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Zhang G, Yang H, Bian J, Asilibieke S, Tian T, Lynn HS, Dai J. Infection and Persistent Infection of Human Papillomavirus Among HIV-Negative Men Who Have Sex with Men in Xinjiang, China: A Prospective Cohort Study. AIDS Behav 2025; 29:834-847. [PMID: 39812751 DOI: 10.1007/s10461-024-04569-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2024] [Indexed: 01/16/2025]
Abstract
Anal HPV infection is particularly prevalent among men who have sex with men (MSM). The purpose of this study was to understand the status and influencing factors of HPV infection in MSM in Urumqi, Xinjiang, in order to provide suggestions for policy formulation. A prospective cohort study was conducted among HIV-negative MSM in Urumqi Xinjiang between April 2016 and June 2023. 824 MSM were recruited. Data were collected anal swab results from self-administered questionnaires and laboratory tests. A Cox regression model was employed to analyze factors associated with HPV infection. The prevalence rates of high-risk HPV and low-risk HPV were 37.99% and 25.97%. Receptive anal intercourse is a well-established risk factor for both incident and persistent HPV infections among MSM. For new high-risk HPV infections, the adjusted hazard ratio is 1.55 (95% CI: 1.28-1.89), and for persistent high-risk HPV infections, the aHR is 1.95 (95% CI: 1.48-2.57). Similarly, for low-risk HPV, receptive anal intercourse increases the risk of incidence (aHR = 1.34, 95% CI: 1.07-1.67) and persistent infection (aHR = 1.64, 95% CI: 1.18-2.29). Seeking sexual partners in bathhouses raised the risk of low-risk HPV infections (aHR = 1.36, 95% CI: 1.05-1.76). Young MSM may face a higher risk of HPV infection. Implementing targeted HPV vaccination catch-up programs for the MSM population in Urumqi could offer significant societal benefits.
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Affiliation(s)
- Guozhen Zhang
- School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China
- The Key Laboratory of Special Environment and Health Research in Xinjiang, Urumqi, China
| | - Heng Yang
- School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China
| | - Juyuan Bian
- School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China
| | - Shulipan Asilibieke
- School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China
| | - Tian Tian
- School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China
- The Key Laboratory of Special Environment and Health Research in Xinjiang, Urumqi, China
| | - Henry S Lynn
- School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China
- The Key Laboratory of Special Environment and Health Research in Xinjiang, Urumqi, China
| | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China.
- The Key Laboratory of Special Environment and Health Research in Xinjiang, Urumqi, China.
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Volpi CR, Chama J, Blanco N, Adebiyi R, Mohanty K, Doroh A, Aigoro JA, Katu C, Ononaku U, Maigida J, Aka A, Shutt A, Dakum P, Charurat M, Adebajo S, Nowak RG. 'Does human papillomavirus (HPV) cause cancer?' - A cross-sectional study of HPV awareness among sexual minority men in Nigeria. Sex Health 2025; 22:SH24250. [PMID: 39883557 PMCID: PMC11908648 DOI: 10.1071/sh24250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Accepted: 01/08/2025] [Indexed: 02/01/2025]
Abstract
Background Human papillomavirus (HPV)-associated cancers are a global concern, particularly for sexual minority men (SMM). Understanding awareness and the determinants of these beliefs is crucial for developing educational programs to reduce HPV-associated cancers. This study explored awareness and determinants of beliefs about HPV's carcinogenicity among SMM living with and without HIV in Nigeria. Methods Participants were recruited through secure social media platforms in Abuja, Nigeria. REDCap surveys captured demographics, sexual practices and participants' beliefs regarding HPV's role in cancer. Multivariable logistic regression modeling was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the relationships between individual characteristics and belief levels stratified by those living with and without HIV. Results Of 982 participants, the median age was 29years (interquartile range: 26-34); 64.1% were living with HIV, and 9.7% believed HPV causes cancer. Awareness was highest for anal (82.1%) and penile cancers (15.8%) and less so for oropharyngeal and female HPV-associated cancers (range: 3-7%). Anogenital warts increased the odds of awareness for SMM living with HIV (aOR: 6.4, CI: 3.0-13.6) and for individuals without HIV (aOR: 4.8, CI: 1.6-14.2). Living with HIV for over 6years was independently associated with a two-fold increased knowledge about HPV's carcinogenicity (aOR: 2.1, CI: 1.1-4.1). Conclusions Awareness of HPV's carcinogenicity was low; however, those who were aware were more likely to identify male HPV-associated cancers relevant to their own cancer risk. Formalizing targeted education in HIV care settings may promote knowledge and advocacy for prevention strategies.
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Affiliation(s)
- Connor R. Volpi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John Chama
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Natalia Blanco
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Ayuba Doroh
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | - Uche Ononaku
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - John Maigida
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Abayomi Aka
- International Centre for Advocacy on Right to Health, Abuja, Nigeria
| | - Ashley Shutt
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sylvia Adebajo
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Mboumba Bouassa RS, Avala Ntsigouaye J, Lemba Tsimba PC, Nodjikouambaye ZA, Sadjoli D, Mbeko Simaleko M, Camengo SP, Longo JDD, Grésenguet G, Veyer D, Péré H, Mossoro-Kpinde CD, Bélec L. Genetic diversity of HPV35 in Chad and the Central African Republic, two landlocked countries of Central Africa: A cross-sectional study. PLoS One 2024; 19:e0297054. [PMID: 38271382 PMCID: PMC10810494 DOI: 10.1371/journal.pone.0297054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Human Papillomavirus (HPV)-35 accounts for up 10% of cervical cancers in Sub-Saharan Africa. We herein assessed the genetic diversity of HPV35 in HIV-negative women from Chad (identified as #CHAD) and HIV-infected men having sex with men (MSM) in the Central African Republic (CAR), identified as #CAR. Ten HPV35 DNA from self-collected genital secretions (n = 5) and anal margin samples (n = 5) obtained from women and MSM, respectively, were sequenced using the ABI PRISM® BigDye Sequencing technology. All but one HPV35 strains belonged to the A2 sublineage, and only #CAR5 belonged to A1. HPV35 from #CAR had higher L1 variability compared to #CHAD (mean number of mutations: 16 versus 6). L1 of #CAR5 showed a significant variability (2.29%), suggesting a possible intra-type divergence from HPV35H. Three (BC, DE, and EF) out of the 5 capsid loops domains remained totally conserved, while FG- and HI- loops of #CAR exhibited amino acid variations. #CAR5 also showed the highest LCR variability with a 16bp insertion at binding sites of the YY1. HPV35 from #CHAD exhibited the highest variability in E2 gene (P<0.05). E6 and E7 oncoproteins remained well conserved. There is a relative maintenance of a well conserved HPV35 A2 sublineage within heterosexual women in Chad and MSM with HIV in the Central African Republic.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Cité, Paris, France
- Ecole Doctorale Régionale (EDR) d’Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon
| | - Juval Avala Ntsigouaye
- Ecole Doctorale Régionale (EDR) d’Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon
- Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, Republic of the Congo
| | - Paola Candyse Lemba Tsimba
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Cité, Paris, France
- Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, Republic of the Congo
| | - Zita Aleyo Nodjikouambaye
- Ecole Doctorale Régionale (EDR) d’Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon
- Service de Gynécologie-Obstétrique, Hôpital de la Mère et de l’Enfant, N’Djamena, Chad
| | - Damtheou Sadjoli
- Cabinet Médical de Gynécologie Obstétrique "La Renaissance Plus," N’Djamena, Chad
| | - Marcel Mbeko Simaleko
- Centre National de Référence des Infections Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
| | - Serge Police Camengo
- Service de Gastro-entérologie, Hôpital de l’Amitié, Bangui, Central African Republic
- Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
| | - Jean De Dieu Longo
- Service de Gastro-entérologie, Hôpital de l’Amitié, Bangui, Central African Republic
- Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Bangui, Central African Republic
| | - Gérard Grésenguet
- Service de Gastro-entérologie, Hôpital de l’Amitié, Bangui, Central African Republic
- Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Bangui, Central African Republic
| | - David Veyer
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Cité, Paris, France
| | - Hélène Péré
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Cité, Paris, France
| | | | - Laurent Bélec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Cité, Paris, France
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Diabaté S, Behanzin L, Guédou F, Olodo M, Goma-Matsetse AE, Aza-Gnandji M, Dossouvo A, Akpaca A, Chagas E, Gangbo FA, Zannou DM, Alary M. Prevalence and determinants of high-risk human papilloma virus among men who have sex with men in Benin: a cross-sectional study embedded in a demonstration project on pre-exposure prophylaxis against HIV. BMJ Open 2023; 13:e074464. [PMID: 37931972 PMCID: PMC10632860 DOI: 10.1136/bmjopen-2023-074464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVES This study aims to assess the prevalence and factors associated with anal high-risk human papilloma virus (HR-HPV). DESIGN A cross-sectional study conducted from 24 August 2020 to 24 November 2020. SETTING Primary care, Cotonou, Benin. PARTICIPANTS 204 HIV-negative men who have sex with men initiating oral pre-exposure prophylaxis. PRIMARY OUTCOME MEASURE Anal HR-HPV genotypes using GeneXpert HPV assay. Fourteen HR-HPV were evaluated: HPV-16 and HPV-18/45 in 2 distinct channels and the 11 other genotypes as a pooled result (31, 33, 35, 39, 51, 52, 56, 58, 59, 66 and 68). The potential independent variables analysed included anal gonorrhoea and chlamydia infections, and sociodemographic and sexual behaviour factors. To assess the determinants of HR-HPV, univariate and multivariate Poisson regression models were performed by using SAS V.9.4. RESULTS Mean age±SD was 25.9±4.8 years. 131/204 men claimed insertive sex procured more pleasure. Thirty-two participants, accounting for 15.7% of the study sample, had gonorrhoea and/or chlamydia. The prevalence of any HR-HPV genotype was 36.3% (95% CI 30.0% to 43.0%). In total, 7.8% of men had HPV-16 and 7.4% had HPV-18/45. The prevalence for the pooled genotypes (31, 33, 35, 39, 51, 52, 56, 58, 59, 66 and 68) was 29.9%. Receptive anal sex during the last 6 months was strongly associated with prevalent HR-HPV infections. The adjusted proportion ratio (aPR) was 1.93 (95% CI 1.31 to 2.83). Gonorrhoea and chlamydia were also associated with the outcome of interest; p value for both infections was <0.05. The aPR comparing patients who perceived some risk of acquiring HIV to other men was 1.44 (95% CI 1.00 to 2.08). CONCLUSIONS In Benin, anal HR-HPV was common among HIV-negative men who have sex with men. Among this highly vulnerable population, there is a need for integrated preventive and management strategies targeting HPV and other sexually transmitted infections.
