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Satora M, Żak K, Frankowska K, Misiek M, Tarkowski R, Bobiński M. Perioperative Factors Affecting the Healing of Rectovaginal Fistula. J Clin Med 2023; 12:6421. [PMID: 37835064 PMCID: PMC10573987 DOI: 10.3390/jcm12196421] [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: 08/27/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
Rectovaginal fistula is rare, but a severe complication in gynecology, which despite the effort of clinicians is still not treated successfully in many cases. According to statistics, the healing rates of surgery in patients with RVF range from 20 to 100%. The treatment effectiveness depends on the etiology of fistula, the age of the patients, the presence of comorbidities, the type of surgery and many other factors. Considering the low efficiency of treatment and the high risk of recurrence, the question of possible methods to improve the results occurs. In our review, we analyzed both modifiable and non-modifiable factors which may influence the treatment, healing rate and future fate of the patients. Taking into account all analyzed risk factors, including age, comorbidities, smoking status, microbiology, medications, stoma and stool features, we are aware that rectovaginal fistula's treatment must be individualized and holistic. In cases of poorly healing RVF, the drainage of feces, the use of antibiotic prophylaxis or the implementation of estrogen therapy may be useful. Moreover, microbiome research in women with RVF and towards estrogen therapy should be performed in order to create treatment algorithms in women with fistulae. Those interventions, in our opinion, may significantly improve the outcome of the patients.
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Affiliation(s)
- Małgorzata Satora
- I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-081 Lublin, Poland; (M.S.); (K.Ż.); (K.F.)
| | - Klaudia Żak
- I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-081 Lublin, Poland; (M.S.); (K.Ż.); (K.F.)
| | - Karolina Frankowska
- I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-081 Lublin, Poland; (M.S.); (K.Ż.); (K.F.)
| | - Marcin Misiek
- Department of Gynecology, Holy Cross Cancer Center, 25-734 Kielce, Poland;
| | - Rafał Tarkowski
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Marcin Bobiński
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-081 Lublin, Poland;
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Laurie C, El-Zein M, Tota J, Tellier PP, Coutlée F, Franco EL, de Pokomandy A. Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV): design and methods for a randomised controlled trial. BMJ Open 2020; 10:e035113. [PMID: 32205376 PMCID: PMC7103806 DOI: 10.1136/bmjopen-2019-035113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Gay, bisexual and other men who have sex with men (gbMSM) have an increased risk of human papillomavirus (HPV) infection and HPV-associated diseases, such as anal cancer and anogenital warts. A carrageenan-based lubricant could prevent HPV infection, thereby reducing the disease burden in this population. This paper describes the protocol for the Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV) study, an ongoing randomised controlled trial (RCT), evaluating efficacy of a carrageenan-based personal lubricant in reducing type-specific anal HPV incidence and prevalence among sexually active gbMSM, efficacy by HIV status, safety and tolerability of the gel and participant adherence to the intervention. METHODS AND ANALYSIS The study is a double-blinded, placebo-controlled RCT. Volunteer gbMSM 18 years and older are randomly assigned 1:1 to receive the treatment (a self-applied anal microbicide gel with carrageenan) or placebo (a self-applied placebo gel). At each visit, computerised questionnaires are used to collect data on sociodemographic and clinical variables, lifestyle, sexual behaviour and the gels' safety and tolerability. At baseline and each follow-up visit (months 1, 2, 3, 6, 9 and 12), nurses collect anal specimens tested for 36 HPV types (linear array assay). HIV status is determined at baseline and 12 months. The primary outcome is incidence of type-specific anal HPV infection(s) undetected at baseline. Secondary outcomes are prevalence of type-specific anal HPV infection, safety, tolerability and adherence. We aim to recruit 380 participants to attain the study's objectives. Data will be analysed using intention-to-treat and per-protocol approaches with subgroup analyses by HIV status. ETHICS AND DISSEMINATION Ethics approval was obtained by the Research Ethics Boards of McGill University, the McGill University Health Centre, Concordia University and Centre Hospitalier de l'Université de Montréal. Trial results will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT02354144.
