensland, Australia
| | - Sarju Vasani
- Griffith Institute for Drug Discovery, School of Environment and Science, Griffith University, Queensland, Australia; Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Liz Kenny
- Royal Brisbane and Women's Hospital, Queensland, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Emma Knowland
- Metro North Sexual Health and HIV Service, Queensland, Australia
| | | | - Chamindie Punyadeera
- Griffith Institute for Drug Discovery, School of Environment and Science, Griffith University, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Ramos Peña DE, Pillet S, Grupioni Lourenço A, Pozzetto B, Bourlet T, Motta ACF. Human immunodeficiency virus and oral microbiota: mutual influence on the establishment of a viral gingival reservoir in individuals under antiretroviral therapy. Front Cell Infect Microbiol 2024; 14:1364002. [PMID: 38660490 PMCID: PMC11039817 DOI: 10.3389/fcimb.2024.1364002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
The role of the oral microbiota in the overall health and in systemic diseases has gained more importance in the recent years, mainly due to the systemic effects that are mediated by the chronic inflammation caused by oral diseases, such as periodontitis, through the microbial communities of the mouth. The chronic infection by the human immunodeficiency virus (HIV) interacts at the tissue level (e.g. gut, genital tract, brain) to create reservoirs; the modulation of the gut microbiota by HIV infection is a good example of these interactions. The purpose of the present review is to assess the state of knowledge on the oral microbiota (microbiome, mycobiome and virome) of HIV-infected patients in comparison to that of HIV-negative individuals and to discuss the reciprocal influence of HIV infection and oral microbiota in patients with periodontitis on the potential establishment of a viral gingival reservoir. The influence of different clinical and biological parameters are reviewed including age, immune and viral status, potent antiretroviral therapies, smoking, infection of the airway and viral coinfections, all factors that can modulate the oral microbiota during HIV infection. The analysis of the literature proposed in this review indicates that the comparisons of the available studies are difficult due to their great heterogeneity. However, some important findings emerge: (i) the oral microbiota is less influenced than that of the gut during HIV infection, although some recurrent changes in the microbiome are identified in many studies; (ii) severe immunosuppression is correlated with altered microbiota and potent antiretroviral therapies correct partially these modifications; (iii) periodontitis constitutes a major factor of dysbiosis, which is exacerbated in HIV-infected patients; its pathogenesis can be described as a reciprocal reinforcement of the two conditions, where the local dysbiosis present in the periodontal pocket leads to inflammation, bacterial translocation and destruction of the supporting tissues, which in turn enhances an inflammatory environment that perpetuates the periodontitis cycle. With the objective of curing viral reservoirs of HIV-infected patients in the future years, it appears important to develop further researches aimed at defining whether the inflamed gingiva can serve of viral reservoir in HIV-infected patients with periodontitis.
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Affiliation(s)
- Diana Estefania Ramos Peña
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
- Team Mucosal Immunity and Pathogen Agents (GIMAP), Centre International de Recherche en Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, Ecole Nationale Supérieure de Lyon, Université de Lyon, Université de Saint-Etienne, Saint-Etienne, France
| | - Sylvie Pillet
- Team Mucosal Immunity and Pathogen Agents (GIMAP), Centre International de Recherche en Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, Ecole Nationale Supérieure de Lyon, Université de Lyon, Université de Saint-Etienne, Saint-Etienne, France
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Alan Grupioni Lourenço
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Bruno Pozzetto
- Team Mucosal Immunity and Pathogen Agents (GIMAP), Centre International de Recherche en Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, Ecole Nationale Supérieure de Lyon, Université de Lyon, Université de Saint-Etienne, Saint-Etienne, France
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Thomas Bourlet
- Team Mucosal Immunity and Pathogen Agents (GIMAP), Centre International de Recherche en Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, Ecole Nationale Supérieure de Lyon, Université de Lyon, Université de Saint-Etienne, Saint-Etienne, France
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Ana Carolina Fragoso Motta
- Department of Stomatology, Public Health and Forensic Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
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Jodry D, Obedin-Maliver J, Flowers L, Jay N, Floyd S, Teoh D, Conageski C, Downs L, Khan MJ. Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus-Related Cancers. J Low Genit Tract Dis 2023; 27:307-321. [PMID: 37729043 PMCID: PMC10545069 DOI: 10.1097/lgt.0000000000000763] [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] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)-related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations. MATERIALS AND METHODS An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines. RESULTS Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk. CONCLUSIONS An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.
