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Krankowska D, Mazzitelli M, Ucak HA, Orviz E, Karakoc HN, Mortimer H, Aebi-Popp K, Gilleece Y. Screening and prevention of HPV-related anogenital cancers in women living with HIV in Europe: Results from a systematic review. HIV Med 2024. [PMID: 38238990 DOI: 10.1111/hiv.13602] [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: 07/25/2023] [Accepted: 12/02/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Women living with HIV (WLWH) are at increased risk of human papillomavirus (HPV)-related cancers. Throughout Europe, there is great heterogeneity among guidelines for screening programmes, access to HPV testing and HPV vaccination. The aim of this systematic review is to summarize available data on screening and prevention measures for HPV-related anogenital cancers in WLWH across the WHO European Region (WER). METHODS The systematic review followed the PRISMA guidelines and was registered on Prospero. PubMed, Embase and Web of Science databases were searched to identify available studies, written in English and published between 2011 and 2022. A metanalysis was conducted using random-effects models to calculate pooled prevalence of HPV. Subgroup analyses were conducted according to country and HPV testing. RESULTS Thirty-four articles involving 10 336 WLWH met the inclusion criteria. Studies were heterogenous in their methodology and presentation of results: 73.5% of studies focused on cervical cancer prevention, and only 4.4% on anal cancer; 76.5% of studies conducted HPV testing as a routine part of screening. The prevalence of high-risk HPV was 30.5-33.9% depending on the detection method used. A total of 77% of WLWH had cervical cytology results reported. Six studies reported the positive association of CD4 cell count <200 cells/μL with HPV prevalence and cervical abnormalities. Anal HPV testing was conducted in <8% of participants. HPV vaccination was completed in 5.6% of women (106/1902) with known vaccination status. There was no information about the vaccination status of the majority of women in the analysed studies (8434/10336). CONCLUSION Data about screening of HPV-related anogenital cancer in WLWH in Europe are heterogenous and lacking, especially in relation to anal cancer. HPV DNA testing is not routinely done as part of screening for HPV-related cancer; guidelines should include indications for when to use this test. Low CD4 count is a risk factor for HPV infection and cytological abnormalities. HPV vaccination data are poor and, when available, vaccination rates are very low among WLWH in Europe. This review concludes that significant improvements are required for data and also consistency on guidelines for HPV screening, prevention and vaccination in WLWH.
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Affiliation(s)
- Dagny Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warszawa, Poland
- Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | | | - Eva Orviz
- Centro Sanitario Sandoval, Hospital Clinico San Carlos, IdlSSC, Madrid, Spain
| | | | - Harriet Mortimer
- Brighton & Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Obstetrics and Gynecology, Lindenhofspital, Bern, Switzerland
| | - Yvonne Gilleece
- Brighton & Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
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Bogale AL, Belay NB, Medhin G, Ali JH. Molecular epidemiology of human papillomavirus among HIV infected women in developing countries: systematic review and meta-analysis. Virol J 2020; 17:179. [PMID: 33198743 PMCID: PMC7670609 DOI: 10.1186/s12985-020-01448-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/05/2020] [Indexed: 12/31/2022] Open
Abstract
Background Although, there is a variable burden of human papillomavirus (HPV) in women infected with HIV in developing countries, there are few studies that attempted to surmise such variable evidences. This review aimed to estimate the pooled prevalence of HPV genotype distribution and risk factors contributing to HPV infection among women infected with HIV in low- and middle-income countries. Methods We conducted a systematic review and meta-analysis of studies conducted in developing countries and reported HPV prevalence. We searched electronic databases: PubMed/Medline, SCOPUS, ScienceDirect, Excerpta Medical Database from Elsevier, Web of science, Cumulative Index of Nursing and allied Health Sciences and Google scholar databases to retrieve primary studies published in English language till 11th August 2019. We used random-effects model to estimate the pooled prevalence of HPV genotypes, and funnel plot to assess publication bias. The registration number of this review study protocol is CRD42019123549. Results We included nineteen studies with a total of 8,175 participants in this review. The prevalence of HPV was extremely heterogeneous across the studies (χ2= 3782.80, p value < 0.001, I2 = 99.6%). The estimated pooled prevalence of all HPV genotypes was 63.0% (95% CI: 48.0–78.0) while the pooled prevalence of high risk and low risk HPV genotypes were 51.0% (95% CI: 38.0–63.0) and 28.0% (95% CI: 12.0–43.0), respectively. The pooled prevalence of HPV genotype 16 was 20%, while genotype 18 and 52 were 15% and 13%, respectively. Different risk factors reported for HPV infection and the frequently reported were low CD4 count below 200 cells/mm3 and high HIV viral load.
Conclusion The pooled prevalence of HPV among HIV infected women in low- and middle-income countries was considerable and the proportion of high risk HPV genotypes were high when compared with low risk genotypes. Therefore, it is essential for the HPV prevention program to prevent the double burden of HPV and HIV in women.