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Affiliation(s)
- Souleymane Diabaté
- Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Luc Behanzin
- École nationale de formation des techniciens supérieurs en santé publique et en surveillance épidémiologique, Parakou, Benin
- Organisation pour la Promotion de la Santé et le Développement communautaire, Cotonou, Benin
| | - Fernand Guédou
- Organisation pour la Promotion de la Santé et le Développement communautaire, Cotonou, Benin
- Centre de santé de Cotonou-1, Dispensaire IST, Cotonou, Benin
| | - Marius Olodo
- Centre de santé de Cotonou 1, Dispensaire IST, Cotonou, Benin
| | | | | | - Alban Dossouvo
- Centre de santé de Cotonou 1, Dispensaire IST, Cotonou, Benin
| | | | | | - Flore Armande Gangbo
- Programme Santé de Lutte contre le Sida, Cotonou, Benin
- Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Djimon Marcel Zannou
- Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Benin
- Centre national hospitalier universitaire HMK, Cotonou, Benin
| | - Michel Alary
- Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Institut national de santé publique du Québec, Québec, Québec, Canada
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Chama J, Adebiyi R, Volpi C, Ononaku U, Maigida J, Aka A, Katu C, Shutt A, Charurat M, Adebajo S, Nowak RG. Brief Report: Prevalence and Predictors of Concern About Anal Cancer Among Sexual and Gender Minorites Living With HIV in Abuja, Nigeria. J Acquir Immune Defic Syndr 2023; 93:313-318. [PMID: 37018922 PMCID: PMC10330150 DOI: 10.1097/qai.0000000000003206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Anal cancer rates are rising among sexual and gender minorities (SGM) who live with HIV and engage in anal sex. Given that secondary cancer prevention programs for nonanal cancers are underutilized in sub-Saharan Africa, our objective was to assess concerns for anal cancer and hesitancy with cancer prevention among at-risk Nigerian SGM. METHODS Within 4 weeks, SGM living with HIV were surveyed on levels of worry and hesitancy in engaging with a future anal cancer screening and treatment study. Worry was measured on a 5-point Likert scale (0%, 25%, 50%, 75%, 100%) and categorized as low ≤25%, moderate 50%, and high ≥75%. Ordinal logistic regression identified factors associated with worry by estimating unadjusted and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). RESULTS Of 800 enrolled SGM, median age was 32 (interquartile range: 25-38) years, 99.2% were on antiretroviral therapy, of which 78.5% reported ≥95% pill adherence. The prevalence of moderate and high worry was 46.9% and 39.5%, respectively. Increasing worry was associated with reporting as a bottom for sexual position (aOR: 3.12; 95% CI: 2.04 to 4.80), top or bottom for sexual position (aOR: 2.94; 95% CI: 1.92 to 4.52), or knowing anyone with anal cancer (aOR: 2.99; 95% CI: 1.36 to 6.57). Participants aged ≥35 years were less worried (aOR: 0.72; 95% CI: 0.59 to 0.95). Ninety-nine percent of participants provided contact information for a future cancer prevention study. DISCUSSION SGM who heard about and engaged in at-risk practices for anal cancer were willing to access secondary prevention. Addressing biopsychosocial factors such as age could foster future engagement.
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Affiliation(s)
- John Chama
- Center for International Health Education Biosecurity, University of Maryland Baltimore, Abuja, Nigeria
| | - Ruxton Adebiyi
- Center for International Health Education Biosecurity, University of Maryland Baltimore, Abuja, Nigeria
| | - Connor Volpi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Uche Ononaku
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - John Maigida
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Abayomi Aka
- International Centre for Advocacy on Right to Health, Abuja Nigeria
| | | | - Ashley Shutt
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sylvia Adebajo
- Center for International Health Education Biosecurity, University of Maryland Baltimore, Abuja, Nigeria
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Omohwovo EJ. Prioritizing equitable access to human papillomavirus (HPV) vaccination for MSM in Africa: Addressing disparities in disease prevention and control. J Med Virol 2023; 95:e28795. [PMID: 37212311 DOI: 10.1002/jmv.28795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
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ADEBAJO SB, ADEBIYI R, CHAMA J, BELLO S, ONONAKU U, AKA A, LAI S, BARAL SD, DYER TV, CROWELL TA, NOWAK RG, CHARURAT M, TRUST/RV368 Study Group. Depression and Sexual Stigma Are Associated With Cardiometabolic Risk Among Sexual and Gender Minorities Living With HIV in Nigeria. J Acquir Immune Defic Syndr 2023; 92:50-58. [PMID: 36150037 PMCID: PMC9742173 DOI: 10.1097/qai.0000000000003096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND People living with HIV are vulnerable to cardiometabolic diseases. We assessed the prevalence of cardiometabolic risk factors (CMRF) and associations with sexual stigma and depression among sexual and gender minorities (SGM) in Abuja and Lagos, Nigeria. METHODS The TRUST/RV368 study enrolled SGM between March 2013 and February 2020. Participants were assessed for depression, sexual stigma, and CMRF. Robust multinomial logistic regression was used to estimate adjusted odds ratio (aORs) and 95% confidence intervals (CIs) for associations of depression, sexual stigma, and other factors with increasing numbers of CMRF. RESULTS Among 761 SGM, the mean age was 25.0 ± 6.0 years; 580 (76%) identified as cisgender men, 641 (84%) had ≥1 CMRF, 355 (47%) had mild-severe depression, and 405 (53%) reported moderate-high sexual stigma. Compared with individuals without depression, those with mild (aOR 8.28; 95% CI: 4.18 to 16.40) or moderate-severe depression (aOR 41.69; 95% CI: 9.60 to 181.04) were more likely to have 3-5 CMRF. Individuals with medium (aOR 3.17; 95% CI: 1.79 to 5.61) and high sexual stigma (aOR 14.42; 95% CI: 2.88 to 72.29) compared with those with low sexual stigma were more likely to have 3-5 CMRF. Participants age 25-34 years were less likely to have 3-5 CMRF (aOR 0.41; 95% CI: 0.23 to 0.73) compared with participants age younger than 25 years. CONCLUSION CMRF increased with severity of depression and sexual stigma, potentially predisposing SGM living with HIV to cardiometabolic diseases. Integrating interventions that address depression and sexual stigma in HIV care programs for SGM may improve cardiometabolic outcomes.