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Affiliation(s)
| | | | - Lisa Flowers
- Emory University School of Medicine, Atlanta, GA
| | - Naomi Jay
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Serina Floyd
- Planned Parenthood of Metropolitan Washington, DC, Washington, DC
| | - Deanna Teoh
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | | | - Levi Downs
- Park Nicollet Health Services, Minneapolis, MN
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Carnalla M, Rojas-Martínez R, Barrientos-Gutiérrez T, Allen-Leigh B, León-Maldonado L, Gutiérrez-Xicoténcatl L, Portillo-Romero AJ, Nyitray AG, Salmerón J, Giuliano AR, Lazcano-Ponce E. Prevalence and development of a risk score for oral human papillomavirus infection in men who have sex with men in Mexico. J Oral Pathol Med 2023; 52:751-757. [PMID: 37525481 DOI: 10.1111/jop.13474] [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: 08/29/2022] [Revised: 05/23/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk for oral human papillomavirus (HPV infection). There are no specific screening guidelines to facilitate the identification of people at risk for oral HPV infection. We aimed to estimate the prevalence of oral high-risk HPV and create a risk score to identify MSM at higher risk for prevalent oral HPV. METHODS We collected baseline data from a clinical trial from a subsample of 500 MSM attending sexually transmitted disease treatment clinics; they provided an oral gargle sample for high-risk HPV detection. We calculated oral high-risk HPV prevalence and 95% confidence intervals (CIs), used a logistic regression model to identify factors associated with high-risk HPV infection, and created a risk score. RESULTS The prevalence of any oral high-risk HPV among MSM was 11.1% (95% CI: 8.6-14.2), with a higher prevalence observed among men living with HIV (14.8%). Factors independently associated with oral high-risk HPV were age ≥40 years (OR = 2.71, 95% CI: 1.28-5.73 compared to <40 years), being HIV-positive with CD4 count 200-499 (OR = 2.76, 95% CI: 1.34-5.65 compared to HIV-negative), and recent recreational use of vasodilators (poppers/sildenafil) (OR = 2.02, 95% CI: 1.02-2.97). The risk score had good discriminatory power (AUC = 0.70, 95% CI: 0.63-0.77). CONCLUSIONS MSM have specific predictors for prevalent oral high-risk HPV, and a risk score could be used by clinicians to target men with vaccine recommendations and counseling, and identify those who could benefit from primary interventions given the available resources, or for referral to dental services for follow-up when available.