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Affiliation(s)
- Agajie Likie Bogale
- Ethiopian Public Health Institute, and Addis Ababa University, P.O. Box 1242, Addis Ababa, Ethiopia.
| | - Nega Berhe Belay
- Department of Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Department of Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Jemal Haidar Ali
- School of Public Health, College of Health Sciences, Addis Ababa University, 1000, P.O. Box 27285, Addis Ababa, Ethiopia
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Extracellular Vesicles from Human Papilloma Virus-Infected Cervical Cancer Cells Enhance HIV-1 Replication in Differentiated U1 Cell Line. Viruses 2020; 12:v12020239. [PMID: 32098055 PMCID: PMC7077309 DOI: 10.3390/v12020239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
In the current study, we hypothesized that extracellular vesicles (EVs) secreted from human papilloma virus (HPV)-infected cervical cancer cells exacerbate human immunodeficiency virus (HIV)-1 replication in differentiated U1 cell line through an oxidative stress pathway. To test the hypothesis, we treated an HIV-1-infected macrophage cell line (U1) with HPV-infected Caski cell culture supernatant (CCS). We observed a significant increase in HIV-1 replication, which was associated with an increase in the expression of cytochrome P450 (CYPs 1A1 and 2A6) in the CCS-treated U1 cells. Furthermore, we isolated EVs from CCS (CCS-EVs), which showed the presence of CYPs (1A1, 2A6), superoxide dismutase 1 (SOD1), and HPV oncoproteins HPV16 E6. CCS-EVs when exposed to the U1 cells also significantly increased HIV-1 replication. Treatment of antioxidant, CYP1A1 and CYP2A6 inhibitors, and chemodietary agents with antioxidant properties significantly reduced the CCS and CCS-EVs mediated HIV-1 replication in U1 cells. Altogether, we demonstrate that cervical cancer cells exacerbate HIV-1 replication in differentiated U1 cell line via transferring CYPs and HPV oncoproteins through EVs. We also show that the viral replication occurs via CYP and oxidative stress pathways, and the viral replication is also reduced by chemodietary agents. This study provides important information regarding biological interactions between HPV and HIV-1 via EVs leading to enhanced HIV-1 replication.
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Wudtisan J, Tantipalakorn C, Charoenkwan K, Sreshthaputra RA, Srisomboon J. Factors Associated with Development of High-Grade Squamous
Intraepithelial Lesions of the Uterine Cervix in Women Younger
than 30 Years. Asian Pac J Cancer Prev 2019; 20:1031-1036. [PMID: 31030470 PMCID: PMC6948903 DOI: 10.31557/apjcp.2019.20.4.1031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective: To determine the factors associated with the increased risk of developing high-grade squamous intraepithelial lesions (HSIL) of the uterine cervix in women younger than 30 years compared with those aged ≥ 30 years who also had HSIL. Methods: Patients with HSIL who underwent loop electrosurgical excision procedure (LEEP) between January 2006 and July 2017 at Chiang Mai University Hospital were retrospectively reviewed. We analyzed the factors associated with the development of HSIL by comparing two age groups between women aged < 30 years and those aged ≥ 30 years. The factors analyzed included the well-recognized risk factors for cervical cancer, i.e. age at sexual debut, number of sexual partners, use of oral contraceptive (OC) pills, smoking history, sexually transmitted diseases and HIV status. Univariate and multivariate logistic regressions were used to assess factors associated with the increased risk of developing HSIL in women younger than 30 years compared with those aged ≥ 30 years. Results: During the study period, there were 345 patients with HSIL, 30 were < 30 years (case group) and 315 aged ≥ 30 years (control group). By multivariate analyses , early sexual debut(OR, 2.86; 95% CI, 1.01-8.13; P=0.047), multiple sexual partners (OR, 2.94; 95% CI, 1.23-7.02; P=0.015), history of genital warts (OR, 20.46; 95% CI, 2.27-183.72; P=0.007) and history of smoking (OR, 2.95; 95% CI, 1.10-7.93; P=0.032) were significantly associated with the development of HSIL in women younger than 30 years when compared with those aged ≥ 30 years. The OC use, HIV status and underlying diseases were not significantly different in both groups. Conclusion: Early age at sexual debut, multiple sexual partners, history of genital warts and smoking are significant risk factors for developing HSIL in women younger than 30 years. Cervical cancer screening should be considered in young women with such factors.
