Multiple HPV infections among men who have sex with men engaged in anal cancer screening in Abuja, Nigeria

IF 3.2
Rebecca G. Nowak , Lisa M. Schumaker , Nicholas P. Ambulos , Nicaise Ndembi , Wuese Dauda , Chinedu H. Nnaji , Andrew Mitchell , Trevor J. Mathias , Paul Jibrin , Teresa M. Darragh , Oluwole Olaomi , Trevor A. Crowell , Stefan D. Baral , Manhattan E. Charurat , Søren M. Bentzen , Joel M. Palefsky , Kevin J. Cullen
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引用次数: 12

Abstract

Background

Anal precancers and cancers can be detected during screening with high-resolution anoscopy (HRA). The sensitivity of HRA depends on the burden and duration of human papillomavirus (HPV) among those screened as well as anoscopist proficiency, which is highly correlated with prior screening experience. Our objective was to compare the identification and type of HPV and the likelihood of HRA-detected precancer for men who have sex with men (MSM) undergoing their first HRA-screening in Nigeria.

Methods

MSM were recruited from an HIV test-and-treat cohort, TRUST/RV368, into a new anal cancer screening program. Anal swabs obtained during screening underwent Ion Torrent next-generation sequencing using barcoded HPV PCR broad-spectrum primers 5+/6+ to detect up to 161 HPVs. All high-risk (HR) HPVs and the most abundant low-risk (LR)-HPVs were evaluated as type-specific infections with some categorized as belonging to a multiple infection. HRA screening results included benign, low-grade squamous intraepithelial lesions (LSIL), or HSIL as detected by cytology or histology. Multivariable logistic regression was used to assess the association of HPV and other cofactors with any SIL.

Results

Among 342 MSM, 60% were HIV-infected, 89% were under 35 years of age, and 51% had 8 or more years since anal coital debut. Of those with SIL, 89% had LSIL and only 11% had HSIL. Prevalence of any HPV and high-risk (HR)-HPV was 92% and 74%, respectively. The most prevalent genotypes in rank order were HPV6 (31%), HPV16 (23%), HPV42 (20%), HPV11 (18%), HPV45 (18%), and HPV51 (17%). For multiple HR-HPVs, 31% had a single HR-HPV, 32% had 2-3, and 10% had 4 or more. Low-risk HPVs, type 6 and/or 11, were common (42%) and were significantly associated with SIL (adjusted odds ratio [aOR]:1.8, 95% confidence interval [CI]: 1.1–3.1) together with perianal warts (aOR:6.7, 95% CI: 3.3–13.5). In contrast, HR-HPV and multiple HR-HPVs were not significantly associated with SIL (all p > 0.05).

Conclusions

Detection of HSIL was low. Although HR-HPV was abundant, HSIL development also depends on the duration of HR-HPV infections and the anoscopist's level of experience. As our cohort ages and the anoscopist becomes more skilled, detection of HSIL will likely improve.

Abstract Image

在尼日利亚阿布贾,与男性发生性行为从事肛门癌筛查的男性中存在多种HPV感染
背景:在高分辨率肛门镜检查(HRA)的筛查过程中可以检测到癌前病变和癌症。HRA的敏感性取决于接受筛查的人乳头瘤病毒(HPV)的负担和持续时间,以及内镜医师的熟练程度,这与先前的筛查经验高度相关。我们的目的是比较尼日利亚男男性行为者(MSM)首次进行hra筛查时HPV的鉴定和类型以及hra检测出癌前病变的可能性。方法从HIV检测和治疗队列TRUST/RV368中招募smsm进入新的肛门癌筛查项目。在筛选期间获得的肛门拭子使用条形码HPV PCR广谱引物5+/6+进行Ion Torrent下一代测序,检测多达161种HPV。所有高风险(HR) hpv和最丰富的低风险(LR) hpv被评估为类型特异性感染,其中一些被归类为属于多重感染。HRA筛查结果包括良性,低级别鳞状上皮内病变(LSIL),或细胞学或组织学检测到的HSIL。多变量逻辑回归用于评估HPV和其他辅助因素与任何SIL的关联。结果342例男男性行为者中,hiv感染者占60%,年龄在35岁以下者占89%,初次肛交时间在8年及以上者占51%。在SIL患者中,89%为低级别SIL,只有11%为高级别SIL。任何HPV和高危(HR) HPV的患病率分别为92%和74%。最常见的基因型依次为HPV6(31%)、HPV16(23%)、HPV42(20%)、HPV11(18%)、HPV45(18%)和HPV51(17%)。对于多发HR-HPV, 31%有单一HR-HPV, 32%有2-3个,10%有4个或更多。低风险hpv, 6型和/或11型很常见(42%),并且与SIL(调整优势比[aOR]:1.8, 95%可信区间[CI]: 1.1-3.1)以及肛周疣(aOR:6.7, 95% CI: 3.3-13.5)显著相关。相比之下,HR-HPV和多发性HR-HPV与SIL无显著相关性(p均为 > 0.05)。结论HSIL检出率低。虽然HR-HPV是丰富的,HSIL的发展也取决于HR-HPV感染的持续时间和肛门镜医生的经验水平。随着我们的队列年龄的增长和窥镜医生变得更加熟练,HSIL的检测可能会提高。
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来源期刊
自引率
0.00%
发文量
0
审稿时长
14 weeks
期刊介绍: The official Journal of the International Papillomavirus Society Papillomavirus Research (PVR), the Journal of HPV and other Small DNA Tumor Viruses publishes innovative papers related to all aspects of papillomaviruses and other small DNA tumor viruses. The official journal of the International Papillomavirus Society, PVR is an open access publication that aims to bring together virologists, immunologists, epidemiologists and clinicians working in the booming field of HPV and animal papillomaviruses, polyomaviruses and other small DNA tumor viruses and their associated diseases, in order to foster and facilitate interdisciplinary communication. The journal welcomes original research articles, reviews, short communications, opinion articles and regional update reports on papillomaviruses and other tumor viruses in the following sections: a. Biology of papillomaviruses and related viruses from life cycle to cancer b. Epidemiology etiology and natural history studies c. Natural and induced immunity including vaccine research d. Intervention studies and strategies including i. Clinical studies and trials ii. HPV treatments iii. HPV vaccination programs iv. Diagnostics and screening e. Infection and disease prevention, modeling studies f. Guidelines and public health recommendations g. HPV Studies in special populations Regional and local studies on these viruses.
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