Title : Anal HPV, diversity and concordance with genital infection in women living or not with HIV-1 in the Tapajós region, Amazon, Brazil.
Abstract:
Published scientific data on human papillomavirus (HPV) are predominantly related to genital infection. Studies on anal HPV, diversity and concordance with genital infection are scarce. Cervical cancer screening might contribute to the prevention of anal cancer in women as secondary prevention programs for the prevention of anal cancer. This study was supported by previous studies, which evaluated the acceptability of the cervico-vaginal self-collection, HPV and other STIs testing, and sociodemographic data in women living (WLWH) or not (WNLWH) with HIV in the Tapajós region. The overall prevalence of anal HPV infection was 49.0% (75/153), and by group of participants was 31.3% (35/112) for WNLWH and 97.6% (40/41) for WLWH. Only WLWH had cervical cytological abnormalities (12.2%). A high diversity of anal HPV genotypes has been identified in the anal scraping of both groups participating in the study. HPV anal types of the genus Alphapapillomavirus and Betapapillomavirus were identified, considering the predominant tissue associations and the typical relationships between HPV type and disease caused. The overall HPV prevalence was 53.3% (40/75) for single anal infections and 46.7% (35/75) for multiple anal infections by HPV types in the participants. Among the WNLWH, 97.0% (34/35) had single anal infections and 3.0% (1/35) multiple anal infections. However, among WLWH, multiple HPV anal infections were much more prevalent, at 85.0% (34/40), and single anal infections accounted for 15.0% (6/40). Anal HPV types found in the participants were predominantly of the genus Alphapapillomavirus. Overall, anal HPV types found in the participants were predominantly of the genus Alphapapillomavirus and included samples grouped into high-risk, "probable" or "possible", and low-risk carcinogenic groups. In WLWH, 42.9% (15/35) of anal hrHPV infection was detected, and HPV-18 (6) and HPV-16 (5) were the most frequent anal hrHPV types, representing 73.3% (11/15) of the total anal hrHPV types genotyped in this group. In WNLWH, 75.0% (30/40) of hrHPV anal infection was detected, and HPV-51 (12), HPV-59 (10), HPV-31 (9) and HPV-58 (9) were the most frequent anal hrHPV types, representing 59.7% (40/67) of the total anal hrHPV types genotyped in this group. The anal hrHPV infections were significantly more prevalent in the WLWH than WNLWH (Chi-square test p < 0.001). The Kappa test was performed for concordance analysis between anal and genital HPV infection and we consider categorizing in the absence and presence of high and low-risk HPV types. The concordance analysis proved to be moderate for HPV considering the oncogenic risk classification, Kappa value 0.44.
What will audience learn from your presentation?
- High overall prevalence of anal HPV infection, 49.0% (75/153), in women living (WLWH) or not (WNLWH) with HIV in the Tapajós region, Amazon, Brazil.
- High prevalence, 97.6% (40/41), of anal HPV infection in WLWH.
- High diversity of anal HPV genotypes has been identified in the anal scraping, including HPV types of the genus Alphapapillomavirus and Betapapillomavirus.
- Among the WNLWH, 97.0% (34/35) had single anal infections and 3.0% (1/35) multiple anal infections. However, among WLWH, multiple HPV anal infections were much more prevalent, at 85.0% (34/40), and single anal infections accounted for 15.0% (6/40).
- The anal high-risk HPV (hrHPV) infections were significantly more prevalent in the WLWH than WNLWH, in which HPV-18 and HPV-16 were the most frequent anal hrHPV type. The concordance analysis proved to be moderate between anal and genital HPV infection considering the oncogenic risk classification, Kappa value 0.44.
Cervical cancer screening might contribute to the prevention of anal cancer in women as secondary prevention programs for prevention of anal cancer.
When evaluating the utility of cervical screening results to stratify anal cancer risk, an important consideration should be given to HIV status, cervical cytological abnormalities, age-specific shifts, types of oncogenic HPV, single or multiple HPV infections, among other factors to be better investigated.
More studies are needed to understand the influence of factors related to anal HPV infection on the development of anal cancer and how these results can improve cancer screening policies.
However, the status of HIV infection in the development of cancer is already well evidenced in the scientific literature. This study adds to the body of evidence in the specialized literature by showing unpublished data on the prevalence of anal HPV, non-HPV STIs diversity, and concordance with genital infection in women non-indigenous in the Amazon, Northern region of Brazil, where cervical cancer continues to be the type with the highest incidence and mortality among women.