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Affiliation(s)
- Jongpeeti Wudtisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Charuwan Tantipalakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Rung-Aroon Sreshthaputra
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Jatupol Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Videla S, Tarrats A, Ornelas A, Badia R, Castella E, Alcalde C, Chamorro A, Esté JA, Clotet B, Sirera G. Incidence of cervical high-grade squamous intraepithelial lesions in HIV-1-infected women with no history of cervical pathology: up to 17 years of follow-up. Int J STD AIDS 2018; 30:56-63. [PMID: 30170532 DOI: 10.1177/0956462418792653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently, Papanicolaou smears are proposed at three-year intervals for cervical screening to all women living with HIV. The aim of this retrospective cohort study was to provide data on the incidence of cervical high-grade squamous intraepithelial lesions (HSIL) in cervical smear confirmed by histology in HIV-1-infected women (two consecutive normal Papanicolaou smears at baseline) after a long-term follow-up. Sixty-seven women (recruited between March 1999 and January 2003) were analyzed. The median period of follow-up was 13.2 years (range: 7.4-17.1 years) with a total of 583 Papanicolaou smears. Twenty-seven percent of these HIV-1-infected women had poorly-controlled HIV. Cumulative incidence of HSIL was 18% (12/67; 95%CI: 11-29%) of which one was an invasive squamous cell carcinoma and two were carcinoma in situ. These women had not been well-engaged with the annual Papanicolaou smear screening program and had poor adherence to antiretroviral therapy. Development of HSIL was associated with high-risk-HPV infection (OR: 14.9; 95%CI: 3.0, 75.1). At last Papanicolaou smear, prevalence of high-risk-HPV infection was 30% (20/66, 95%CI: 21-42%). In conclusion, the incidence of cervical HSIL in HIV-1-infected women with poor antiretroviral therapy adherence or poor immunological status reinforces the need to identify those HIV-1-infected women at risk of developing cervical cancer.
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Affiliation(s)
- Sebastián Videla
- 1 Lluita Contra La SIDA Foundation and AIDS Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain.,2 Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)/University of Barcelona, L'Hospitalet del Llobregat, Barcelona
| | - Antoni Tarrats
- 3 Department of Gynecology, University Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - Arelly Ornelas
- 1 Lluita Contra La SIDA Foundation and AIDS Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - Roger Badia
- 4 AIDS Research Institute-IrsiCaixa, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Eva Castella
- 5 Department of Pathology, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - Carme Alcalde
- 1 Lluita Contra La SIDA Foundation and AIDS Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - Anna Chamorro
- 1 Lluita Contra La SIDA Foundation and AIDS Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - José A Esté
- 4 AIDS Research Institute-IrsiCaixa, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- 1 Lluita Contra La SIDA Foundation and AIDS Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain.,4 AIDS Research Institute-IrsiCaixa, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Guillem Sirera
- 1 Lluita Contra La SIDA Foundation and AIDS Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
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Teixeira MF, Sabidó M, Leturiondo AL, de Oliveira Ferreira C, Torres KL, Benzaken AS. High risk human papillomavirus prevalence and genotype distribution among women infected with HIV in Manaus, Amazonas. Virol J 2018; 15:36. [PMID: 29454382 PMCID: PMC5816532 DOI: 10.1186/s12985-018-0942-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 02/01/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive women have a high prevalence of human papillomavirus (HPV), and are infected with a broader range of HPV types than HIV-negative women. We aimed to determine the prevalence of cervical cytologic abnormalities, high-risk (HR)-HPV prevalence, type distribution according to the severity of cervical lesions and CD4 cell count and identify factors associated with HR-HPV infection among women living with HIV in Manaus, Amazonas. METHODS We enrolled 325 women living with HIV that attended an infectious diseases referral hospital. Each woman underwent a gynecological exam, cervical cytology, HR-HPV detection by Polymerase chain Reaction (PCR) using the BD Onclarity™ HPV Assay, colposcopy and biopsy, when necessary. We assessed the associations between potential risk factors and HR-HPV infection. RESULTS Overall, 299 (92.0%) women had a PCR result. The prevalence of HR-HPV- infection was 31.1%. The most prevalent HR-HPV types were: 56/59/66 (32.2%), 35/39/68 (28.0%), 52 (21.5%), 16 (19.4%), and 45 (12.9%). Among the women with HR-HPV infection (n = 93), 43.0% had multiple infections. Women with HPV infection showed higher prevalence of cervical abnormalities than that HPV-negative (LSIL: 22.6% vs. 1.5%; HSIL: 10.8% vs. 0.0%). The prevalence of HR-HPV among women with cytological abnormalities was 87.5% for LSIL and 100.0% for HSIL. Women with CD4 < 200 cell/mm3 showed the highest HR-HPV prevalence (59.3%) although this trend was not statistically significant (p-value = 0.62). The mean CD4 cell count decreased with increasing severity of cervical lesions (p-value = 0.001). The multivariable analysis showed that increasing age was associated with a decreased risk of HR-HPV infection with an adjusted prevalence odds ratio of 0.9 (95.0% CI: 0.9-1.0, p-value: 0.03) for each additional year. The only factor statistically significant associated with HR-HPV infection was CD4 cell count. CONCLUSIONS HR-HPV and abnormal cytology prevalence are high among women in the Amazonas. The low CD4 cell count was an important determinant of HPV infection and abnormal cytological findings. HPV quadrivalent vaccination used in Brazil might not offer protection for an important fraction of HPV-related disease burden in women living with HIV. This is partly explained by the high presence of non targeted vaccine HR-HPVs, such as the HPV genotype groups 56/59/66, 35/39/68 and individually HPV-52 and HPV-45, some of which contribute to high-grade lesion.