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Affiliation(s)
- Sylvia B ADEBAJO
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - Ruxton ADEBIYI
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - John CHAMA
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - Segun BELLO
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | | | - Abayomi AKA
- International Centre for Advocacy on Right to Health - ICARH, Abuja, Nigeria
| | - Shenghan LAI
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stefan D. BARAL
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Typhanye V. DYER
- University of Maryland School of Public Health, College Park, MD, USA
| | - Trevor A. CROWELL
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rebecca G. NOWAK
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Man CHARURAT
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
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Adebajo SB, Nowak RG, Adebiyi R, Shoyemi E, Ekeh C, Ramadhani HO, Gaydos CA, Ake JA, Baral SD, Charurat ME, Crowell TA, for the TRUST/RV368 Study Group. Prevalence and factors associated with anogenital warts among sexual and gender minorities attending a trusted community health center in Lagos, Nigeria. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001215. [PMID: 36962635 PMCID: PMC10021808 DOI: 10.1371/journal.pgph.0001215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
Anogenital warts caused by human papillomavirus are common in sexual and gender minorities (SGM). The prevalence of, and factors associated with warts were described for SGM with a high burden of HIV in Nigeria. Individuals who reported anal sex with men were enrolled in the TRUST/RV368 cohort. Participants completed an interviewer-led survey, provided biological samples, and had a physical examination. Specific to the Lagos site, clinic staff offered standardized warts treatment services. RDS-weighted multivariable logistic regression was used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors potentially associated with anogenital warts. Of 672 enrolled SGM, 478 (71%) engaged in warts services and had complete data. The median age (interquartile range) was 22 (20-26) years, 272 (52%) initiated sex before age 18, and 347 (79%) were cisgender men. Multiple male sexual partners in the previous year were reported by 448 (90%) of the participants, and 342 (66%) were living with HIV. Warts were diagnosed in 252 (54%), including anal warts in 234 (43%) and penile warts in 44 (8%); 26 (5%) had both anal and penile warts. Factors independently associated with warts included HIV (AOR:2.97; CI:1.44-6.14), engaging in receptive anal sex (AOR:3.49; CI:1.25-9.75), having multiple male sexual partners (AOR:7.26; CI:2.11-24.87), age at sexual debut (AOR:0.53; CI:0.28-0.98), and non-binary gender identity (AOR:0.20; CI:0.05-0.71). Warts were common among SGM in Nigeria, particularly those living with HIV. Administration of HPV vaccination before sexual debut or as a catch-up vaccination may prevent HPV-associated complications.
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Affiliation(s)
- Sylvia B. Adebajo
- Center for International Health Education Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Ruxton Adebiyi
- Center for International Health Education Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | | | | | - Habib O. Ramadhani
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Charlotte A. Gaydos
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Julie A. Ake
- United States. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Stefan D. Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Trevor A. Crowell
- United States. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry Martin Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
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Liu L, Zhang G, Zhang Z, Wang L, Wang D, Dai J. Reinfection of Nine-Valent Human Papillomavirus Vaccine Types Among HIV-Negative Men Who Have Sex With Men: A Prospective Cohort Study. Front Public Health 2022; 10:896479. [PMID: 35923960 PMCID: PMC9340213 DOI: 10.3389/fpubh.2022.896479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Reinfection of human papillomavirus (HPV) among men who have sex with men (MSM) after clearing the infection of HPV has not been well characterized. To understand the reinfection of HPV among human immunodeficiency virus (HIV) negative MSM without HPV vaccine, we analyzed the reinfection of nine-valent HPV vaccine (9v-HPV) types. Methods Data were acquired from a prospective cohort study among HIV-negative MSM in Urumqi of Xinjiang from 1 April 2016 to 14 July 2020. Participants were recruited through a local non-government organization using a website advertisement. Self-administered questionnaires and self-collected anal swabs were collected at baseline and every 6 months. The incidence rates of reinfection was calculated based on the number of events divided by person-months of observation of event risk. 95% confidence intervals (CIs) were calculated based on the Poisson distribution. Results A total of 515 HIV-negative unvaccinated MSM were included with a mean age of 30.93 years (SD 7.85), and 27.68% were reinfected with any 9v-HPV type after clearance. The reinfection incidence rate of any 9v-HPV was 14.47 per 1000 person-months (95% CI: 11.52–17.87). HPV52 was the most common type of reinfection, with a reinfection rate of 17.96 per 1,000 person months (95% CI: 11.58–26.33). Univariate analysis showed that MSM over the age of 30 had a slightly higher risk of reinfection with any 9v-HPV (Hazard ratio (HR): 1.57; 95% CI: 1.01–2.45), but no significant association was observed in multivariate analysis. Conclusions Our study showed MSM without HPV vaccine will become reinfected following the natural clearance of specific HPV types. It is also suggested that HPV vaccination is recommended not only prior to sexual debut but also after viral clearance for MSM to reduce HPV prevalence.
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Affiliation(s)
- Lirong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, China
- Center for Disease Control and Prevention of Yining, Yining, China
| | - Guozhen Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Zewen Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Lu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jianghong Dai
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, China
- *Correspondence: Jianghong Dai
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10
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Michael KC, Musa J, Aboki D, Evule N, Simon R, Sagay E, Akpa E, Ameh J. RARE PRESENTATION OF FLORID VULVA WARTS - A CASE REPORT AND REVIEW OF LITERATURE. JOS JOURNAL OF MEDICINE 2022; 16:1-7. [PMID: 38155766 PMCID: PMC10754055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Background Condyloma acuminata is an extremely common cutaneous sexually transmitted disease often diagnosed clinically, on the basis of its warty, cauliflower, and verrucous appearance. It is caused by the "low risk" Human papillomavirus types 6 and 11 in 90 percent of cases. The immune system plays a critical role in determining the course of viral infection, with immune-suppression and advanced age increasing the risk for long term wart persistence. Treatment options include the use of a wide variety of topical medications as well as surgical excision by cauterisation. Patient A rare case of florid vulvar warts in a 21-year old nulliparous immuno-competent woman is presented and the literature reviewed. She had a 7-month history of progressive vulva swelling with associated itching, contact bleeding, and malodorous discharge. It measured about 14 × 10 cm in dimensions, occupying the posterior two-thirds of the labia majora and minora and obliterating the posterior commissure. Intervention There was no positive response to Podophyllin application, however, it was eventually excised and histologic analysis excluded malignancy. Conclusion Florid vulvar warts though rare in immune-competent patients, could occur. Patients with persistent and recurrent infection often require surgical procedures as was performed in our patient with the possibility of speedy recovery and restoration of normal anatomy and cosmesis.
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Affiliation(s)
- K C Michael
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Plateau state, Nigeria
| | - J Musa
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Plateau state, Nigeria
| | - D Aboki
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Plateau state, Nigeria
| | - N Evule
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Plateau state, Nigeria
| | - R Simon
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Plateau state, Nigeria
| | - E Sagay
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Plateau state, Nigeria
| | - E Akpa
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Plateau state, Nigeria
| | - J Ameh
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Plateau state, Nigeria
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11
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Yaya I, Boyer V, Ehlan PA, Coulibaly A, Agboyibor MK, Traoré I, Kouamé MJB, Maiga AK, Kotchi OR, Nyasenu YT, Maradan G, Rojas-Castro D, Diallo F, Anoma C, Dah TTE, Mensah E, Dembélé Keita B, Spire B, Dagnra CA, Laurent C. Heterogeneity in the Prevalence of High-Risk Human Papillomavirus Infection in Human Immunodeficiency Virus-Negative and Human Immunodeficiency Virus-Positive Men Who Have Sex With Men in West Africa. Clin Infect Dis 2021; 73:2184-2192. [PMID: 33606001 DOI: 10.1093/cid/ciab157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk of human papillomavirus (HPV) infection. We assessed (i) the prevalence of high-risk HPV (HR-HPV) infection and associated factors, and (ii) the prevalence of vaccine-preventable HPV infections in MSM in Burkina Faso, Côte d'Ivoire, Mali, and Togo. METHODS A cross-sectional study was conducted in 2017-2018 among MSM ≥18 years old followed in community-based clinics. HPV infection was investigated in oral and anal samples using the e-BRID system. Factors associated with HR-HPV infection were identified using multivariate logistic regressions. RESULTS Among 631 participants, 425 were HIV-negative and 206 HIV-positive. HR-HPV prevalence ranged from 9.2% to 34.8% in the former, and 33.3% to 71.0% in the latter, according to the study country. In multivariate analysis, HIV infection (adjusted odds ratio (aOR) 3.61, 95% confidence interval (CI) 2.48-5.27) and study country (4.73, 2.66-8.43 for Mali; 3.12, 1.68-5.80 for Burkina Faso; 3.51, 1.92-6.42 for Togo) were associated with HR-HPV infection. Other associated factors were low educational level, self-defined homosexual identity, and condomless anal sex. The prevalence of infections which can be prevented with bivalent, quadrivalent, and nonavalent vaccines was 5.9, 27.1, and 34.6% in HIV-negative participants, and 18.9, 43.7, and 54.9% in HIV-positive participants, respectively. CONCLUSIONS HR-HPV prevalence was very heterogeneous between the study countries in both HIV-negative and HIV-positive MSM. Vaccine-preventable HPV infections predominated. Vaccination should be proposed to young MSM to reduce the burden of HPV infection in this vulnerable population and their female partners in West Africa.
