High-risk human papillomavirus infection and associated factors in the anal canal of HIV-positive patients in Medellín, 2017–2018

Authors

DOI:

https://doi.org/10.11606/s1518-8787.2020054001692

Keywords:

Human Papillomavirus Infections, Epidemiology, HIV Infections, Anal Neoplasia, Sexual Behavior, Risk Factors, Socioeconomic Factors

Abstract

OBJECTIVE: To estimate the prevalence of high-risk human papillomavirus (HR-HPV) anal infection and associated factors in human immunodeficiency virus (HIV) positive patients in Medellín. METHODS: Descriptive cross-sectional study in 300 HIV-positive patients, adults, with history of anal intercourse, treated in two health care services of Medellín 2017–2018. We conducted a structured survey on sociodemographics, sexual behavior and medical history. HPV was detected in anal swabs tested by the COBAS 4800 system. Exploratory data analysis of risk factors associated with HR-HPV was conducted by chi-square test of independence and both raw and adjusted prevalence ratios used the Poisson regression model, at a 95% confidence interval. RESULTS: The high-risk HPV had a prevalence of 82.7%; HPV16 had a prevalence of 32.7%, HPV18 a prevalence of 21.7% and other HPV types scored 78.3%. The high-risk HPV prevalence in women was of 68.2% and 83.8% in men. The risk factors associated with high-risk HPV after adjustment were age under 30 years, elementary education, casual sex partners, and first sexual activity before 18 years old. CONCLUSIONS: The high incidence of high-risk HPV, along with the occurrence of coinfections by multiple types in the study population shows their susceptibility to develop some type of anal intra-epithelial neoplasia. It is important to establish sexual health programs focused on primary health care.

Author Biographies

  • Daniela Herrera Posada, Universidad de Antioquia

    Universidad de Antioquia. Escuela de Microbiología. Medellín, Antioquia, Colombia

  • Lucia Stella Tamayo Acevedo, Universidad de Antioquia

    Universidad de Antioquia. Escuela de Microbiología. Medellín, Antioquia, Colombia

  • Marleny Valencia Arredondo, Universidad de Antioquia

    Universidad de Antioquia. Escuela de Microbiología. Medellín, Antioquia, Colombia

  • Gloria Inéz Sánchez Vásquez, Universidad de Antioquia

    Universidad de Antioquia. Facultad de Medicina. Medellín, Antioquia, Colombia

References

Burgos J, Hernandez-Losa J, Landolfi S, Guelar A, Dinares MC, Villar J, et al. The role of oncogenic human papillomavirus determination for diagnosis of high-grade anal intraepithelial neoplasia in HIV-infected MSM. AIDS. 2017;31(16):2227-33.

https://doi.org/10.1097/QAD.0000000000001605

Silverberg MJ, Lau B, Justice AC, Engels E, Gill MJ, Goedert JJ, et al, Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America. Clin Infect Dis. 2012;54(7):1026-34. https://doi.org/10.1093/cid/cir1012

Hoots BE, Palefsky JM, Pimenta JM, Smith JS, Human papillomavirus type distribution in anal cancer and anal intraepithelial lesions. Int J Cancer. 2009;124(10):2375-83. https://doi.org/10.1002/ijc.24215

Parkin DM, Bray F. Chapter 2: The burden of HPV-related cancers. Vaccine. 2006;24 Suppl 3:S3/11-S3/25. https://doi.org/10.1016/j.vaccine.2006.05.111

Machalek DA, Poynten M, Jin F, Fairley CK, Farnsworth A, Garland SM, et al. Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis. Lancet Oncol. 2012;13(5):487-500. https://doi.org/10.1016/S1470-2045(12)70080-3

Johnson LG, Madeleine MM, Newcomer LM, Schwartz SM, Daling JR. Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973-2000. Cancer. 2004;101(2):281-8. https://doi.org/10.1002/cncr.20364

Critchlow CW, Hawes SE, Kuypers JM, Goldbaum GM, Holmes KK, Surawicz CM, et al. Effect of HIV infection on the natural history of anal human papillomavirus infection. AIDS. 1998;12(10):1177-84. https://doi.org/10.1097/00002030-199810000-00010

Palefsky JM, Holly EA, Ralston ML, Costa M, Greenblatt RM, Prevalence and risk factors for anal human papillomavirus infection in Human Immunodeficiency Virus (HIV)- positive and high-risk HIV-negative women. J Infect Dis. 2001;183(3):383-91. https://doi.org/10.1086/318071