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Affiliation(s)
- Monique Figueiredo Teixeira
- Universidade Federal do Amazonas (UFAM), 6200, Coroado I, General Rodrigo Octávio Ave, Manaus, Amazon, 69080-900, Brazil.
| | - Meritxell Sabidó
- TransLab. Departament de Ciències Mèdiques, Facultat de Medicina, Girona, Catalunya, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Kátia Luz Torres
- Fundação Centro de Controle de Oncologia do Amazonas (FCecon), Manaus, Amazonas, Brazil
| | - Adele Schwartz Benzaken
- Fundação Alfredo da Matta (FUAM), Manaus, Amazonas, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil.,Departamento de IST, Aids, e Hepatites Virais, Ministério da Saúde, Brasília, DF, Brazil
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High-risk human papillomavirus genotypes distribution in a cohort of HIV-positive women living in Europe: epidemiological implication for vaccination against human papillomavirus. AIDS 2016; 30:425-33. [PMID: 26765936 DOI: 10.1097/qad.0000000000000929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Worldwide, human papillomavirus (HPV) 16 and 18 represents 70% of high-risk (HR) HPV found in cervical cancer. However HIV-positive women are more frequently infected by HRHPV other than HPV 16 or 18 (OHR). We aimed to analyse the HRHPV genotype distribution in a cohort of HIV-positive women and to estimate the potential protection offered by the different HPV vaccines. METHODS HRHPV genotypes by PCR and cytology were assessed in cervical samples from 508 HIV-positive women prospectively followed in Brussels. RESULTS Women characteristics were as follows: African origin (84%), median age 42 years, median CD4 T 555/μl, 89% under combined antiretroviral therapy and 73% with HIVRNA less than 20 copies/ml. HRHPV prevalence was 23% (116/508): 38% had abnormal cytology, 76% carried OHR without HPV 16 or 18 and 11% had concomitant infection by OHR and HPV 16 or 18. The most frequent HRHPV were HPV52 (19.8%), HPV18 (14.6%), HPV31/35/51/58 (12.1% each), HPV56 (9.9%) and HPV16 (9.5%). Less than 30% of women had their HRHPV genotypes included in the bivalent or quadrivalent vaccines against HRHPV 16 and 18; however, 79% had their HRHPV covered by the ninevalent vaccine against HRHPV 16/18/31/33/45/52/58. CONCLUSION The HRHPV genotypes distribution found in these women living in Europe with a successfully treated HIV is similar to the one found in Central Africa with HRHPV other than HPV16 or 18 retrieved in 87%. In this population, the bivalent or quadrivalent vaccines could offer protection in only 30% of women; however this protection could be extended up to 80% with the ninevalent vaccine.
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Park LS, Hernández-Ramírez RU, Silverberg MJ, Crothers K, Dubrow R. Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS: a meta-analysis. AIDS 2016; 30:273-91. [PMID: 26691548 PMCID: PMC4689318 DOI: 10.1097/qad.0000000000000922] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The burden of cancer among persons living with HIV/AIDS (PLWHA) is substantial and increasing. We assessed the prevalence of modifiable cancer risk factors among adult PLWHA in Western high-income countries since 2000. DESIGN Meta-analysis. METHODS We searched PubMed to identify articles published in 2011-2013 reporting prevalence of smoking, alcohol consumption, overweight/obesity, and infection with human papillomavirus (HPV), hepatitis C virus (HCV) and hepatitis B virus (HBV) among PLWHA. We conducted random effects meta-analyses of prevalence for each risk factor, including estimation of overall, sex-specific, and HIV-transmission-group-specific prevalence. We compared prevalence in PLWHA with published prevalence estimates in US adults. RESULTS The meta-analysis included 113 publications. Overall summary prevalence estimates were current smoking, 54% [95% confidence interval (CI) 49-59%] versus 20-23% in US adults; cervical high-risk HPV infection, 46% (95% CI 34-58%) versus 29% in US females; oral high-risk HPV infection, 16% (95% CI 10-23%) versus 4% in US adults; anal high-risk HPV infection (men who have sex with men), 68% (95% CI 57-79%), with no comparison estimate available; chronic HCV infection, 26% (95% CI 21-30%) versus 0.9% in US adults; and HBV infection, 5% (95% CI 4-5%) versus 0.3% in US adults. Overweight/obesity prevalence (53%; 95% CI 46-59%) was below that of US adults (68%). Meta-analysis of alcohol consumption prevalence was impeded by varying assessment methods. Overall, we observed considerable study heterogeneity in prevalence estimates. CONCLUSION Prevalence of smoking and oncogenic virus infections continues to be extraordinarily high among PLWHA, indicating a vital need for risk factor reduction efforts.