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Affiliation(s)
- Martha Carnalla
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Rosalba Rojas-Martínez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Betania Allen-Leigh
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Leith León-Maldonado
- Centro de Investigación en Salud Poblacional, National Institute of Public Health, Cuernavaca, Mexico
| | - Lourdes Gutiérrez-Xicoténcatl
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | | | - Alan G Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
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Wijstma ES, Jongen VW, Alberts CJ, de Melker HE, Hoes J, Schim van der Loeff MF. Approaches to Estimating Clearance Rates for Human Papillomavirus Groupings: A Systematic Review and Real Data Examples. Epidemiology 2023; 34:119-130. [PMID: 36137191 DOI: 10.1097/ede.0000000000001550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Approaches to estimating clearance rates, an important metric of human papillomavirus (HPV) clearance, for HPV groupings differ between studies. We aimed to identify the approaches used in the literature for estimating grouped HPV clearance rates. We investigated whether these approaches resulted in different estimations, using data from existing studies. METHODS In this systematic review, we included articles that reported clearance rates of HPV groupings. We identified approaches to data in the HAVANA cohort, comprising adolescent girls, and the H2M cohort, comprising men who have sex with men. We estimated clearance rates for six HPV groupings (bivalent-, quadrivalent- and nonavalent vaccine-related, and low-risk, high-risk, and any HPV). RESULTS From 26 articles, we identified 54 theoretically possible approaches to estimating clearance rates. These approaches varied regarding definitions of clearance events and person-time, and prevalence or incidence of infections included in the analysis. Applying the nine most-used approaches to the HAVANA ( n = 1,394) and H2M ( n = 745) cohorts demonstrated strong variation in clearance rate estimates depending on the approach used. For example, for grouped high-risk HPV in the H2M cohort, clearance rates ranged from 52.4 to 120.0 clearances/1000 person-months. Clearance rates also varied in the HAVANA cohort, but differences were less pronounced, ranging from 24.1 to 57.7 clearances/1000 person-months. CONCLUSIONS Varied approaches from the literature for estimating clearance rates of HPV groupings yielded different clearance rate estimates in our data examples. Estimates also varied between study populations. We advise clear reporting of methodology and urge caution in comparing clearance rates between studies.
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Affiliation(s)
- Eline S Wijstma
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Vita W Jongen
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Hester E de Melker
- Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joske Hoes
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- From the Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
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Nemcova J, Riegert J, Cerna K, Rob F, Smahelova J, Hercogova JT, Martinek P, Ondic O. Prevalence of oral and anal human papillomavirus infection in Czech predominantly Human immunodeficiency virus-positive men having sex with men - data from a previously unreported population. Int J STD AIDS 2022; 33:1054-1064. [PMID: 36073929 DOI: 10.1177/09564624221123869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: HIV-positive men who have sex with men (MSM) are more likely to experience human papillomavirus (HPV) infection. The persistent HPV infection is the major factor in the development of anal and oropharyngeal neoplasms. Data on the prevalence of anal and oral HPV in MSM are almost absent from the countries of Central and Eastern Europe. We conducted a cross-sectional study focused on the prevalence of oral and anal HPV infections and the relationship between current anal and oral HPV intrapersonal infection in a Czech population of predominantly HIV-positive MSM. Methods: Oral gargle and anal swab samples from 205 predominantly HIV-positive MSM from the Czech Republic were analysed for HPV infection using PCR. Selected sociodemographic and clinical data were correlated with HPV detection using generalized linear models and multivariate analysis. Results: HPV infection was detected in 183 (96.8%) anal and 48 (23.6%) oral samples. The most common type of HR-HPV was HPV16 in both anal (25.4%) and oral (2.5%) samples. Multiple anal HPV infections and the presence of vaccine-targeted HR-HPV types were significantly correlated with abnormal anal cytology and HIV status. Conclusion: The prevalence of anal HPV infection in Czech predominantly HIV-positive MSM ranks among the highest reported, while oral HPV prevalence is consistent with MSM populations. Minimal overlap of oral and anal HPV types within a patient was observed.
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Affiliation(s)
- Jana Nemcova
- Biomedical Center of the Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Sikl's Department of Pathology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Jan Riegert
- Department of Zoology, Faculty of Science, 48271University of South Bohemia, České Budějovice, Czech Republic
| | - Katerina Cerna
- Biomedical Center of the Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Sikl's Department of Pathology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Filip Rob
- Department of Dermatovenereology, Second Faculty of Medicine, Bulovka University Hospital, 60568Charles University, Prague, Czech Republic
| | - Jana Smahelova
- National Reference Laboratory for Papillomaviruses and Polyomaviruses, 48231Institute Hematology and Blood Transfusion, Prague, Czech Republic.,Department of Genetics and Microbiology, Faculty of Science, 112302Charles University, Prague, Czech Republic
| | - Jana Tresnak Hercogova
- Department of Dermatovenereology, Second Faculty of Medicine, Bulovka University Hospital, 60568Charles University, Prague, Czech Republic
| | - Petr Martinek
- 524358Biopticka Laborator s.r.o., Pilsen, Czech Republic
| | - Ondrej Ondic
- Biomedical Center of the Faculty of Medicine in Pilsen, Pilsen, Czech Republic.,Sikl's Department of Pathology, University Hospital in Pilsen, Pilsen, Czech Republic
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Pérez-González A, Cachay E, Ocampo A, Poveda E. Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection. Microorganisms 2022; 10:1047. [PMID: 35630489 PMCID: PMC9147826 DOI: 10.3390/microorganisms10051047] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 12/01/2022] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Although most HPV infections will spontaneously resolve, a considerable proportion of them will persist, increasing the risk of anogenital dysplasia, especially within certain populations, such as patients infected with human immunodeficiency virus (HIV). Furthermore, high-risk oncogenic HPV types (HR-HPV) are the main cause of cervix and other anogenital cancers, such as cancer of the vagina, vulva, penis, or anus. HIV and HPV coinfection is common among people living with HIV (PLWH) but disproportionally affects men who have sex with men (MSM) for whom the rate of persistent HPV infection and reinfection is noteworthy. The molecular interactions between HIV and HPV, as well as the interplay between both viruses and the immune system, are increasingly being understood. The immune dysfunction induced by HIV infection impairs the rate of HPV clearance and increases its oncogenic risk. Despite the availability of effective antiretroviral therapy (ART), the incidence of several HPV-related cancers is higher in PLWH, and the burden of persistent HPV-related disease has become a significant concern in an aging HIV population. Several public health strategies have been developed to reduce the transmission of HIV and HPV and mitigate the consequences of this type of coinfection. Universal HPV vaccination is the most effective preventive tool to reduce the incidence of HPV disease. In addition, screening programs for HPV-related cervical and vulvovaginal diseases in women are well-recognized strategies to prevent cervical cancer. Similarly, anal dysplasia screening programs are being implemented worldwide for the prevention of anal cancer among PLWH. Herein, the main epidemiological features and clinical implications of HIV and HPV coinfection are reviewed, focusing mainly on the relationship between HIV immune status and HPV-related diseases and the current strategies used to reduce the burden of HPV-related disease.
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Affiliation(s)
- Alexandre Pérez-González
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), 36312 Vigo, Spain;
- Infectious Disease Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain;
| | - Edward Cachay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California at San Diego, San Diego, CA 92093, USA;
| | - Antonio Ocampo
- Infectious Disease Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain;
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), 36312 Vigo, Spain;
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Giuliani E, Rollo F, Donà MG, Garbuglia AR. Human Papillomavirus Oral Infection: Review of Methodological Aspects and Epidemiology. Pathogens 2021; 10:pathogens10111411. [PMID: 34832567 PMCID: PMC8625118 DOI: 10.3390/pathogens10111411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/15/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Oral infection by Human Papillomavirus (HPV) has recently gained great attention because of its involvement in the development of a subset of head and neck squamous cell carcinoma. The role of specific Alpha-HPVs in this regard has been well established, whereas the contribution of other genera is under investigation. Despite their traditional classification as “cutaneous” types, Beta and Gamma HPVs are frequently detected in oral samples. Due to the lack of a standardized protocol, a large variety of methodologies have been used for oral sample collection, DNA extraction, HPV detection and genotyping. Laboratory procedures influence the evaluation of oral HPV prevalence, which largely varies also according to the population characteristics, e.g., age, gender, sexual behavior, Human Immunodeficiency Virus (HIV) status. Nevertheless, oral infection by Beta and Gamma HPVs seems to be even more common than Alpha-HPVs. The latter is 5–7% in the general population, and increases up to 30% approximately in HIV-infected men who have sex with men. Despite major advances in the evaluation of oral HPV prevalence, its natural history is still little understood, especially for Beta and Gamma HPVs. The latest technologies, such as Next Generation Sequencing (NGS), can be exploited to gain new insights into oral HPV, and to improve the identification of novel HPV types.