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Affiliation(s)
- Issifou Yaya
- IRD, Inserm, University Montpellier, TransVIHMI, Montpellier, France
| | - Véronique Boyer
- IRD, Inserm, University Montpellier, TransVIHMI, Montpellier, France
| | - Phyllis Amivi Ehlan
- Laboratoire de Biologie Moléculaire et d'Immunologie, Faculté des Sciences de la Santé, University Lomé, Lomé, Togo
| | | | | | - Issa Traoré
- Association African Solidarité, Ouagadougou, Burkina Faso
| | | | | | | | - Yawo Tufa Nyasenu
- Laboratoire de Biologie Moléculaire et d'Immunologie, Faculté des Sciences de la Santé, University Lomé, Lomé, Togo
| | | | | | | | | | - Ter Tiero Elias Dah
- IRD, Inserm, University Montpellier, TransVIHMI, Montpellier, France.,Association African Solidarité, Ouagadougou, Burkina Faso.,Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | - Bruno Spire
- University Aix Marseille, Inserm, IRD, SESSTIM, Marseille, France
| | - Claver Anoumou Dagnra
- Laboratoire de Biologie Moléculaire et d'Immunologie, Faculté des Sciences de la Santé, University Lomé, Lomé, Togo
| | - Christian Laurent
- IRD, Inserm, University Montpellier, TransVIHMI, Montpellier, France
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12
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Santos CDPC, Brandão CC, Mota FS, Ferreira IS, Oliveira CNT, Souza CL, Freire de Melo F, Oliveira MV. Prevalence of anal human papillomavirus infection in patients with human immunodeficiency virus infection: A systematic review. World J Clin Infect Dis 2021; 11:38-48. [DOI: 10.5495/wjcid.v11.i3.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/14/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Caio Caires Brandão
- Medical School, Faculdade Santo Agostinho, Vitória da Conquista 45028-100, Bahia, Brazil
| | - Fernanda Santos Mota
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Isis Souza Ferreira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Cláudio Lima Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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13
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Koyalta D, Mboumba Bouassa RS, Maiga AI, Balde A, Bagendabanga JB, Alinity AA, Veyer D, Péré H, Bélec L. High Prevalence of Anal Oncogenic Human Papillomavirus Infection in Young Men Who Have Sex with Men Living in Bamako, Mali. Infect Agent Cancer 2021; 16:51. [PMID: 34210322 PMCID: PMC8252282 DOI: 10.1186/s13027-021-00385-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-risk human papillomavirus (HR-HPV) anal infection is a major problem among men who have sex with men (MSM) living in sub-Saharan Africa. The prevalence of anal HR-HPV infection and associated risk factors were estimated in a cross-sectional study in MSM living in Bamako, Mali. METHODS MSM consulting at sexual health center of the National NGO Soutoura, Bamako, were prospectively included. Sociodemographic and clinical-biological data were collected. HPV detection and genotyping were performed from anal swabs using multiplex real-time PCR. Risk factors associated with anal HPV infection were assessed by logistic regression analysis. RESULTS Fifty MSM (mean age, 24.2 years; range, 18-35) of which 32.0% were infected with HIV-1, were prospectively included. The overall prevalence of anal HPV infection of any genotypes was 70.0% (35/50) with 80.0% (28/35) of swabs positive for HR-HPV. HR-HPV-58 was the most detected genotype [13/35 (37.1%)], followed by HR-HPV-16 and low-risk (LR)-HPV-6 [12/35 (34.2%)], LR-HPV-40 [10/35 (28.6%)], LR-HPV-11 [9/35 (25.7%)], HR-HPV-51 [8/35 (22.8%)], HR-HPV types 18 and 39 [7/35 (20.0%)] and LR-HPV-43 [6/35 (17.1%)]. HR-HPV-52 and LR-HPV-44 were detected in lower proportions [5/35 (14.3%) and 4/35 (11.4%), respectively]. LR-HPV-42, LR-HPV-54, HR-HPV-31 and HR-HPV-35 were detected in very low proportions [3/35 (8.5%)]. Multiple HR-HPV infections were diagnosed in one-third of anal samples [16/50 (32.0%)], including around half of HR-HPV-positive anal swabs [16/35 (45.7%)]. More than half [27/50 (54.0%)] swabs were infected by at least one of HPV genotypes targeted by Gardasil-9® vaccine, including a majority of vaccine HR-HPV [22/50 (44.0%)]. In multivariate analysis, participation to sex in group was associated with anal infection by multiple HPV (aOR: 4.5, 95% CI: 1.1-18.1%; P = 0.032), and HIV-1 infection was associated with anal shedding of multiple HR-HPV (aOR: 5.5, 95% CI: 1.3-24.5%; P = 0.024). CONCLUSIONS These observations indicate that the MSM community living in Bamako is at high-risk for HR-HPV anal infections, with a unique epidemiological HPV genotypes profile and high prevalence of anal HPV covered by the Gardasil-9® vaccine. Scaling up prevention strategies against HPV infection and related cancers adapted to this highly vulnerable MSM community should be urgently prioritized with innovative interventions.
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Affiliation(s)
- Donato Koyalta
- Centre Hospitalo-Universitaire Gabriel Touré, Bamako, Bamako, Mali. .,Faculté des Sciences de la Santé Humaine de N'Djamena, N'Djamena, Chad.
| | - Ralph-Sydney Mboumba Bouassa
- Ecole Doctorale Régionale en Infectiologie Tropicale, Franceville, Gabon.,Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
| | | | - Aliou Balde
- Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University, INSERM, Paris, France
| | | | | | - David Veyer
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
| | - Hélène Péré
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
| | - Laurent Bélec
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
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14
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Abstract
Men who have sex with men (MSM) have a high prevalence of anal and penile human papillomavirus (HPV) infections with MSM living with HIV (MSMLH) bearing the highest rates. Data on anogenital high-risk HPV (hrHPV) among MSM in Rwanda and the associated risk factors are scant.
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15
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Farahmand M, Monavari SH, Tavakoli A. Prevalence and genotype distribution of human papillomavirus infection in different anatomical sites among men who have sex with men: A systematic review and meta-analysis. Rev Med Virol 2021; 31:e2219. [PMID: 33527636 DOI: 10.1002/rmv.2219] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022]
Abstract
Men who have sex with men (MSM) are at increased risk of human papillomavirus (HPV) infection because of their high-risk sexual behaviours. In this study, a meta-analytic approach was used to systematically analyse the literature to elucidate the prevalence and genotype distribution of anal, penile, oral and urethral HPV infection among MSM in the world. To carry out this systematic review, five electronic databases including Web of Science, PubMed, Scopus, Embase, and Google Scholar were searched for relevant studies published from January 2012 to November 2019, and pertinent data were collected from the eligible articles. The pooled HPV prevalence was calculated for each anatomical region using a random-effect model weighted by the inverse variance method. The meta-analysis was performed using the "Metaprop" function in the R package Meta. The overall pooled prevalence of anal, penile, oral and urethral HPV infection among MSM were 78.4% (95% confidence interval [CI]: 75.6%-81.0%), 36.2% (95% CI: 29.1%-44.0%), 17.3% (95% CI: 13.6%-21.7%) and 15.4% (95% CI: 7.8%-27.9%), respectively. Stratified analyses showed that the prevalences of HPV were significantly higher in HIV-positive than HIV-negative MSM. The most frequent HPV high-risk type detected in the anus, penis and oral cavity was HPV-16 (19.9%, 4.9% and 3.1%, respectively). HPV infection is rising in MSM because of high-risk sexual behaviours, suggesting an increased future risk of developing HPV-related diseases and malignancies in this population.