Lin C, Franceschi S, Clifford GM. Human papillomavirus types from infection to cancer in the anus, according to sex and HIV status: a systematic review and meta-analysis. Lancet Infect Dis. 2018;18(2):198-206. https://doi.org/10.1016/S1473-3099(17)30653-9

Sendagorta E, Herranz P, Guadalajara H, Zamora FX. Detección precoz de la neoplasia intraepitelial anal en pacientes de alto riesgo. Actas Dermosifiliogr. 2011;102(10):757-65. https://doi.org/10.1016/j.ad.2011.01.005

New York State Department of Health of AIDS Institute; Johns Hopkins University. Clinical Guidelines Program. Cerviccal screening for dysplasia and cancer. Baltimore, MD: Johns Hopkins University; 2018. [citado 5 de septiembre de 2018]. Disponible en: https://www.hivguidelines.org/hiv-care/cervical-dysplasia-cancer/

Ministério de Salud y Protección Social (COL). Situación del VI/Sida- Colombia 2013. Bol Epidemiol VIH/ Sida. 2013 [citado 15 de enero de 2019]. Disponible en: https://www.minsalud.gov.co/Documentos%20y%20Publicaciones/BOLETIN%20EPIDEMIOLOGICO%20VIH%20

-2012.pdf

Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo. Situación del VIH en Colombia 2015. Bogotá (COL); 2015 [citado 16 de enero de 2019]. Disponible en: https://cuentadealtocosto.org/site/publicaciones/situacion-del-vih-en-colombia-2015/

Pardo C, Cendales R. Incidencia, mortalidad y prevalencia de cáncer en Colombia 2007-2011. Vol. 1. Bogotá (COL): Instituto Nacional de Cancerologia; 2015 [citado 3 de septiembre de 2018]. Disponible en: https://www.cancer.gov.co/files/libros/archivos/incidencia1.pdf

Darragh TM, Palefsky JM. Anal cytology. In: Nayar R Wilbur DC, editor, The Bethesda System for reporting cervical cytology. 3.ed. New York: Springer; 2015. p. 263-85.

Darragh TM, Winkler B. Screening for anal neoplasia: anal cytology - sampling, processing and reporting. Sex Health. 2012;9(6):556-61. https://doi.org/10.1071/SH12003

Castle PE, Stoler MH, Wright TC Jr, Sharma A, Wright TL, Behrens CM. Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening of women aged 25 years and older: a subanalysis of the ATHENA Study. Lancet Oncol. 2011;12(9):880-90. https://doi.org/10.1016/S1470-2045(11)70188-7

Instituto Nacional de Salud. VIH/SIDA Colombia 2017. Bogotá (COL): 2018 [citado 20 de enero de 2019]. Disponible en: https://www.ins.gov.co/buscador-eventos/Informesdeevento/VIHSIDA%202017.pdf

Ministerio de Salud y Protección Social, Profamilia. Encuesta Nacional de Demografía y Salud 2015 Tomo II: Componente de salud sexual y salud reproductiva. Bogotá (COL): MinSalud; 2017.

Yu CT, Chao SC, Lee HC, Chou CY, Ko WC, Liu HY, et al. High prevalence of anal human papillomavirus infection and associated risky behaviors in men infected with human immunodeficiency virus in Taiwan. AIDS Behav. 2013;17(3):1211-8.

https://doi.or/10.1007/s10461-012-0173-6

Cheng SH, Liao KS, Wang CC, Cheng CY, Chu FY. Multiple types of human papillomavirus infection and anal precancerous lesions in HIV-infected men in Taiwan: a cross-sectional study. BMJ Open. 2018;8(1):e019894. https://doi.org/10.1136/bmjopen-2017-019894

Nagata N, Watanabe K, Nishijima T, Tadokoro K, Watanabe K, Shimbo T, et al. Prevalence of anal human papillomavirus infection and risk factors among hiv- positive patients in Tokyo, Japan. PLoS One. 2015;10(9):e0137434. https://doi.org/10.1371/journal.pone.0137434

Hu Y, Qian HZ, Sun J, Gao L, Yin L, Li X, et al. Anal human papillomavirus infection among HIV-infected and uninfected men who have sex with men in Beijing, China. J Acquir Immune Defic Syndr. 2013;64(1):103-14. https://doi.org/10.1097/QAI.0b013e31829b6298

Lee CH, Lee SH, Lee S, Cho H, Kim KH, Lee JE, et al. Anal human papillomavirus infection among HIV-infected men in Korea. PLoS One. 2016;11(8):e0161460. https://doi.org/10.1371/journal.pone.0161460