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Affiliation(s)
- Cassandra Laurie
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Joseph Tota
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | | | - Francois Coutlée
- Service de Microbiologie Médicale et Service d'Infectiologie, Départements de Médecine et de médecine de laboratoire, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Zheng LH, Zhang AZ, Shi YY, Li X, Jia LS, Zhi CC, Yu QX, Zhang W, Liu YJ, Wang L, Xiao D, Wang C. Impact of Smoking on Anal Abscess and Anal Fistula Diseases. Chin Med J (Engl) 2018; 131:1034-1037. [PMID: 29692373 PMCID: PMC5937310 DOI: 10.4103/0366-6999.230738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Several studies have investigated the association between smoking and anal abscess and anal fistula (AA/F) diseases. However, the relationship between cigarette smoking and AA/F remains unclear. This study sought to assess the role of smoking in anorectal male patients in a Chinese population. Methods In this retrospective study, a questionnaire, including smoking history, was completed over a 3-month period by male inpatients in the Proctology Department of China-Japan Friendship Hospital. "Cases" were patients who had AA/F, and "controls" were patients with other anorectal complaints. Mann-Whitney U-test and Chi-square test were carried out to examine differences in baseline characteristics between groups. Subsequently, multivariate logistic regression was used to explore any related factors. Results A total of 977 patients aged from 18 to 80 years were included, excluding those diagnosed with inflammatory bowel disease or diabetes mellitus. Out of this total, 805 patients (82.4%) completed the entire questionnaire. Among the 805 patients, 334 (41.5%) were cases and 471 (58.5%) were controls. Results showed significant differences between cases and controls (χ2 = 205.2, P < 0.001), with smoking found to be associated with the development of AA/F diseases (odds ratio: 12.331, 95% confidence interval: 8.364-18.179, P < 0.001). Conclusions This study suggested smoking to be a potential risk factor for the development of AA/F diseases in a Chinese population. Consequently, current smoking patients should be informed of this relationship, and further research should be conducted to explore and investigate this further.
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Affiliation(s)
- Li-Hua Zheng
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ao-Zhe Zhang
- Centre for Respiratory Diseases, China-Japan Friendship Hospital; Tobacco Medicine and Tobacco Cessation Centre, China-Japan Friendship Hospital; WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, China-Japan Friendship Hospital; National Clinical Research Centre for Respiratory Diseases, Beijing 100029, China
| | - Yu-Ying Shi
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xin Li
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Lan-Si Jia
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Cong-Cong Zhi
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qiu-Xiang Yu
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wen Zhang
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yan-Jun Liu
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Luan Wang
- Proctology Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Dan Xiao
- Centre for Respiratory Diseases, China-Japan Friendship Hospital; Tobacco Medicine and Tobacco Cessation Centre, China-Japan Friendship Hospital; WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, China-Japan Friendship Hospital; National Clinical Research Centre for Respiratory Diseases, Beijing 100029, China
| | - Chen Wang
- Centre for Respiratory Diseases, China-Japan Friendship Hospital; WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, China-Japan Friendship Hospital; National Clinical Research Centre for Respiratory Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Prevalence of Anal Dysplasia in Human Immunodeficiency Virus-Infected Transgender Women. Sex Transm Dis 2018; 44:714-716. [PMID: 28876310 DOI: 10.1097/olq.0000000000000673] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Although human immunodeficiency virus-infected men who have sex with men are at high risk for anal cancer, little is known about the prevalence of anal dysplasia in human immunodeficiency virus (HIV)-infected transgender women. Our study found that prevalence rates of abnormal anal cytology and histology in HIV-infected transgender women were similar to those in HIV-infected men who have sex with men.
