Multiple types of human papillomavirus infection and anal precancerous lesions in HIV-infected men in Taiwan: a cross-sectional study

BMJ Open. 2018 Jan 27;8(1):e019894. doi: 10.1136/bmjopen-2017-019894.

Abstract

Objectives: This study aimed to assess the relationship between infection with multiple human papillomavirus (HPV) types and abnormal anal cytology in HIV-infected men.

Design: An observational, cross-sectional study.

Setting: A regional referral hospital in Taiwan.

Participants: In total, 714 HIV-infected men were enrolled between March 2011 and June 2016. Thin preparation anal Pap smears were interpreted according to the 2001 Bethesda System. Thirty-seven types of HPV were detected by reverse line blotting, including 13 oncogenic types and 24 non-oncogenic types.

Outcome measures: The relationship between anal HPV infection and abnormal anal cytology in people of Asian ethnicity and the coverage efficacy in HPV-vaccinated HIV-infected men.

Results: On anal cytology, 175 (24.5%) subjects had atypical squamous cells of undetermined significance (ASCUS) or higher grades of dysplasia, including 87 (49.7%) with ASCUS, 73 (41.7%) with low-grade squamous intraepithelial lesions (LSILs) and 15 (8.6%) with high-grade squamous intraepithelial lesions (HSILs). A higher proportion of subjects with those without LSIL/HSIL (93.1% vs 67.3%, P<0.0001) had multiple HPV types. The odds of having LSIL/HSIL increased with an increasing number of HPV types: the ORs ranged from 1 for no HPV types to 6.96 (95% CI 2.38 to 20.37) for more than five types (Ptrend <0.0001). Multivariate logistic regression analysis showed a significant association between LSIL/HSIL and the number of HPV genotypes present (OR 1.20; 95% CI 1.02 to 1.42, P<0.05). HPV types covered by the nonavalent HPV vaccine (types 6/11/16/18/31/33/45/52/58) were detected in 70.1% of the patients in this study.

Conclusions: The odds of having anal LSIL/HSIL are approximately seventimes greater in HIV-infected men with than withoutsix or more types of HPV. Multiple HPV types in HIV-infected patients deserves aggressive follow-up, and HPV vaccination programme require scaling up.

Keywords: cytopathology; oncology.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anal Canal / pathology*
  • Anal Canal / virology
  • Anus Neoplasms / etiology*
  • Anus Neoplasms / virology
  • Asian People
  • Cross-Sectional Studies
  • Epithelial Cells / pathology
  • Female
  • Genotype
  • HIV Infections / complications*
  • Humans
  • Intestinal Mucosa / cytology
  • Intestinal Mucosa / pathology*
  • Intestinal Mucosa / virology
  • Logistic Models
  • Male
  • Odds Ratio
  • Papanicolaou Test
  • Papillomaviridae / genetics*
  • Papillomavirus Infections / etiology*
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / virology
  • Papillomavirus Vaccines
  • Precancerous Conditions / epidemiology
  • Precancerous Conditions / etiology*
  • Precancerous Conditions / pathology
  • Precancerous Conditions / virology
  • Prevalence
  • Risk Factors
  • Taiwan / epidemiology
  • Vaccination Coverage
  • Young Adult

Substances

  • Papillomavirus Vaccines