Müller EE, Rebe K, Chirwa TF, Struthers H, McIntyre J, Lewis DA. The prevalence of human papillomavirus infections and associated risk factors in men-who-have-sex-with-men in Cape Town, South Africa. BMC Infect Dis. 2016;16(1):440.

https://doi.org/10.1186/s12879-016-1706-9

Müller EE, Chirwa TF, Lewis DA. Human papillomavirus (HPV) infection in heterosexual South African men attending sexual health services: associations between HPV and HIV serostatus. Sex Transm Infect. 2010;86(3):175-80. https://doi.org/10.1136/sti.2009.037598

Nyitray AG, Silva RJC, Baggio ML, Lu B, Smith D, Abrahamsen M, et al. Age-specific prevalence of and risk factors for anal human papillomavirus (HPV) among men who have sex with women and men who have sex with men: the HPV in Men (HIM) Study. J Infect Dis. 2011;203(1):49-57. https://doi.org/10.1093/infdis/jiq021

Medina-Laabes DT, Suarez-Perez EL, Guiot HM, Muñoz C, Colón-López V, Tirado-Gómez M, et al. Human papillomavirus correlates with histologic anal high-grade squamous intraepithelial lesions in Hispanics with HIV. J Low Genit Tract Dis. 2018;22(4):320-5. https://doi.org/10.1097/LGT.0000000000000416

Sahasrabuddhe VV, Castle PE, Follansbee S, Borgonovo S, Tokugawa D, Schwartz LM, et al. Human papillomavirus genotype attribution and estimation of preventable fraction of anal intraepithelial neoplasia cases among HIV-infected men who have sex with men. J Infect Dis. 2013;207(3):392-401. https://doi.org/10.1093/infdis/jis694

Pokomandy A, Rouleau D, Ghattas G, Vézina S, Coté P, Macleod J, et al. Prevalence, clearance, and incidence of anal human papillomavirus infection in HIV-infected men: the HIPVIRG Cohort Study. J Infect Dis. 2009;199(7):965-73. https://doi.org/10.1086/597207

Gonçalves MAG, Randi G, Arslan A, Villa LL, Burattini MN, Franceschi S, et al. HPV type infection in different anogenital sites among HIV-positive Brazilian women. Infect Agent Cancer. 2008;3:5. https://doi.org/10.1186/1750-9378-3-5

Acevedo Fontánez AI, Suárez E, Torres Cintrón CR, Ortiz AP. Risk of anal cancer in women with a human papillomavirus related gynecological neoplasm. J Low Genit Tract Dis. 2018;22(3):225-30. https://doi.org/10.1097/LGT.0000000000000395

Rovelli C, Poli A, Galli L, Cernuschi M, Tamburini AM, Racca S, et al, Presence of multiple genotypes in subjects with HPV-16 infection is highly associated with anal squamous intraepithelial lesions in HIV-1 infected males. PLoS One. 2017;12(10):e0186367. https://doi.org/10.1371/journal.pone.0186367

Cañadas MP, Lloveras B, Lorincz A, Ejarque M, Font R, Bosch X, et al. Evaluación de las técnicas de detección del VPH en los programas de cribado para cáncer de cuello uterino. Salud Publica Mex. 2006;48(5):373-8.

Lin CC, Hsieh MC, Hung HC, Tsao SM, Chen SC, Yang HJ, et al. Human papillomavirus prevalence and behavioral risk factors among HIV-infected and HIV- uninfected men who have sex with men in Taiwan. Medicine (Baltimore). 2018;97(45):e13201. https://doi.org/10.1097/MD.0000000000013201

Glick SN, Feng Q, Popov V, Koutsky LA, Golden MR. High rates of incident and prevalent anal human papillomavirus infection among young men who have sex with men. J Infect Dis. 2014;209(3):369-76. https//doi.org/10.1093/infdis/jit441

González Natera R, Molina VJS, Comegna M. Genotipificación de la infección por el virus del papiloma humano en pacientes hombres con Virus de Inmunodeficiencia Humana que tienen sexo con hombres. Med Interna (Caracas). 2008;24(1):22-32.

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Published

2020-11-20

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Original Articles

How to Cite

Posada, D. H., Acevedo, L. S. T., Arredondo, M. V., & Vásquez, G. I. S. (2020). High-risk human papillomavirus infection and associated factors in the anal canal of HIV-positive patients in Medellín, 2017–2018. Revista De Saúde Pública, 54, 93. https://doi.org/10.11606/s1518-8787.2020054001692