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Affiliation(s)
- Lesley S Park
- aDivision of Endocrinology, Gerontology, and Metabolism, Department of Medicine and Division of Epidemiology, Department of Health Policy and Research, Stanford University School of Medicine, Stanford, CaliforniabDepartment of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, ConnecticutcDivision of Research, Kaiser Permanente, Oakland, CaliforniadDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA.*Lesley S. Park and Raúl U. Hernández-Ramírez contributed equally to this article
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Belglaiaa E, Elannaz H, Mouaouya B, Aksim M, Mercier M, Prétet JL, Chouham S, Mougin C. Human papillomavirus genotypes among women with or without HIV infection: an epidemiological study of Moroccan women from the Souss area. Infect Agent Cancer 2015; 10:44. [PMID: 26664495 PMCID: PMC4673842 DOI: 10.1186/s13027-015-0040-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/21/2015] [Indexed: 01/18/2023] Open
Abstract
Background Data on Human PapillomaVirus (HPV) infection are scarce in Morocco. The objective of the study was to determine the prevalence of HPV and cervical cytology abnormalities in women from the Souss area, Morocco. Methods Two hundred and thirty two women who attended the Hassan II hospital (Agadir, Morocco) were recruited in this study. Socio-economic data, sexual activity, reproductive life, history of Pap smear, smoking and HIV status were recorded. Cervical samples were taken using an Ayre spatula. Cytology was reported using the Bethesda system. HPVs were first detected by MY09/11 consensus PCR and then genotyped with INNO-LiPA® assay. Data were analyzed using the logistic regression model. Results The median age of women was 42 years (18–76 years). HIV prevalence was 36.2 %. Any HPV type prevalence was 23.7 % in the study population, lower in HIV-negative women (13.3 %) than in HIV-positive women (39.3 %). HPV16 was the most prevalent type (6.5 %), followed by HPV53 and HPV74 (3.4 % each). Most women had normal cervical smears (82 %), the remaining were diagnosed with LGSIL (13 %) and HGSIL (5 %). HPV was detected in 17.4 % of normal smears, 43.4 % of LGSIL and 75 % of HGSIL. HIV status was the most powerful predictor of high risk (hr) and probable hr (phr) HPV infection (odds ratio 4.16, 95 % confidence interval 1.87–9.24, p = 0.0005) followed by abnormal cytology (OR 3.98, 95 % CI 1.39–11.40, p = 0.01), independently of socio-demographic and behavioral risk factors. Conclusions In a Moroccan hospital based-population of the Souss area, HPV infections are frequently detected. In addition, high prevalence of hr and phrHPVs and precancerous lesions among HIV-positive women is likely associated with an increased risk of cervical cancer. This highlights the need for HPV and cervical cancer prevention campaigns in Morocco.
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Affiliation(s)
- Essaada Belglaiaa
- Laboratoire de Biologie Cellulaire et Génétique Moléculaire, Faculté des Sciences, Université Ibn Zohr, BP8106, Agadir, 80000 Maroc ; EA 3181, Lab Ex LipSTIC ANR-11-LABX-0021, Université de Franche-Comté UBFC, F-25000 Besançon, France
| | - Hicham Elannaz
- Laboratoire de biologie moléculaire, 5ème Hôpital Militaire, Guelmim, Maroc
| | | | - Mohamed Aksim
- Service d'anatomopathologie, Hôpital Hassan II, Agadir, Maroc
| | - Mariette Mercier
- EA 3181, Lab Ex LipSTIC ANR-11-LABX-0021, Université de Franche-Comté UBFC, F-25000 Besançon, France
| | - Jean-Luc Prétet
- EA 3181, Lab Ex LipSTIC ANR-11-LABX-0021, Université de Franche-Comté UBFC, F-25000 Besançon, France ; Laboratoire de Biologie Cellulaire et Moléculaire, Inserm CIC 1431, CHRU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France
| | - Said Chouham
- Laboratoire de Biologie Cellulaire et Génétique Moléculaire, Faculté des Sciences, Université Ibn Zohr, BP8106, Agadir, 80000 Maroc
| | - Christiane Mougin
- EA 3181, Lab Ex LipSTIC ANR-11-LABX-0021, Université de Franche-Comté UBFC, F-25000 Besançon, France ; Laboratoire de Biologie Cellulaire et Moléculaire, Inserm CIC 1431, CHRU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France
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Ursu RG, Onofriescu M, Luca A, Prisecariu LJ, Sălceanu SO, Nemescu D, Iancu LS. The Need for Cervical Cancer Control in HIV-Positive and HIV-Negative Women from Romania by Primary Prevention and by Early Detection Using Clinically Validated HPV/DNA Tests. PLoS One 2015; 10:e0132271. [PMID: 26186361 PMCID: PMC4506070 DOI: 10.1371/journal.pone.0132271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 06/11/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In Romania, a country with no organized national surveillance program regarding cervical cancer, the early diagnosis of HPV (Human Papilloma Virus) infections is a major requirement, especially in HIV-infected women. The objective of this study was to determine the HPV prevalence and type