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Barbeiro S, Atalaia-Martins C, Marcos P, Gonçalves C, Cotrim I, Vasconcelos H. A Case Series of Anal Carcinoma Misdiagnosed as Idiopathic Chronic Anal Fissure. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 24:227-231. [PMID: 29255757 DOI: 10.1159/000452869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/17/2016] [Indexed: 12/31/2022]
Abstract
Chronic anal fissure is a linear ulcer in the anal canal that has not cicatrized for more than 8-12 weeks of treatment. Most anal fissures are idiopathic and are located in the posterior midline. Squamous cell carcinoma of the anus commonly presents as bleeding and anal pain. It may also present as a mass, nonhealing ulcer, itching, discharge, fecal incontinence and fistulae. Not uncommonly, small and early cancers are misdiagnosed as benign anorectal disorders like anal fissures or hemorrhoids. The clinical suspicion of squamous cell carcinoma of the anus is of paramount importance in patients with nonhealing anal fissures, fissures in atypical positions or with indurated or ulcerated anal tags and in patients with risk factors for the development of anal squamous intraepithelial lesions that are precursors of invasive anal squamous cell carcinoma. The authors present 3 cases of squamous cell carcinoma of the anus initially misdiagnosed as benign chronic anal fissure.
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Affiliation(s)
- Sandra Barbeiro
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Pedro Marcos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cláudia Gonçalves
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Isabel Cotrim
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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Anal Cancer Screening in Men Who Have Sex With Men in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr 2016; 71:570-6. [PMID: 26656784 DOI: 10.1097/qai.0000000000000910] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the prevalence of anal cytology (ACyt) abnormalities among HIV-infected and HIV-uninfected men who have sex with men (MSM). DESIGN Multicenter cohort study of 723 HIV-infected and 788 HIV-uninfected MSM with ACyt, with a second ACyt collected 2 years later. A referral for high-resolution anoscopy was suggested for abnormal ACyt. METHODS ACyt samples were collected using a polyester swab and liquid cytology media and read in a central laboratory. RESULTS Prevalence of any abnormal ACyt was 25% in HIV-uninfected MSM and increased to 38%, 41%, and 47% among HIV-infected MSM with current CD4 T-cell counts ≥500, 350-499, and <350 cells/mm (P < 0.001), respectively. Anal HPV16 DNA was also more common in HIV-infected than HIV-uninfected MSM (25% versus 16%, P < 0.001). Abnormal baseline ACyt together with prevalent HPV16 DNA detection was present in only 7% of HIV-uninfected MSM compared to 18% of HIV-infected MSM with current CD4 < 350, P < 0.001. Among HIV-infected men, 56% of the men with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions ASCs-US/LSILs and 81% of men with atypical squamous cells cannot exclude high-grade (ASC-H/)/high-grade squamous intraepithelial lesions (HSIL) had lower grade ACyt findings 18-30 months later ("regressed"). However, 19% of untreated HIV-infected men with ASC-H/HSIL cytology maintained that same grade of cytology in their second test approximately 2 years later, and 15% with ASC-US/LSIL "progressed" to ASC-H/HSIL. Abnormal ACyt had high sensitivity (96%) but low specificity (17%) for biopsy-proven HSIL. CONCLUSIONS Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current antiretroviral therapy era.
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Walsh T, Bertozzi-Villa C, Schneider JA. Systematic review of racial disparities in human papillomavirus-associated anal dysplasia and anal cancer among men who have sex with men. Am J Public Health 2015; 105:e34-45. [PMID: 25713941 DOI: 10.2105/ajph.2014.302469] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We systematically reviewed the literature on anal human papillomavirus (HPV) infection, dysplasia, and cancer among Black and White men who have sex with men (MSM) to determine if a racial disparity exists. We searched 4 databases for articles up to March 2014. Studies involving Black MSM are nearly absent from the literature. Of 25 eligible studies, 2 stratified by race and sexual behavior. Both reported an elevated rate of abnormal anal outcomes among Black MSM. White MSM had a 1.3 times lower prevalence of group-2 HPV (P < .01) and nearly 13% lower prevalence of anal dysplasia than did Black MSM. We were unable to determine factors driving the absence of Black MSM in this research and whether disparities in clinical care exist. Elevated rates of abnormal anal cytology among Black MSM in 2 studies indicate a need for future research in this population.