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Affiliation(s)
- Mohammad Farahmand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamidreza Monavari
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
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16
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Robbins SJ, Dauda W, Kokogho A, Ndembi N, Mitchell A, Adebajo S, Gaydos CA, Peel S, Ramadhani HO, Robb ML, Baral SD, Ake JA, Charurat ME, Crowell TA, Nowak RG, on behalf of the TRUST/RV368 Study Group. Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria. PLoS One 2020; 15:e0238745. [PMID: 32886722 PMCID: PMC7473579 DOI: 10.1371/journal.pone.0238745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are at risk for sexually transmitted infections (STIs), including those of the oropharynx. We estimated the prevalence and factors associated with oral sex practices and characterized oropharyngeal STIs among a cohort of MSM and TGW in Nigeria. Methods From 2013 to 2018, TRUST/RV368 recruited MSM and TGW into HIV/STI diagnosis and treatment at community-based clinics in Nigeria. Participants who completed HIV testing and oral sex questions at enrollment were selected. Cross-sectional analyses with bivariate and multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs). Oropharyngeal swab testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) began in 2014 and for those with diagnostic results at enrollment, the unadjusted association of oral sex practices with oropharyngeal STIs was conducted. Results A total of 1342 participants had a median age of 25 years (interquartile range: 22–29), 58% were living with HIV, and 69% reported oral sex practices. Factors associated with increased odds of engaging in oral sex included living with HIV (adjusted [a]OR: 1.4, 95% CI: 1.1–1.8), self-identifying as a woman (aOR:1.8, 95% CI: 1.1–2.8), mobile phone ownership (aOR:2.3, 95% CI: 1.3–3.9), receptive anal sex (aOR:1.7, 95% CI:1.3–2.3) and multiple male sexual partners (2 to 4 vs. ≤1, aOR:1.5, 95% CI: 1.0–2.2; 5+ vs ≤1, aOR:2.9, 95% CI:1.9–4.3). Oropharyngeal STI prevalence was 7% (52/752) and higher among those who engaged in oral sex compared to those who did not (unadjusted OR: 2.5, 95% CI:1.2–5.3). Conclusions Oral sex was common and associated with an increased odds of oropharyngeal STIs among MSM and TGW from Nigeria. In the absence of screening and treatment guidelines, condoms continue to be the mainstay for oral STI prevention. A pre-exposure prophylaxis for bacterial STIs would complement current prevention strategies to curb transmission.
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Affiliation(s)
- Sarah J. Robbins
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Wuese Dauda
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Afoke Kokogho
- HJF Medical Research International, Abuja, Nigeria
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Nicaise Ndembi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Andrew Mitchell
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation- A University of Maryland Baltimore Affiliate, Abuja, Nigeria
| | - Charlotte A. Gaydos
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Sheila Peel
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Habib O. Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Stefan D. Baral
- Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Man E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
- * E-mail:
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17
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Ferré VM, Gbeasor-Komlanvi FA, Collin G, Dagnra AC, Le Hingrat Q, Jaquet A, Salou M, Descamps D, Charpentier C, Ekouevi DK. Prevalence of Human Papillomavirus, Human Immunodeficiency Virus, and Other Sexually Transmitted Infections Among Men Who Have Sex With Men in Togo: A National Cross-sectional Survey. Clin Infect Dis 2020; 69:1019-1026. [PMID: 30520971 DOI: 10.1093/cid/ciy1012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa is a region of both high human immunodeficiency virus (HIV) and anal cancer incidence. We conducted the first national study in Togo to assess human papillomavirus (HPV), HIV, and other sexually transmitted infection (STI) prevalence among men who have sex with men (MSM). METHODS A multicentric cross-sectional study was conducted among MSM recruited in 4 Togolese cities. Anal swabs were collected to test HPV, herpes simplex virus (HSV), and 7 STIs. RESULTS Among the 207 MSM, HIV and high-risk HPV (hrHPV) overall prevalence were 26.1% and 44.9%, respectively. The most common hrHPV types were HPV-35 (15.0%) and HPV-16 (13.0%). Prevalence of hrHPV and multiple HPV infections were higher among HIV-infected than among HIV-uninfected MSM (85.2% vs 30.7%, P < 10-5 and 85.2% vs 28.7%, P < 10-5, respectively). Other STIs, except hepatitis B virus, were also more prevalent among HIV-infected MSM (Neisseria gonorrhoeae, P = .03; Mycoplasma genitalium, P = .04; HSV-2, P = .001; and a trend for Chlamydia trachomatis, P = .06). In multivariate analysis (adjusted odds ratio [95% confidence interval]), HIV (10.1 [4.0-25.6]), living in Lomé (2.8 [1.1-7.1]), HSV-2 excretion (26.7 [2.9-244.3]), C. trachomatis (11.7 [2.3-58.9]), and M. genitalium infection (9.6 [3.1-29.9]) were associated with increased risk of hrHPV infection. CONCLUSIONS We report a high burden of anal STIs with an unusual hrHPV type distribution among MSM, highlighting the critical need of implementation of a national strategy regarding prevention of STIs and vaccination against HPV.
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Affiliation(s)
- Valentine Marie Ferré
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution, Unité Mixte de Recherche.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, Paris, France
| | - Fifonsi A Gbeasor-Komlanvi
- Université de Lomé, Faculté des Sciences de la Santé, Département de Santé Publique.,Centre Africain de Recherche en Epidémiologie et en Santé Publique
| | - Gilles Collin
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution, Unité Mixte de Recherche.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, Paris, France
| | - Anoumou Claver Dagnra
- Université de Lomé, Centre de Biologie Moléculaire et d'Immunologie.,Programme national de lutte contre le sida et les infections sexuellement transmissibles, Togo
| | - Quentin Le Hingrat
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution, Unité Mixte de Recherche.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, Paris, France
| | - Antoine Jaquet
- Institut de santé publique, d'épidémiologie et de développement, Université de Bordeaux and Centre INSERM U1219, Bordeaux Population Health, France
| | - Mounerou Salou
- Université de Lomé, Centre de Biologie Moléculaire et d'Immunologie
| | - Diane Descamps
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution, Unité Mixte de Recherche.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, Paris, France
| | - Charlotte Charpentier
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution, Unité Mixte de Recherche.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Laboratoire de Virologie, Paris, France
| | - Didier Koumavi Ekouevi
- Université de Lomé, Faculté des Sciences de la Santé, Département de Santé Publique.,Centre Africain de Recherche en Epidémiologie et en Santé Publique.,Institut de santé publique, d'épidémiologie et de développement, Université de Bordeaux and Centre INSERM U1219, Bordeaux Population Health, France
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18
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Nowak RG, Ndembi N, Dauda W, Jibrin P, Bentzen SM, Nnaji CH, Olaomi O, Darragh TM, Madukwe J, Crowell TA, Baral SD, Blattner WA, Charurat ME, Palefsky JM, Cullen KJ. Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men. J Glob Oncol 2020; 5:1-11. [PMID: 31322994 PMCID: PMC6690628 DOI: 10.1200/jgo.19.00102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Anal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria. METHODS From August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL. RESULTS Median age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL. CONCLUSION Proficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening.
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Affiliation(s)
| | | | - Wuese Dauda
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | | | | | | | | | - Trevor A Crowell
- Walter Reed Army Institute of Research, Silver Spring, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | - Kevin J Cullen
- University of Maryland School of Medicine, Baltimore, MD
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19
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Nyitray AG, D'Souza G, Stier EA, Clifford G, Chiao EY. The Utility of Digital Anal Rectal Examinations in a Public Health Screening Program for Anal Cancer. J Low Genit Tract Dis 2020; 24:192-196. [PMID: 31972661 PMCID: PMC7147422 DOI: 10.1097/lgt.0000000000000508] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES There are no uniform screening recommendations for anal cancer. Medical practice guidelines are now available on the use of Digital Anal Rectal Examinations (DARE) for the detection of anal cancer; however, because screening can result in more harm than benefit, our objective was to assess the evidence for use of DARE as a public health screening tool. MATERIALS AND METHODS We conducted a current critical appraisal of anal cancer literature using World Health Organization criteria for assessing the potential utility of a public health screening program. RESULTS Digital Anal Rectal Examination satisfies most, but not all, World Health Organization criteria for a public health program that seeks to detect early invasive anal cancer in populations at high risk for anal cancer, most notably HIV-positive men who have sex with men; however, DARE is not appropriate when facilities for treatment are nonexistent. In addition, there are insufficient data on DARE sensitivity and specificity. CONCLUSIONS The mildly invasive nature of DARE, limited likelihood of adverse procedure-related events, cost-effectiveness and patient acceptability, as well as wide availability of DARE support consideration of its integration into screening for populations at high risk of anal cancer, especially HIV-positive men who have sex with men.
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Affiliation(s)
- Alan G. Nyitray
- Clinical Cancer Center and Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth A. Stier
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA
| | - Gary Clifford
- International Agency for Research on Cancer, Lyon, France
| | - Elizabeth Y. Chiao
- Section Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
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20
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Anal human papillomavirus and its associations with abnormal anal cytology among men who have sex with men. Sci Rep 2020; 10:3165. [PMID: 32081941 PMCID: PMC7035349 DOI: 10.1038/s41598-020-59967-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022] Open
Abstract
Human papillomavirus (HPV) infection contributes to most anal cancers and premalignant intraepithelial lesions. This study investigated anal HPV infections and cytological abnormalities among men who have sex with men (MSM). Sociodemographic characteristics and sexual behaviors were collected by using a structured questionnaire. Anal cytological results were examined, and HPV genotyping was performed by the Linear Array HPV Genotyping test. Logistic regression was used to estimate risk factors and their associations with high-risk HPV infection and cytological abnormalities. Among 163 MSM, 101 were seropositive for human immunodeficiency virus (HIV) and 62 were seronegative for HIV. The overall prevalence of HPV was 66.2%. A total of 61.9% and 48.2% of participants had never acquired any of either the quadrivalent or nonavalent vaccine HPV types, respectively. Cytological findings showed 15.3% atypical squamous cells of undetermined significance, 16.6% low-grade squamous intraepithelial lesion, 4.9% atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesion and 17% high-grade squamous intraepithelial lesion. The number of high-risk HPV types was the predominant risk factor for abnormal anal cytology (OR 2.02, 95% CI 1.27–3.24). Infection with high-risk HPV was a significant predictor for cytological abnormality. MSM should be encouraged to obtain the HPV vaccine.
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21
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Coulaud PJ, Sagaon-Teyssier L, Mimi M, M'madi Mrenda B, Maradan G, Mora M, Bourrelly M, Keita BD, Keita AA, Anoma C, Babo Yoro SA, Dah TTE, Coulibaly C, Mensah E, Agbomadji S, Bernier A, Couderc C, Laurent C, Spire B. Combined Sexual Behavioral Profiles in HIV-Seronegative Men Who have Sex with Men in West Africa (CohMSM ANRS 12324-Expertise France). ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:331-345. [PMID: 31399923 DOI: 10.1007/s10508-019-01513-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 06/10/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
Understanding the dynamics of HIV infection in men who have sex with men (MSM) can help improve efficiency in existing prevention strategies. We aimed to identify and describe the sexual behaviors of MSM most at risk of HIV infection in West Africa. HIV-negative MSM were provided a quarterly preventive follow-up package in the community-based cohort CohMSM. They completed face-to-face sociobehavioral questionnaires every 6 months. This sub-study on 520 participants used a baseline, 6-, 12- and 18-month data cluster analysis to categorize two profiles (high risk [HRE] and moderate risk [MRE] of exposure to HIV) based on three risky sexual practices over the previous 6 months. HRE-MSM (61%) were more engaged in receptive practices, had a higher proportion of inconsistent condom use during anal sex, and reported more sexual partners than MRE-MSM (39%). The proportion of HIV seroconversions observed during the first 18 months of follow-up using sexual behavioral profiles (92% are HRE-MSM) was higher than using the three risky sexual practices separately. Factors associated with the HRE-MSM profile were being younger (18-21 years), reporting stigma, and having had no female partner while being attracted only to men. Our findings suggest that in order to identify MSM most at risk of HIV infection, several risky sexual practices need to be evaluated in a combined approach. Prevention programs should pay particular attention to younger MSM, and implement activities addressing questions of MSM identity and stigma in order to reduce the dynamic of HIV infection in Western African MSM.
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Affiliation(s)
- Pierre-Julien Coulaud
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Luis Sagaon-Teyssier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Mohamed Mimi
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Bakridine M'madi Mrenda
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaëlle Maradan
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marion Mora
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | | | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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22
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Del Pino M, Martí C, Gaber J, Svanholm-Barrie C, Rodríguez-Carunchio L, Rodriguez-Trujillo A, Carreras N, Fuertes I, Barnadas E, Marimón L, Blanco JL, Persing DH, Torné A, Ordi J. mRNA Detection in Anal Cytology: A Feasible Approach for Anal Cancer Screening in Men Who Have Sex with Men Living With HIV. Diagnostics (Basel) 2019; 9:diagnostics9040173. [PMID: 31684110 PMCID: PMC6963475 DOI: 10.3390/diagnostics9040173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022] Open
Abstract
There is growing interest in anal cancer screening strategies. However, cytological/molecular evaluation of anal samples is challenging. We aimed to determine the feasibility of detecting, in anal liquid-based cytologies, the expression of biomarkers involved in the cell cycle disturbance elicited by human papillomavirus (HPV). The accuracy of this approach in the identification of high-grade squamous intraepithelial lesions/anal intraepithelial neoplasia grade2-3 (HSIL/AIN2-3) was also evaluated. 215 anal cytologies from men having sex with men living with human immunodeficiency virus were evaluated. Patients showing concordant cytological and anoscopy-directed biopsy diagnosis were selected: 70 with negative cytology and HPV test, 70 with low-grade SIL (LSIL/AIN1) cytology and biopsy, and 75 with cytology and biopsy of HSIL/AIN2-3. CDKN2A/p16, MKI67 and TOP2A mRNA expression was analyzed. HPV detection was performed with Xpert HPV Assay (Cepheid, Sunnyvale, CA, USA). HSIL/AIN2-3 showed higher expression for the biomarkers than LSIL/AIN1 or negative samples. The specificity for HSIL/AIN2-3 detection for a sensitivity established at 70% was 44.7% (95%confidence interval [CI] 36.5-53.2) for TOP2A and MKI67 and 54.5% (95%CI 46.0-62.8%) for CDKN2A/p16. mRNA detection of cell biomarkers in anal liquid-based cytology is feasible. Further studies are warranted to confirm if strategies based on mRNA detection have any role in anal cancer screening.
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Affiliation(s)
- Marta Del Pino
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Cristina Martí
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | | | | | | | - Adriano Rodriguez-Trujillo
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Núria Carreras
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Irene Fuertes
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
| | - Esther Barnadas
- Department of Pathology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.
| | - Lorena Marimón
- Department of Pathology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.
| | - Jose Luis Blanco
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain.
| | | | - Aureli Torné
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Jaume Ordi
- Department of Pathology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.
- Institut de Salut Global de Barcelona (ISGlobal), 08036 Barcelona, Spain.
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23
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Hidalgo-Tenorio C, Gil-Anguita C, López Ruz MA, Omar M, López-Hidalgo J, Pasquau J. ART is key to clearing oncogenic HPV genotypes (HR-HPV) in anal mucosa of HIV-positive MSM. PLoS One 2019; 14:e0224183. [PMID: 31648254 PMCID: PMC6813028 DOI: 10.1371/journal.pone.0224183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/06/2019] [Indexed: 12/23/2022] Open
Abstract
Background Anal squamous cell carcinoma (ASCC) is one of the most frequent non-AIDS-defining neoplasias in HIV patients, mainly in MSM, and it has been associated with chronic infection with high-risk human papilloma virus (HR-HPV). Our main objective was to determine HR-HPV clearance and acquisition rates and related factors and their relationship with the incidence of HSILs and ASCC in anal mucosa of HIV+ MSM. Patients and methods The study included consecutive HIV-infected MSM between May 2010 and December 2018. Data were gathered at baseline and annually on their sexual behavior, CD4 and CD8 levels, plasma HIV viral load, and results of anal cytology, HPV PCR, and high-resolution anoscopy. Results Out of the 405 patients studied, 34.9% of patients cleared oncogenic genotypes (IQR: 37–69) within 49 months, and 42.9% acquired new genotypes within 36 months (IQR:12–60). In multivariate analysis, clearance was only significantly influenced by the duration of antiretroviral therapy (ART) (OR: 1.016, 95% CI 1.003–1.030). The incidence of HSILs was 30.86/1,000 patient-years and that of ASCC was 81.22/100,000 patient-years; these incidences were not influenced by the acquisition (acquired: 14.9% vs. non-acquired: 10.4%; p = 0.238) or clearance (cleared 11.4% vs. non-cleared: 13.2%; p = 0.662) rates of these viruses. Conclusions The duration of ART appears to positively affect oncogenic genotype clearance in the anal mucosa of HIV+ MSM, although this clearance does not affect the incidence of HSILs or ASCC. The reduction in HSIL+ rate observed in our patients may be attributable to the bundle of measures adopted at our center.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
- * E-mail:
| | - Concepción Gil-Anguita
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Miguel Angel López Ruz
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Mohamed Omar
- Unit of Infectious Diseases, Jaen “Hospital Complex”, Spain
| | - Javier López-Hidalgo
- Pathology Department; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Juan Pasquau
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
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24
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Kahn JA, Belzer M, Chi X, Lee J, Gaur AH, Mayer K, Martinez J, Futterman DC, Stier EA, Paul ME, Chiao EY, Reirden D, Goldstone SE, Ortiz Martinez AP, Cachay ER, Barroso LF, Da Costa M, Wilson CM, Palefsky JM. Pre-vaccination prevalence of anogenital and oral human papillomavirus in young HIV-infected men who have sex with men. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2019; 7:52-61. [PMID: 30658128 PMCID: PMC6356116 DOI: 10.1016/j.pvr.2019.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/06/2018] [Accepted: 01/10/2019] [Indexed: 11/23/2022]
Abstract
The aims of this study were to: 1) determine prevalence of anogenital and oral HPV, 2) determine concordance between HPV at anal, perianal, scrotal/penile, and oral sites; and 3) describe factors associated with anogenital HPV types targeted by the 9-valent vaccine. Data were collected from 2012 to 2015 among men who have sex with men 18-26 years of age enrolled in a vaccine trial (N = 145). Penile/scrotal, perianal, anal, and oral samples were tested for 61 HPV types. Logistic regression was used to identify factors associated with types in the 9-valent vaccine. Participants' mean age was 23.0 years, 55.2% were African-American, and 26.2% were Hispanic; 93% had anal, 40% penile, and 6% oral HPV. Among those with anogenital infection, 18% had HPV16. Concordance was low between anogenital and oral sites. Factors independently associated with a 9-valent vaccine-type HPV were: race (African-American vs. White, OR=2.67, 95% CI=1.11-6.42), current smoking (yes vs. no, OR=2.37, 95% CI=1.03-5.48), and number of recent receptive anal sex partners (2+ vs. 0, OR=3.47, 95% CI=1.16-10.4). Most MSM were not infected with HPV16 or HPV18, suggesting that they may still benefit from HPV vaccination, but anogenital HPV was very common, highlighting the importance of vaccinating men before sexual initiation. CLINICAL TRIAL NUMBER: NCT01209325.
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Affiliation(s)
- Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Marvin Belzer
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA.
| | - Xiaofei Chi
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Aditya H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Kenneth Mayer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jaime Martinez
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
| | | | | | - Mary E Paul
- Baylor College of Medicine, Houston, TX, USA.
| | | | - Daniel Reirden
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | | | - Ana P Ortiz Martinez
- Cancer Control and Population Sciences Program, University of Puerto Rico, San Juan, PR, USA.
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA, USA.
| | - Luis F Barroso
- Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
| | - Maria Da Costa
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Craig M Wilson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Joel M Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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25
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Ferré VM, Ekouevi DK, Gbeasor-Komlanvi FA, Collin G, Le Hingrat Q, Tchounga B, Salou M, Descamps D, Charpentier C, Dagnra AC. Prevalence of human papillomavirus, human immunodeficiency virus and other sexually transmitted infections among female sex workers in Togo: a national cross-sectional survey. Clin Microbiol Infect 2019; 25:1560.e1-1560.e7. [PMID: 31051265 DOI: 10.1016/j.cmi.2019.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Sub-Saharan Africa is a region with high incidence of both human immunodeficiency virus (HIV) and cervical cancer. We conducted the first national study in Togo to assess prevalence of human papillomavirus (HPV), HIV and other sexually transmitted infections (STIs) among female sex workers (FSW). METHODS A multicentric cross-sectional study was conducted among FSW recruited in hot spots (clubs, streets) in four Togolese cities. HPV and STIs were tested from cervical and anal swabs. HIV and syphilis were screened with rapid tests. RESULTS In all, 310 FSW were recruited; HIV and cervical high-risk HPV (hrHPV) prevalence were 10.6% (33/310) and 32.9% (102/310), respectively. The most frequent hrHPV types were HPV58 (13.6%, 19/140), HPV35 (12.9%, 18/140), HPV31 (12.1%, 17/140) and HPV16 (10.7%, 15/140). Prevalence of hrHPV and multiple hrHPV infections showed higher rates in HIV-positive than in HIV-negative FSW (48.5% versus 31.0%, p 0.04 and 21.2% versus 9.0%, p 0.03; respectively). Prevalence of hrHPV was higher in cervical than anal swabs (34.1% versus 20.7%, p 0.0004). High-risk HPV anal infections were more frequent among HIV-positive than HIV-negative FSW (51.9% versus 17.3%, p 2 × 10-5). Concomitant anal and cervical hrHPV infections were present in 43.2% (41/95) of hrHPV-positive FSW. Overall prevalence in the cervix of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis were 4.2%, 6.1%, 5.5% and 6.5%, respectively. CONCLUSIONS This first African study on paired cervical and anal samples showed a high prevalence of genital HPV infections with a rather high rate of concomitant HPV infections but low type concordance. We report an unusual distribution of hrHPV types. These findings highlight the critical need for implementation of a national HPV vaccination strategy.
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Affiliation(s)
- V M Ferré
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France
| | - D K Ekouevi
- Université de Lomé, Faculté des Sciences de la Santé, Département de Santé Publique, Lomé, Togo; Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo; ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France
| | - F A Gbeasor-Komlanvi
- Université de Lomé, Faculté des Sciences de la Santé, Département de Santé Publique, Lomé, Togo; Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - G Collin
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France
| | - Q Le Hingrat
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France
| | - B Tchounga
- Programme PACCI, site ANRS, Abidjan, Cote d'Ivoire
| | - M Salou
- Université de Lomé, Centre de Biologie Moléculaire et d'Immunologie, Lomé, Togo
| | - D Descamps
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France
| | - C Charpentier
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France.
| | - A C Dagnra
- Université de Lomé, Centre de Biologie Moléculaire et d'Immunologie, Lomé, Togo; Programme national de lutte contre le sida et les infections sexuellement transmissibles, Lomé, Togo
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Nowak RG, Bentzen SM, Ravel J, Crowell TA, Dauda W, Ma B, Liu H, Blattner WA, Baral SD, Charurat ME, Charurat M, Ake J, Adebajo S, Baral S, Billings E, Crowell T, Eluwa G, Fasina A, Gaydos C, Ketende S, Kokogho A, Liu H, Malia J, Makanjuola O, Michael N, Ndembi N, Njab J, Nowak R, Olawore O, Parker Z, Peel S, Ramadhani H, Robb M, Rodriguez-Hart C, Sanders-Buell E, Tovanabutra S. Anal Microbial Patterns and Oncogenic Human Papillomavirus in a Pilot Study of Nigerian Men Who Have Sex with Men at Risk for or Living with HIV. AIDS Res Hum Retroviruses 2019; 35:267-275. [PMID: 30215262 DOI: 10.1089/aid.2018.0158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
To cluster anal microbiota and define microbial patterns associated with biological, clinical, and behavioral correlates among Nigerian men who have sex with men (MSM) living with or at risk for HIV. In this cross-sectional pilot study, the 15 most abundant 16S taxa in the anal microbiota of 113 MSM underwent unsupervised K-means clustering and z-score comparisons to define similarities and dissimilarities among 4 microbiota taxonomic profiles. Distributions of oncogenic HPV (high-risk human papillomavirus [HR-HPV]), concurrent HIV, antiretroviral therapy (ART), and other clinical and behavioral data were evaluated using Fisher's exact and Kruskal-Wallis tests to determine biological signatures of cluster membership. Prevotella was consistently represented in each cluster, but the average composition ranged from 14% to 44%. Cluster 2 was enriched with a member of the Fusobacteria phylum, Sneathia (29%). More participants of cluster 2 were HIV infected and taking ART (83%, 5/6), were virally suppressed (80%, 4/5), had HPV-16 (66.7%, 4/6), and reported no vaginal sex partners (83%, 5/6). HPV-35, a highly prevalent oncogenic HPV in Nigeria, was observed in all clusters except cluster 2 (0%, 0/6). Other covariates were similar across clusters (all p > .05). K-means unsupervised clustering, a canonical pattern recognition method, generalized the microbial community composition and structure while accounting for among sample variability. Further studies are needed to evaluate whether an anal microbial community enriched with members of the Fusobacteria phylum is associated with HIV-infected MSM who are virally suppressed and have a concurrent HPV-16.
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Affiliation(s)
- Rebecca G. Nowak
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Søren M. Bentzen
- University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Wuese Dauda
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Bing Ma
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland
| | - William A. Blattner
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Man E. Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
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Human Papillomavirus Knowledge, Attitudes, Practices, and Prevalence Among Men Who Have Sex With Men in Monrovia, Liberia. J Low Genit Tract Dis 2018; 22:326-332. [PMID: 30256337 DOI: 10.1097/lgt.0000000000000436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess human papillomavirus (HPV) prevalence, knowledge, attitudes, and practices, among men who have sex with men (MSM) in Monrovia, Liberia. MATERIALS AND METHOD This cross-sectional study was conducted with 107 MSM, aged 18 to 58 years, completing questionnaires and anal HPV screenings. Using peer-educators and direct community involvement, demographics, risk factors, and HPV knowledge data were collected. RESULTS Forty-eight participants (45%) were HPV positive and 21 participants (19.6%) self-identified as HIV positive. When examining HPV risk factors, 22 participants reported first sexual experience before the age of 15 years. Approximately half of participants (n = 58, 54.2%) have receptive anal sex and 40 (37.4%) reported more than 20 lifetime sexual partners. Eight participants (7.5%) had no formal education and 80 (74.8%) were not formally employed. Two-thirds of participants (64%) had never heard of HPV. Education was not significantly correlated with HPV knowledge. χ tests of independence were performed, and the relation between oral and anal sex and HPV knowledge was significant (χ (1) = 5.08, p < .05; χ (1) = 4.18, p < .05), respectively, such that those who engaged in oral and anal sex had lower levels of HPV knowledge. CONCLUSIONS Among the MSM population, HPV prevalence is high, as are high-risk practices. Participants lack HPV knowledge, independent of educational achievement, and are eager to receive educational information. Future studies should focus on identifying additional risk factors and implementing public health educational interventions.