distribution in young HIV-positive women and to assess the difference in the risk factors for developing cervical cancer compared to those of HIV-negative women. METHOD We conducted one cross-sectional cohort study from June 2013-September 2014, including 1,032 women: 992 HIV- women who were 36.5 years old (limits: 17 ÷ 84) and 40 HIV + women who were 22.9 years old (limits: 17 ÷ 30) with iatrogenic HIV infected. We detected HPV types with the Linear Array HPV Genotyping test (Roche, Romania). RESULTS DNA/HPV was detected in 18/40 (45%) of the HIV+ patients and in 350/992 (35.2%) of the HIV- patients (OR = 1.5, 95%CI 0.76÷2.96). After age adjustment, the overall HPV prevalence was 51.6% in HIV+ versus 63.2% in HIV- women aged under 25, and 22.2% in HPV+ versus 47.2% in HIV- women aged 25-34. We detect HIV being a risk factor for acquiring multiple HPV type infections (OR = 2.30, 95% CI 0.88÷5.97). The eight most common HPV types (high-risk, and low-risk) for women below age 30, HIV+ / - were: HPV 16, 18, 31, 51, 58, 68, and 6 and 82 respectively. To assess the risk factors of HIV-positive women for acquiring HPV infection, we analyzed the CD4/μL, ARN/HIV copies/μL, the age group, the number of sexual partners, smoking, and the type of HPV infection (single versus multiple infections). We found that the number of sexual partners and smoking are statistically significant risk factors. CONCLUSION Even though there are no significant differences regarding the prevalence of HPV infection in HIV + versus HIV - patients, multiple infections were more frequent in the first group. In our study group young HIV-infected patients under HAART therapy, high number of sexual partners (more than 3) and smoking were detected to be risk factors. Future organized screening for HPV infection using sensitive and specific methods are necessary at the national level in Romania.
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Affiliation(s)
- Ramona Gabriela Ursu
- Department of Microbiology, University of Medicine and Pharmacy “Gr. T. Popa”, Iaşi, Romania
- * E-mail:
| | - Mircea Onofriescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr.T.Popa”, Iasi, Romania, “Cuza Voda” Obstetrics and Gynecology Hospital, Iasi, Romania
| | - Alexandru Luca
- “Cuza Voda” Obstetrics and Gynecology Hospital, Iasi, Romania
| | - Liviu Jany Prisecariu
- Infectious Disease “St. Parascheva” Clinical University Hospital Iaşi, Iaşi, Romania
| | | | - Dragoş Nemescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr.T.Popa”, Iasi, Romania, “Cuza Voda” Obstetrics and Gynecology Hospital, Iasi, Romania
| | - Luminiţa Smaranda Iancu
- Department of Microbiology, University of Medicine and Pharmacy “Gr. T. Popa”, Iaşi, Romania
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11
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Thorsteinsson K, Ladelund S, Jensen-Fangel S, Katzenstein TL, Johansen IS, Pedersen G, Junge J, Helleberg M, Storgaard M, Obel N, Lebech AM. Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population. HIV Med 2015; 17:7-17. [PMID: 26058995 DOI: 10.1111/hiv.12271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Women living with HIV (WLWH) are reportedly at increased risk of invasive cervical cancer (ICC). A recent publication found that WLWH in Denmark attend the national ICC screening programme less often than women in the general population. We aimed to estimate the incidence of cervical dysplasia and ICC in WLWH in Denmark compared with that in women in the general population. METHODS We studied a nationwide cohort of WLWH and a cohort of 15 age-matched women per WLWH from the general population for the period 1999-2010. Pathology samples were obtained from The Danish Pathology Data Bank, which contains nationwide records of all pathology specimens. The cumulative incidence and hazard ratios (HRs) for time from inclusion to first cervical intraepithelial neoplasia (CIN)/ICC and time from first normal cervical cytology result to first CIN/ICC were estimated. Sensitivity analyses were performed to include prior screening outcome, screening intensity and treatment of CIN/ICC in the interpretation of results. RESULTS We followed 1140 WLWH and 17 046 controls with no prior history of ICC or hysterectomy for 9491 and 156 865 person-years, respectively. Compared with controls, the overall incidences of CIN1 or worse (CIN1+), CIN2+ and CIN3+, but not ICC, were higher in WLWH and predicted by young age and a CD4 count < 200 cells/μL. In women with normal baseline cytology, incidences of CIN1+ and CIN2+ were higher in WLWH. However, when we compared subgroups of WLWH and controls where women in both groups were adherent to the national ICC screening programme and had a normal baseline cytology, incidences of CIN and ICC were comparable. CONCLUSIONS Overall, WLWH developed more cervical disease than controls. Yet, in WLWH and controls adherent to the national ICC screening programme and with normal baseline cytology, incidences of CIN and ICC were comparable.