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Affiliation(s)
- Tim Walsh
- Tim Walsh, Clara Bertozzi-Villa, and John. A. Schneider are with the Department of Medicine and the Chicago Center for HIV Elimination, University of Chicago, IL. John A. Schneider is also with the Department of Public Health Sciences, University of Chicago
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Wiley DJ, Li X, Hsu H, Seaberg EC, Cranston RD, Young S, D’Souza G, Martínez-Maza O, DeAzambuja K, Chua K, Hussain SK, Detels R. Factors affecting the prevalence of strongly and weakly carcinogenic and lower-risk human papillomaviruses in anal specimens in a cohort of men who have sex with men (MSM). PLoS One 2013; 8:e79492. [PMID: 24278140 PMCID: PMC3835810 DOI: 10.1371/journal.pone.0079492] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/22/2013] [Indexed: 02/06/2023] Open
Abstract
Background MSM are at higher risk for invasive anal cancer. Twelve human papillomaviruses (HPVs) cause cervical cancer in women (Group 1 high-risk HPVs (hrHPVs)) and 13 HPVs are probable/possible causes (Group 2 hrHPVs) of cervical malignancy. HPVs rarely associated with malignancy are classified as lower-risk HPVs (lrHPVs). Materials and Methods Dacron-swab anal-cytology specimens were collected from and data complete for 97% (1262/1296) of Multicenter AIDS Cohort Study (MACS) men tested for HPVs using the Linear Array assay. Multivariate Poisson regression analyses estimated adjusted prevalence ratios for Group 1/2 hrHPVs and lrHPVs, controlling for the effects of age, race, ethnicity, sexual partnerships, smoking; HIV-infection characteristics, treatment, and immune status among HIV-infected men. Results HIV-infected men showed 35–90% higher prevalence of Group 1/2 hrHPVs and lrHPVs than HIV-uninfected men, and higher prevalence of multi-Type, and multiple risk-group infections. CD4+ T-cell count was inversely associated with HPV Group 2 prevalence (p<0.0001). The number of receptive anal intercourse (RAI) partners reported in the 24 months preceding HPV testing predicted higher prevalence of Group 1/2 hrHPVs. Men reporting ≥30 lifetime male sex partners before their first MACS visit and men reporting ≥1 RAI partners during the 24 months before HPV testing showed 17–24% and 13–17% higher prevalence of lrHPVs (p-values ≤0.05). Men reporting smoking between MACS visit 1 and 24 months before HPV testing showed 1.2-fold higher prevalence of Group 2 hrHPVs (p = 0.03). Both complete adherence to CART (p = 0.02) and HIV load <50 copies/mL (p = 0.04) were protective for Group 1 hrHPVs among HIV-infected men. Conclusions HIV-infected men more often show multi-type and multi-group HPV infections HIV-uninfected men. Long-term mutual monogamy and smoking cessation, generally, and CART-adherence that promotes (HIV) viremia control and prevents immunosuppression, specifically among HIV-infected MSM, are important prevention strategies for HPV infections that are relevant to anal cancer.
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Affiliation(s)
- Dorothy J. Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Xiuhong Li
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hilary Hsu
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Eric C. Seaberg
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ross D. Cranston
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Stephen Young
- Tricore Diagnostic Laboratories, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Gypsyamber D’Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Otoniel Martínez-Maza
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- UCLA AIDS Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Katherine DeAzambuja
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kristofer Chua
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Shehnaz K. Hussain
- Jonathan and Karen Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Roger Detels
- Jonathan and Karen Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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Assoumou SA, Mayer KH, Panther L, Linas BP, Kim JJ. Cost-effectiveness of surveillance strategies after treatment for high-grade anal dysplasia in high-risk patients. Sex Transm Dis 2013; 40:298-303. [PMID: 23486494 PMCID: PMC3780795 DOI: 10.1097/olq.0b013e31827f4fe9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anal cancer is one of the most common cancers affecting human immunodeficiency virus (HIV)-infected male patients. Currently, there is no consensus on posttreatment surveillance of HIV-infected men who have sex with men (MSM) who have been treated for high-grade intraepithelial neoplasia (HGAIN), the likely precursor to anal cancer. OBJECTIVE The aim of this study was to assess the cost-effectiveness of a range of strategies for anal cancer surveillance in HIV-infected MSM previously treated for HGAIN. METHODS We developed a Markov model to project quality-adjusted life expectancy, lifetime costs, and the incremental cost-effectiveness ratios of 5 strategies using high-resolution anoscopy (HRA) and/or anal cytology testing after treatment. RESULTS Performing HRA alone at 6- and 12-month visits was associated with a cost-effectiveness ratio of $4446 per quality-adjusted life year gained. In comparison, combined HRA and anal cytology at both visits provided greater health benefit at a cost of $17,373 per quality-adjusted life year gained. Our results were robust over a number of scenarios and assumptions including patients' level of immunosuppression. Results were most sensitive to test characteristics and cost, as well as progression rates of normal to HGAIN and HGAIN to cancer. CONCLUSIONS Our results suggest that combined HRA and anal cytology at 6 and 12 months may be a cost-effective surveillance strategy after treatment of HGAIN in HIV-infected MSM.
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Affiliation(s)
- Sabrina A. Assoumou
- Instructor in Medicine, Boston University School of Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, P: 617-414-2896, F:617-638-8070,
| | - Kenneth H. Mayer
- Infectious Disease Attending and Director of HIV Prevention Research, Beth Israel Deaconess Medical Center, Visiting Professor of Medicine, Harvard Medical School, Medical Research Director and Co-Chair, The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th floor, Boston, Mass 02215, P: 617-927-6087, F: 617-267-0764,
| | - Lori Panther
- Associate Medical Director for Clinical Research, The Fenway Institute, Division of Infectious Disease, Beth Israel Deaconess Medical Center, 1340 Boylston Street, Boston, MA USA 02215, P: 617-927-6056, F: 617-632-7626,
| | - Benjamin P. Linas
- Assistant Professor of Medicine, Boston University School of Medicine, Assistant Professor of Epidemiology, Boston University School of Public Health, Boston Medical Center, 850 Harrison Ave., Dowling - 3N room 3205, Boston, MA 02118, P: 617-414-5238, F: 617-414-706,
| | - Jane J. Kim
- Assistant Professor of Heath Decision Science, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115, P: (617) 432-0095,
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HPV Infection in a Cohort of HIV-Positive Men and Women: Prevalence of Oncogenic Genotypes and Predictors of Mucosal Damage at Genital and Oral Sites. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:915169. [PMID: 26316967 PMCID: PMC4437419 DOI: 10.1155/2013/915169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 12/03/2022]
Abstract
The aim of this study was to assess the prevalence of HPV infection and determinants of abnormal cytology in HIV-positive patients.
In a cross-sectional study, patients of both sexes, asymptomatic for HPV, underwent anorectal (men)/cervical (women) and oral swabs. Cytology and HPV-PCR detection/genotyping (high- and low-risk genotypes, HR-LR/HPV) were performed. A total of 20% of the 277 enrolled patients showed oral HPV, with no atypical cytology; in men, anal HPV prevalence was 81% with 64% HR genotypes. In women, cervical HPV prevalence was 58% with 37% HR-HPV. The most frequent genotypes were HPV-16 and HPV-18; 37% of men and 20% of women harbored multiple genotypes. Also, 47% of men showed anal squamous intraepithelial lesions (SILs); 6% had high- and 35% low-grade SILs (HSILs/LSILs); 5% had atypical squamous cells of undetermined significance (ASC-US). HR-HPV was independently associated with anal-SIL in men (P = 0.039). Moreover, 37% of women showed cervical SIL: 14 ASC-US, 15 LSILs, 4 HSILs, and 1 in situ cancer. The presence of both LR and HR-HPV in women was independently associated with SIL (P = 0.003 and P = 0.0001). HR-HPV and atypical cytology were frequently identified in our cohort. HPV screening should be mandatory in HIV-infected subjects, and vaccine programs for HPV-negative patients should be implemented.