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Palefsky J. Reprint of: Human papillomavirus infection and its role in the pathogenesis of anal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mboumba Bouassa RS, Mbeko Simaleko M, Camengo SP, Mossoro-Kpinde CD, Veyer D, Matta M, Robin L, Longo JDD, Grésenguet G, Péré H, Meye JF, Belec L. Unusual and unique distribution of anal high-risk human papillomavirus (HR-HPV) among men who have sex with men living in the Central African Republic. PLoS One 2018; 13:e0197845. [PMID: 29795661 PMCID: PMC5967740 DOI: 10.1371/journal.pone.0197845] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/27/2018] [Indexed: 12/05/2022] Open
Abstract
Background High-risk (HR) human papillomavirus (HPV) infection remains a great concern in relation to African men who have sex with men (MSM), especially those infected with HIV. The prevalence of HR-HPV and associated risk factors was estimated in a cross-sectional observational study covering MSM living in Bangui, Central African Republic. Methods MSM receiving care at the Centre National de Référence des Infections Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, were included. HIV serostatus and socio-demographic and behavioral characteristics were collected. HPV DNA was detected and genotyped on anal swabs using Anyplex™ II HPV28 test (Seegene, South Korea), and HSV DNA by in-house real-time PCR. Logistic regression analyses were used to determine risk factors associated with HPV outcomes. Results 42 MSM (mean age, 23.2 years; range, 14–39) including 69.1% HIV-1-positive and 30.9% HIV-negative were prospectively enrolled. The prevalence of anal HPV was 69.1%, including 82.7% of HR-HPV which were multiple in 52.0%. The most prevalent genotypes were HPV-35, HPV-58, HPV-59 and HPV-31. While, HPV-16 and HPV-18 were present in a minority of samples. Multiple HR-HPV infection was more frequent in HIV-positive MSM (41.4%) with 2.7 genotypes per anal samples than in HIV-negative (7.7%) with 1.5 genotypes per anal samples. HPV types included in the prophylactic Gardasil-9® vaccine were detected in 68.9% of specimens and HPV-58 was the most frequently detected. MSM infected by HPV-16 and HPV-18 were all infected by HIV-1. Few anal swabs (11.9%) contained HSV-2 DNA without relationship with HPV detection. Condomless receptive anal intercourse was the main risk factor to being infected with any type of HPV and condomless insertive anal intercourse was significantly less associated with HPV contamination than receptive anal intercourse (Odd ratio = 0.02). Conclusion MSM in Bangui are at-risk of HIV and HR-HPV anal infections. The unusual distribution of HPV-35 as predominant HPV suggests possible geographic specificities in the molecular epidemiology of HR-HPV in sub-Saharan Africa. Scaling up prevention strategies against HPV infection and related cancers adapted for MSM in Africa should be prioritized. Innovative interventions should be conceived for the MSM population living in Bangui.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Ecole Doctorale Régionale d’Infectiologie Tropicale de Franceville, Franceville, Gabon
- Ecole Doctorale Bio Sorbonne Paris Cité, BioSPC, Paris Descartes, Paris, France
| | - Marcel Mbeko Simaleko
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
| | - Serge Police Camengo
- Servivce de Gastro-entérologie, Hôpital de l’Amitié, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Christian Diamant Mossoro-Kpinde
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Laboratoire National de Biologie Clinique et de Santé Publique, Bangui, Central African Republic
- * E-mail:
| | - David Veyer
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Mathieu Matta
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Leman Robin
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean De Dieu Longo
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Gérard Grésenguet
- Centre National de Référence des Infection Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, Central African Republic
- Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
- Unité de Recherches et d’Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - Hélène Péré
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-François Meye
- Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire d’Angondjé, Libreville et Faculté de Médecine de Libreville, Université des Sciences de la Santé, Libreville, Gabon
| | - Laurent Belec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Abstract
PURPOSE OF REVIEW Adults living with HIV have an increased risk of malignancy yet there is little data for adolescents and young adults. We reviewed recently published cancer epidemiology, treatment, and outcome data for adolescents and young adults living with HIV (AYALHIV) aged 10 to less than 25 years between 2016 and 2017. RECENT FINDINGS AYALHIV are at increased risk of developing cancer compared to their uninfected peers. Kaposi sarcoma and non-Hodgkin lymphoma occur most frequently with variation by geographical region. Increased cancer risk is associated with HIV-related immunosuppression and coinfection with oncogenic viruses. Published data, particularly on posttreatment outcomes, remain limited and analyses are hampered by lack of data disaggregation by age and route of HIV transmission. SUMMARY Although data are sparse, the increased cancer risk for AYALHIV is the cause for concern and must be modified by improving global access and uptake of antiretroviral therapy, human papilloma virus (HPV) and hepatitis B virus (HBV) vaccination, screening for hepatitis B and C infection, and optimized cancer screening programs. Education aimed at reducing traditional modifiable cancer risk factors should be embedded within multidisciplinary services for AYALHIV.
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Affiliation(s)
- Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Caroline Foster
- 900 and Family Clinics, Imperial College NHS Trust, London, UK
| | - Gita Naidu
- Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Mazvita Sengayi
- National Cancer Registry, National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Turkova
- MRC CTU, University College London Institute of Clinical Trials and Methodology, London, UK
- Paediatric infectious Diseases Department, Great Ormond Street Hospital, London UK
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31
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Somia IKA, Teeratakulpisarn N, Jeo WS, Yee IA, Pankam T, Nonenoy S, Trachuntong D, Mingkwanrungrueng P, Sukmawati MDD, Ramautarsing R, Nilasari H, Hairunisa N, Azwa I, Yunihastuti E, Merati TP, Phanuphak P, Palefsky J, Phanuphak N. Prevalence of and risk factors for anal high-risk HPV among HIV-negative and HIV-positive MSM and transgender women in three countries at South-East Asia. Medicine (Baltimore) 2018; 97:e9898. [PMID: 29517698 PMCID: PMC5882413 DOI: 10.1097/md.0000000000009898] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/26/2017] [Accepted: 01/25/2018] [Indexed: 11/26/2022] Open
Abstract
This study aimed to assess the prevalence of and associated risk factors for anal high-risk human papillomavirus (hr-HPV) infection among men who have sex with men (MSM) and transgender women (TGW) in Indonesia, Thailand, and Malaysia.This was baseline data from a prospective cohort study with clinic sites in Jakarta and Bali (Indonesia), Bangkok (Thailand), and Kuala Lumpur (Malaysia).MSM and TGW aged 18 years and older from Indonesia, Thailand, and Malaysia were enrolled. Demographic and behavioral characteristics were assessed, and anal samples were collected for HPV genotyping. Multivariate logistic regression models were used to assess risk factors for anal hr-HPV overall and among HIV-positive participants.A total of 392 participants were enrolled, and 48 were TGW. As many as 245 were HIV-positive, and 78.0% of the participants were on combination antiretroviral therapy (cART). Median CD4 count was 439 cells/mm and 68.2% had undetectable HIV-RNA. HIV-positive participants had significantly more hr-HPV compared to HIV-negative participants (76.6% vs 53.5%, P < .001). HPV-16 was the most common high-risk type (20%), whereas HPV-33, -39, and -58 were significantly more common among HIV-positive participants. HIV-positive participant significantly associated with anal hr-HPV infection compared with HIV-negative (OR: 2.87, 95% CI: 1.76-4.70, P ≤ .001), whereas among HIV-positive participants transgender identity had lower prevalence of hr-HPV infection (OR: 0.42, 95% CI: 0.19-0.91, P = .03).High-risk HPV infection was very common among MSM and TGW in South-East Asia. Overall, HIV-infection, regardless of cART use and immune status, significantly increased the risk, while among HIV-positive participants transgender identity seemed to decrease the risk of anal hr-HPV.
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Affiliation(s)
- I Ketut Agus Somia
- Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Udayana University and Sanglah Hospital, Denpasar, Bali, Indonesia
| | | | - Wifanto S. Jeo
- Department of Surgery, School of Medicine Universitas Indonesia/HIV Integrated Clinic Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | - Ilias A. Yee
- Clinical Investigation Centre, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tippawan Pankam
- Prevention Department, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Siriporn Nonenoy
- Prevention Department, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Made Dewi D. Sukmawati
- Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Udayana University and Sanglah Hospital, Denpasar, Bali, Indonesia
| | | | | | - Nany Hairunisa
- Clinical Investigation Centre, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Clinical Investigation Centre, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Evy Yunihastuti
- Department of Internal Medicine, School of Medicine Universitas Indonesia/HIV Integrated Clinic Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | - Tuti P. Merati
- Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Udayana University and Sanglah Hospital, Denpasar, Bali, Indonesia
| | - