Prevalent, persistent anal HPV infection and squamous intraepithelial lesions: Findings from a cohort of men living with HIV in South Africa


Autoři: Admire Chikandiwa aff001;  Pedro. T. Pisa aff001;  Catherine Tamalet aff002;  Etienne. E. Muller aff003;  Pamela Michelow aff004;  Matthew. F. Chersich aff001;  Philippe Mayaud aff001;  Sinead Delany-Moretlwe aff001
Působiště autorů: Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa aff001;  Department of Clinical Microbiology IHU and CNRS-URMITE, UMR 7278 Timone University Hospital Marseille, France aff002;  National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa aff003;  Cytology Unit, Department of Anatomical Pathology, University of the Witwatersrand and National Health Laboratory Services, Johannesburg, South Africa aff004;  London School of Hygiene and Tropical Medicine, London, United Kingdom aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0225571

Souhrn

Objective

To estimate the prevalence, incidence and persistence of anal HPV infection and squamous intra-epithelial lesions (SILs) among men living with HIV (MLHIV), and determine their risk factors.

Methods

We enrolled MLHIV ≥18 years, who attended 6-monthly visits for 18 months. Socio-behavioural data were collected by questionnaire. Clinicians collected blood sample (CD4+ count and HIV plasma viral load), anal swabs (HPV DNA testing) and anal smears (Bethesda classification) at each visit. HPV DNA testing and classification of smears were done at enrolment and last follow-up visit (two time points). Factors associated with persistent anal HPV infection and SILs were evaluated with generalized estimating equations logistic regression and standard logistic regression respectively.

Results

Mean age of 304 participants was 38 (Standard Deviation, 8) years; 25% reported >1 sexual partner in the past 3 months. Only 5% reported ever having sex with other men. Most (65%) participants were taking antiretroviral treatment (ART), with a median CD4+ count of 445 cells/μL (IQR, 328–567). Prevalence of any-HPV infection at enrolment was 39% (88/227). In total, 226 men had anal HPV DNA results at both enrolment and final visits. Persistence of any-anal HPV infection among 80 men who had infection at enrolment was 26% (21/80). Any persistent anal HPV infection was more frequent among MLHIV with low CD4+ count (<200 vs. >500 cells/μL; aOR = 6.58; 95%CI: 2.41–17.94). Prevalence of anal SILs at enrolment was 49% (118/242) while incidence of SILs among MLHIV who had no anal dysplasia at enrolment was 27% (34/124). Of the 118 men who had anal dysplasia at enrolment, 15% had regressed and 38% persisted by month 18. Persistent anal HPV infection was associated with persistent SILs (aOR = 2.95; 95%CI: 1.08–10.89). ART status or duration at enrolment were not associated with persistent anal HPV infection or persistent SILs during follow-up.

Conclusion

In spite of a high prevalence of anal HPV, HIV-positive heterosexual men have a low burden of anal HPV related disease. HPV vaccine and effective ART with immunological reconstitution could reduce this burden of infection.

Klíčová slova:

Cell enumeration techniques – Cytology – Dysplasia – Human papillomavirus – Human papillomavirus infection – Infectious disease control


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2019 Číslo 12