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Donà MG, Benevolo M, Vocaturo A, Palamara G, Latini A, Giglio A, Moretto D, Rollo F, Impara G, Ensoli F, Pimpinelli F, Di Carlo A, Giuliani M. Anal cytological abnormalities and epidemiological correlates among men who have sex with men at risk for HIV-1 infection. BMC Cancer 2012; 12:476. [PMID: 23072547 PMCID: PMC3517502 DOI: 10.1186/1471-2407-12-476] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/12/2012] [Indexed: 11/16/2022] Open
Abstract
Background The incidence of anal cancer, a Human Papillomavirus (HPV)-related neoplasia, has been increasing in recent decades, mainly in men who have sex with men (MSM). Cytological changes of the anal epithelium induced by HPV can be detected through an anal pap smear. This study aimed to evaluate the prevalence and epidemiological correlates of anal cytological abnormalities among relatively young MSM at risk for HIV-1 infection, to help clarify whether or not this population deserves further investigation to assess the presence of anal cancer precursor lesions. Methods MSM were recruited among attendees of a large STI clinic for a HIV-1 screening program. Anal samples, collected with a Dracon swab in PreservCyt, were used both for liquid-based cytology and HPV testing by the Linear Array HPV Genotyping Test. Data regarding socio-demographic characteristics and sexual behavior were collected in face-to-face interviews. Results A total of 346 MSM were recruited (median age 32 years). Overall, 72.5% of the individuals had an anal HPV infection, with 56.1% of them being infected by oncogenic HPV genotypes. Anal cytological abnormalities were found in 29.8% of the cases (16.7% ASC-US and 13.1% L-SIL). Presence of ASC-US+ was strongly associated with infection by any HPV type (OR=4.21, 95% CI: 1.97-9.23), and particularly by HPV 16 and/or 18 (OR=5.62, 95% CI: 2.33-13.81). A higher proportion of ASC-US+ was found in older MSM, in those with a higher number of lifetime partners and in those with a history of ano-genital warts. However, none of these variables or the others analyzed showed any significant association with abnormal cytological findings. Conclusions The presence of anal cytological abnormalities in about one third of the recruited MSM and their strong association with HPV infection, in particular that caused by HPV 16 and/or 18, might provide a further complement to the data that now support the introduction of HPV vaccination among MSM to protect them from the development of HPV-associated diseases. Additional studies are needed to determine whether and how screening for anal cancer precursor lesions should be performed in younger MSM.
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Affiliation(s)
- Maria Gabriella Donà
- Sexually Transmitted Infections Unit, San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
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Colón-López V, Ortiz AP, Palefsky J. Burden of human papillomavirus infection and related comorbidities in men: implications for research, disease prevention and health promotion among Hispanic men. PUERTO RICO HEALTH SCIENCES JOURNAL 2010; 29:232-40. [PMID: 20799510 PMCID: PMC3038604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Genital human papillomavirus (HPV) infection is one of the most commonly diagnosed sexually transmitted infections world-wide. Over the last two decades, research has established a strong causal link between specific types of HPV infection and cancer, particularly cervical, anal, vulvar/vaginal, penile, and oropharyngeal cancer. Limited epidemiological studies of anogenital HPV infection have been conducted in Hispanic populations (including Puerto Rico), and population-based incidence and prevalence estimates of HPV infection among Hispanics are limited. Studies that evaluate knowledge and awareness of HPV among men are also scarce. With the world-wide introduction of two new prophylactic vaccines against high-risk HPVs causing cervical cancer, and the recent FDA approval of the quadrivalent vaccine in preventing genital warts in men, there is an urgency to determine the burden of HPV in Hispanic populations before vaccine programs are implemented on a widespread basis. Knowledge and acceptability of the vaccine prior to implementation of these programs are also necessary to allow a targeted assessment. This review article summarizes existing research on HPV infection and HPV-related morbidities in men, with a particular emphasis on Hispanic men in the United States and Puerto Rico. Three major areas are discussed: (1) genital warts, (2) HPV and related cancers and (3) biobehavioral and psychosocial factors related to HPV infection and vaccination. Specific recommendations for advancing HPV research and knowledge among Hispanic populations also are suggested.
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Affiliation(s)
- Vivian Colón-López
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico.
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Smoking enhances risk for new external genital warts in men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:1215-34. [PMID: 19440442 PMCID: PMC2672382 DOI: 10.3390/ijerph6031215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 03/17/2009] [Indexed: 11/25/2022]
Abstract
Repeat episodes of HPV-related external genital warts reflect recurring or new infections. No study before has been sufficiently powered to delineate how tobacco use, prior history of EGWs and HIV infection affect the risk for new EGWs. Behavioral, laboratory and examination data for 2,835 Multicenter AIDS Cohort Study participants examined at 21,519 semi-annual visits were evaluated. Fourteen percent (391/2835) of men reported or were diagnosed with EGWs at 3% (675/21,519) of study visits. Multivariate analyses showed smoking, prior episodes of EGWs, HIV infection and CD4+ T-lymphocyte count among the infected, each differentially influenced the risk for new EGWs.
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Abstract
Prophylactic HPV L1 VLP quadrivalent and bivalent vaccines are of great importance for patients seen by dermatologists and venereologists. Both vaccines protect against HPV16- and HPV18-associated anogenital cancers, as well as cancers of the mouth, the upper respiratory tract and skin, especially of the fingers and periungual region. The quadrivalent HPV6, 11, 16, 18 vaccine also prevents anogenital warts (condylomata acuminata) which are the most common benign tumors of this body region. HPV-vaccination (Gardasil) has been approved in Germany since October 2006 for young girls between 9-16 and young women between 16-26 years of age. Many experts feel that boys and young men should also be vaccinated. Men would profit from a vaccine that protects against HPV infections, especially anogenital warts, as well as penile and anal carcinomas. In immunosuppressed organ transplant recipients and HIV-positive individuals, HPV can be widespread, chronic and often rapidly progressive to malignant tumors; thus these groups would greatly benefit from HPV immunization.
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Affiliation(s)
- G Gross
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum AöR, Universität Rostock, Augustenstrasse 80-84, 18055 Rostock, Deutschland.
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Zhang J, Martins CR, Fansler ZB, Roemer KL, Kincaid EA, Gustafson KS, Heitjan DF, Clark DP. DNA methylation in anal intraepithelial lesions and anal squamous cell carcinoma. Clin Cancer Res 2005; 11:6544-9. [PMID: 16166431 DOI: 10.1158/1078-0432.ccr-05-0374] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Anal intraepithelial neoplasia is associated with human papillomavirus infection and may progress to invasive squamous cell carcinoma (SCC), which is increasing in immunocompromised patients. We hypothesize that anal intraepithelial neoplasia is associated with abnormal DNA methylation and that detection of these events may be used to improve screening programs. EXPERIMENTAL DESIGN Seventy-six patients were identified who underwent anal cytology screening and subsequent biopsy at our institution between 1999 and 2004. The specimens from these patients included 184 anal biopsies [normal, n = 57; low-grade squamous intraepithelial lesion (LSIL), n = 74; high-grade squamous intraepithelial lesion (HSIL), n = 41; and invasive SCC, n = 12] and 37 residual liquid-based anal cytology specimens (normal, n = 11; LSIL, n = 12; HSIL, n = 14). The methylation status of the following genes was determined for each biopsy and cytology sample using real-time methylation-specific PCR: HIC1, RASSF1, RARB, CDKN2A, p14, TP73, APC, MLH1, MGMT, DAPK1, and IGSF4. RESULTS Methylation-specific PCR analysis of biopsy samples revealed that DNA methylation was more common in SCC and HSIL than LSIL and normal mucosa. Specifically, methylation of IGSF4 and DAPK1 was prevalent in SCC (75% and 75% of cases, respectively) and HSIL (59% and 71%, respectively) but was absent in LSIL and normal biopsy samples. Methylation profiles of cytologic samples were similar to those found in the biopsy samples. CONCLUSIONS Aberrant DNA methylation is a frequent event in anal HSIL and SCC. Methylation of IGSF4 and DAPK1 is specific for HSIL and SCC, and may serve as a useful molecular biomarker.
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Affiliation(s)
- Jun Zhang
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
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Scott M, Nakagawa M, Moscicki AB. Cell-mediated immune response to human papillomavirus infection. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2001; 8:209-20. [PMID: 11238198 PMCID: PMC96039 DOI: 10.1128/cdli.8.2.209-220.2001] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Scott
- Department of Pediatrics, School of Medicine, University of California San Francisco, San Francisco, California 94143, USA.
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