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Affiliation(s)
- Eugenia Giuliani
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652665393
| | - Anna Rosa Garbuglia
- Laboratory of Virology, National Institute for Infectious Diseases, INMI Lazzaro Spallanzani IRCCS, Via Portuense 292, 00149 Rome, Italy;
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10
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Rollo F, Latini A, Benevolo M, Giglio A, Giuliani E, Pichi B, Pellini R, Giuliani M, Donà MG. Concurrent and Concordant Anal and Oral Human PapillomaVirus Infections Are Not Associated with Sexual Behavior in At-Risk Males. Pathogens 2021; 10:pathogens10101254. [PMID: 34684203 PMCID: PMC8538601 DOI: 10.3390/pathogens10101254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022] Open
Abstract
Men who have sex with men (MSM) harbor the highest prevalence of anal and oral Human Papillomavirus (HPV) infection, particularly if HIV-infected. We investigated anal and oral HPV infections in HIV-infected and HIV-uninfected MSM, to assess concurrent (HPV detected at both sites, irrespective of the genotypes), and concordant infections (same genotype[s] detected at both sites). Matched anal and oral samples from 161 MSM (85 HIV-infected, and 76 HIV-uninfected) were tested with the Linear Array. Determinants of concurrent and concordant infections were evaluated using logistic regression. Anal infections were 4 to 7 times more frequent than oral infections in both study groups (p < 0.0001). Concurrent infections were not significantly different in HIV-infected (25.9%) and HIV-uninfected MSM (17.1%), p = 0.18. A concordant infection was found in 15 MSM (9.3%). Concordance was for one genotype in 14 individuals and for four genotypes in the remaining subject. In the overall population, only age was independently associated with a concurrent infection (AOR = 3.10, 95% CI: 1.34–7.19 for >39 vs. ≤39 years). None of the parameters of sexual behavior showed independent association with concordant infections. Among MSM, concordant anal and oral HPV infections do not seem to be explained by sexual behavior, but might derive from sequential acquisition by autoinoculation.
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Affiliation(s)
- Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.); (M.B.)
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (A.L.); (M.G.D.)
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.); (M.B.)
| | - Amalia Giglio
- Microbiology and Pathology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Eugenia Giuliani
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Barbara Pichi
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Raul Pellini
- Otolaryngology Head Neck Surgery Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (A.L.); (M.G.D.)
- Correspondence: ; Tel.: +39-0652662806
| | - Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (A.L.); (M.G.D.)
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11
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Giuliani M, Gheit T, Rollo F, Tommasino M, Latini A, Benevolo M, Pichi B, Pellini R, McKay-Chopin S, Cristaudo A, Giuliani E, Morrone A, Donà MG. Predictors of Oral Infection by Mucosal and Cutaneous Human Papillomaviruses in HIV-Infected and Uninfected Men Who Have Sex with Men of the OHMAR Study. J Clin Med 2021; 10:2804. [PMID: 34202235 PMCID: PMC8269418 DOI: 10.3390/jcm10132804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/09/2021] [Accepted: 06/22/2021] [Indexed: 02/04/2023] Open
Abstract
Mucosal Human Papillomaviruses (HPVs) play a role in the development of a subset of head and neck cancers. Cutaneous HPVs are abundantly present in the oral cavity. The determinants of these infections have not been extensively investigated. We assessed the correlates of oral infection by alpha and beta and/or gamma HPVs in HIV-infected and uninfected men who have sex with men (MSM). Oral rinse-and-gargles were collected with a mouthwash. Alpha and beta/gamma HPVs were detected using the Linear Array HPV genotyping test and a multiplex PCR combined with Luminex technology, respectively. Multiple logistic regression was performed to identify independent predictors of oral HPV infection. Overall, 193 HIV-uninfected and 117 HIV-infected MSM were enrolled. Among HIV-infected MSM, the only determinant of alpha HPV infection was the number of lifetime oral sex partners (AOR: 8.26, 95% CI: 2.26-30.16). The strongest determinant of beta/gamma HPV infection was represented by practicing condomless receptive oral sex (AOR: 10.76, 95% CI: 1.56-74.17). Age was independently associated with alpha HPV infection in HIV-uninfected MSM. Beta/gamma HPV infection was not associated with sexual behavior in these subjects. In conclusion, predictors of oral infection differ between HIV-infected and uninfected MSM, as well as between alpha and beta/gamma HPVs.
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Affiliation(s)
- Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (M.G.); (A.L.); (A.C.); (M.G.D.)
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 69372 Lyon, France; (T.G.); (M.T.); (S.M.-C.)
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, 00144 Rome, Italy;
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 69372 Lyon, France; (T.G.); (M.T.); (S.M.-C.)
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (M.G.); (A.L.); (A.C.); (M.G.D.)
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, 00144 Rome, Italy;
| | - Barbara Pichi
- Otolaryngology Head&Neck Surgery Department, Regina Elena National Cancer Institute IRCCS, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Raul Pellini
- Otolaryngology Head&Neck Surgery Department, Regina Elena National Cancer Institute IRCCS, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Sandrine McKay-Chopin
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 69372 Lyon, France; (T.G.); (M.T.); (S.M.-C.)
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (M.G.); (A.L.); (A.C.); (M.G.D.)
| | - Eugenia Giuliani
- Scientific Direction San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (E.G.); (A.M.)
| | - Aldo Morrone
- Scientific Direction San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (E.G.); (A.M.)
| | - Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (M.G.); (A.L.); (A.C.); (M.G.D.)
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12
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YILMAZ B, HAT BN, YÜREKLİ Y, OSKAY Ü. Genç Erişkinlerin Human Papilloma Virüs (HPV) ve HPV Aşısına İlişkin Bilgi ve Görüşleri: Kesitsel Bir Çalışma. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.874847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Donà MG, Rollo F, Latini A, Benevolo M, Pichi B, Pellini R, Giuliani E, Giglio A, Cristaudo A, Giuliani M. Anal and oral human papillomavirus infection in men who have sex with men: implications for risk-targeted vaccination. Future Microbiol 2021; 15:1713-1722. [PMID: 33404267 DOI: 10.2217/fmb-2020-0186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: Men who have sex with men (MSM) harbor a significant burden of human papillomavirus (HPV)-related diseases that could be prevented by vaccination. Materials & methods: Prevalence of HPVs targeted by the quadrivalent (4vHPV) and nonavalent vaccines (9vHPV) was assessed in anal (n = 443) and oral (n = 193) specimens of immunocompetent, sexually active MSM, using the Linear Array. Results: Of the anal samples, 34.1 and 46.0% were positive for at least one genotype of those covered by the 4vHPV and 9vHPV, respectively. At least one of the HPVs targeted by the 9vHPV was detected in 5.7% of the oral specimens. Conclusion: The majority of the subjects were not currently infected by HPV-16 and other vaccine-preventable HPVs. Universal HPV vaccination should be strongly promoted in order to achieve protection for all risk groups. In the meanwhile, vaccination should be offered to sexually active adult MSM attendees of sexually transmitted infection centers, although its potential benefit for these subjects needs to be further investigated.
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Affiliation(s)
| | - Francesca Rollo
- Department of Pathology, Regina Elena National Cancer Institute IRCCS, Rome 00144, Italy
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome 00144, Italy
| | - Maria Benevolo
- Department of Pathology, Regina Elena National Cancer Institute IRCCS, Rome 00144, Italy
| | - Barbara Pichi
- Department of Otolaryngology Head & Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome 00144, Italy
| | - Raul Pellini
- Department of Otolaryngology Head & Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome 00144, Italy
| | - Eugenia Giuliani
- Department of Molecular Medicine, Sapienza University, Rome 00161, Italy
| | - Amalia Giglio
- Clinical Pathology & Microbiology, San Gallicano Dermatological Institute IRCCS, Rome 00144, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome 00144, Italy
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome 00144, Italy
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14
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Gheit T, Rollo F, Brancaccio RN, Robitaille A, Galati L, Giuliani M, Latini A, Pichi B, Benevolo M, Cuenin C, McKay-Chopin S, Pellini R, Cristaudo A, Morrone A, Tommasino M, Donà MG. Oral Infection by Mucosal and Cutaneous Human Papillomaviruses in the Men Who Have Sex with Men from the OHMAR Study. Viruses 2020; 12:E899. [PMID: 32824507 PMCID: PMC7472018 DOI: 10.3390/v12080899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Both mucosal and cutaneous Human Papillomaviruses (HPVs) can be detected in the oral cavity, but investigations regarding the epidemiology of cutaneous HPVs at this site are scarce. We assessed mucosal (alpha) and cutaneous (beta and gamma) HPV infection in oral samples of HIV-infected and uninfected men who have sex with men (MSM). Oral rinse-and-gargles were collected from 310 MSM. Alpha HPVs were detected using the Linear Array, whereas beta and gamma HPVs were detected using multiplex PCR and Luminex technology. An amplicon-based next-generation sequencing (NGS) protocol was applied to a subset of samples collected from 30 HIV-uninfected and 30 HIV-infected MSM. Beta HPVs were significantly more common than alpha types (53.8% vs. 23.9% for HIV-infected subjects, p < 0.0001; 50.3% vs. 17.1% for HIV-uninfected subjects, p < 0.0001). Gamma HPVs were also frequently detected (30.8% and 25.9% in HIV-infected and uninfected MSM, respectively). NGS produced 2,620,725 reads representative of 146 known HPVs (16 alpha-PVs, 53 beta-PVs, 76 gamma-PVs, one unclassified) and eight putative new HPVs, taxonomically assigned to the beta genus. The oral cavity contains a wide spectrum of HPVs, with beta types representing the predominant genus. The prevalence of beta and gamma HPVs is high even in immunorestored HIV-infected individuals. NGS confirmed the abundance of cutaneous HPVs and identified some putative novel beta HPVs. This study confirms that cutaneous HPVs are frequently present at mucosal sites and highlights that their pathological role deserves further investigation since it may not be limited to skin lesions.
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Affiliation(s)
- Tarik Gheit
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (T.G.); (R.N.B.); (A.R.); (L.G.); (C.C.); (S.M.-C.); (M.T.)
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.); (M.B.)
| | - Rosario N Brancaccio
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (T.G.); (R.N.B.); (A.R.); (L.G.); (C.C.); (S.M.-C.); (M.T.)
| | - Alexis Robitaille
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (T.G.); (R.N.B.); (A.R.); (L.G.); (C.C.); (S.M.-C.); (M.T.)
| | - Luisa Galati
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (T.G.); (R.N.B.); (A.R.); (L.G.); (C.C.); (S.M.-C.); (M.T.)
| | - Massimo Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (M.G.); (A.L.); (A.C.)
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (M.G.); (A.L.); (A.C.)
| | - Barbara Pichi
- Otolorayngology Head&Neck Surgery Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.); (M.B.)
| | - Cyrille Cuenin
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (T.G.); (R.N.B.); (A.R.); (L.G.); (C.C.); (S.M.-C.); (M.T.)
| | - Sandrine McKay-Chopin
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (T.G.); (R.N.B.); (A.R.); (L.G.); (C.C.); (S.M.-C.); (M.T.)
| | - Raul Pellini
- Otolorayngology Head&Neck Surgery Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (M.G.); (A.L.); (A.C.)
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatologic Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Massimo Tommasino
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (T.G.); (R.N.B.); (A.R.); (L.G.); (C.C.); (S.M.-C.); (M.T.)
| | - Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (M.G.); (A.L.); (A.C.)
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