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Affiliation(s)
- K Thorsteinsson
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - S Ladelund
- Clinical Research Center, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - S Jensen-Fangel
- Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark
| | - T L Katzenstein
- Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - G Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - J Junge
- Department of Pathology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - M Helleberg
- Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Storgaard
- Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark
| | - N Obel
- Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A-M Lebech
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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12
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Gaester K, Fonseca LAM, Luiz O, Assone T, Fontes AS, Costa F, Duarte AJS, Casseb J. Human papillomavirus infection in oral fluids of HIV-1-positive men: prevalence and risk factors. Sci Rep 2014; 4:6592. [PMID: 25322857 PMCID: PMC5377573 DOI: 10.1038/srep06592] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/12/2014] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus is one of the most common sexually transmitted diseases worldwide. The natural history of oral HPV infection is unclear, and its risk factors have not been explored. Immunocompromised individuals, as exemplified by HIV patients, are at high risk for HPV-related diseases. The mean of this study is to determine the prevalence of HPV in the oral tract of HIV-1-positive male subjects and its association with risk factors. A total of 283 oral wash samples from HIV-1-positive men were tested. The oral fluid samples were used for DNA extraction and conventional PCR amplification; HPV genotyping was performed by hybridization. HPV genotyping revealed that nine samples (3.5%) were positive for HPV DNA; the major high-risk HPV types identified were 51 and 66. Worldwide studies have shown a variable prevalence of oral HPV. The diversity of genotypes and the high prevalence of multiple infections in HIV-infected subjects can be better explained by the effects of HIV-induced immunosuppression. The most important risk factors are unprotected sexual intercourse, but other factors for this infection have been described elsewhere including smoking, age and HIV-positive serostatus. In this study, smoking was the most important risk factor for acquiring oral HPV in HIV-1-infected subjects in Brazil.
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Affiliation(s)
- Karen Gaester
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Luiz A. M. Fonseca
- Department of Preventive Medicine, University of São Paulo Medical School, Brazil
| | - Olinda Luiz
- Department of Preventive Medicine, University of São Paulo Medical School, Brazil
| | - Tatiane Assone
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Adriele Souza Fontes
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Fernando Costa
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Alberto J. S. Duarte
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Jorge Casseb
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
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13
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Gonfrier G, Delotte J, Chevallier A, Giordanengo V. [Distribution of human papillomavirus genotypes amongst HIV-negative and HIV-positive women diagnosed with ASC-US cytology. Preliminary data of a local retrospective study]. ACTA ACUST UNITED AC 2014; 42:692-5. [PMID: 25281479 DOI: 10.1016/j.gyobfe.2014.09.004] [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: 02/28/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Analysis of the distribution of human papillomavirus (HPV) genotypes amongst HIV-negative and HIV-positive women diagnosed with atypical squamous cells of undetermined significance (ASC-US). PATIENTS AND METHODS We performed a retrospective study of HPV genotype distribution in 313 ASC-US Pap smears from women who consulted at the University Hospital of Nice between 2008 and 2012. HPV genotyping results, conducted on PapilloCheck(®) HPV DNA Chip, and information on the status of HIV patients were retrospectively collected. The odds ratio were calculated by logistic regression. RESULTS In co-infected HIV/HPV women we observed a low prevalence of HPV16, a high prevalence of oncogenic HPV low risk and a high prevalence of HPV 68 compared to non-co-infected women. By grouping HPV HR based on their prevalence in cervical cancer of the uterus and their genetic proximity we observe that HPV 18, 45, 68 (the "alpha-7") are 7.4 times more represented (CI95 [2.48 to 22.35]) than HPV 16, 31, 33, 52, 58 (the "alpha-9") in the population of women co-infected with HIV. DISCUSSION AND CONCLUSION Given that HPV "alpha-7" are responsible for 46.3% of adenocarcinomas, the high prevalence of these HPV found in ASC-US Pap smears of co-infected women should be put in relation with the highest prevalence of glandular abnormalities found in this population. HPV genotyping could become an essential tool for gynecological care for HIV positive women.
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Affiliation(s)
- G Gonfrier
- Laboratoire de virologie, hôpital Archet 2, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice cedex 3, France; Inserm, U1065, centre méditerranéen de médecine moléculaire, C3M, toxines microbiennes dans la relation hôte pathogènes, 151, route de Saint-Antoine de Ginestière, 06200 Nice cedex 3, France; Université de Nice-Sophia-Antipolis, UFR médecine, Nice, France.
| | - J Delotte
- Service de gynécologie-obstétrique-reproduction, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice cedex 3, France.
| | - A Chevallier
- Laboratoire d'anatomo-pathologie, hôpital Archet 2, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice cedex 3, France.
| | - V Giordanengo
- Laboratoire de virologie, hôpital Archet 2, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice cedex 3, France; Inserm, U1065, centre méditerranéen de médecine moléculaire, C3M, toxines microbiennes dans la relation hôte pathogènes, 151, route de Saint-Antoine de Ginestière, 06200 Nice cedex 3, France; Université de Nice-Sophia-Antipolis, UFR médecine, Nice, France.
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14
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Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population. BMC Infect Dis 2014; 14:256. [PMID: 24885577 PMCID: PMC4025560 DOI: 10.1186/1471-2334-14-256] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/30/2014] [Indexed: 11/10/2022] Open
Abstract
Background Women living with HIV (WLWH) are at increased risk of invasive cervical cancer (ICC). International HIV guidelines suggest cervical screening twice the first year after HIV diagnosis and thereafter annually. Adherence to the HIV cervical screening program in Denmark is unknown. Methods We studied women from a population-based, nationwide HIV cohort in Denmark and a cohort of age-matched females from the general population. Screening behaviour was assessed from 1999–2010. Adjusted odds ratios (OR’s) for screening attendance in the two cohorts and potential predictors of attendance to guidelines were estimated. Pathology specimens were identified from The Danish Pathology Data Bank. Results We followed 1143 WLWH and 17,145 controls with no prior history of ICC for 9,509 and 157,362 person-years. The first year after HIV diagnosis 2.6% of WLWH obtained the recommended two cervical cytologies. During the different calendar intervals throughout the study period between 29-46% of WLWH followed the HIV cervical screening guidelines. Adjusted OR’s of attendance to the general population screening program for WLWH aged 30, 40 and 50 years, compared to controls, were 0.69 (95% CI: 0.56-0.87), 0.67 (0.55-0.80) and 0.84 (0.61-1.15). Predictors of attendance to the HIV cervical screening program were a CD4 count > 350 cells/μL and HIV RNA < 500 copies/mL. Calendar period after 2002 and HIV RNA < 500 copies/mL predicted attendance to the general population cervical screening program. Conclusions The majority of WLWH do not follow the HIV guidelines for cervical screening. We support the idea of cytology as part of an annual review and integration of HIV care and cervical screening in a single clinic setting.
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Garcia-Chagollan M, Jave-Suarez LF, Haramati J, Sanchez-Hernandez PE, Aguilar-Lemarroy A, Bueno-Topete MR, Pereira-Suarez AL, Fafutis-Morris M, Cid-Arregui A, del Toro-Arreola S. Substantial increase in the frequency of circulating CD4+NKG2D+ T cells in patients with cervical intraepithelial neoplasia grade 1. J Biomed Sci 2013; 20:60. [PMID: 23947399 PMCID: PMC3751941 DOI: 10.1186/1423-0127-20-60] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/15/2013] [Indexed: 01/13/2023] Open
Abstract
Background The NKG2D receptor confers important activating signals to NK cells via ligands expressed during cellular stress and viral infection. This receptor has generated great interest because not only is it expressed on NK cells, but it is also seen in virtually all CD8+ cytotoxic T cells and is classically considered absent in CD4+ T cells. However, recent studies have identified a distinctive population of CD4+ T cells that do express NKG2D, which could represent a particular cytotoxic effector population involved in viral infections and chronic diseases. On the other hand, increased incidence of human papillomavirus-associated lesions in CD4+ T cell-immunocompromised individuals suggests that CD4+ T cells play a key role in controlling the viral infection. Therefore, this study was focused on identifying the frequency of NKG2D-expressing CD4+ T cells in patients with cervical intraepithelial neoplasia (CIN) 1. Additionally, factors influencing CD4+NKG2D+ T cell expansion were also measured. Results Close to 50% of patients with CIN 1 contained at least one of the 37 HPV types detected by our genotyping system. A tendency for increased CD4+ T cells and CD8+ T cells and decreased NK cells was found in CIN 1 patients. The percentage of circulating CD4+ T cells co-expressing the NKG2D receptor significantly increased in women with CIN 1 versus control group. Interestingly, the increase of CD4+NKG2D+ T cells was seen in patients with CIN 1, despite the overall levels of CD4+ T cells did not significantly increase. We also found a significant increase of soluble MICB in CIN 1 patients; however, no correlation with the presence of CD4+NKG2D+ T cells was seen. While TGF-beta was significantly decreased in the group of CIN 1 patients, both TNF-alpha and IL-15 showed a tendency to increase in this group. Conclusions Taken together, our results suggest that the significant increase within the CD4+NKG2D+ T cell population in CIN 1 patients might be the result of a chronic exposure to viral and/or pro-inflammatory factors, and concomitantly might also influence the clearance of CIN 1-type lesion.
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Affiliation(s)
- Mariel Garcia-Chagollan
- Laboratorio de Inmunología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada # 950, Colonia Independencia, Guadalajara, Jalisco CP 44340, México
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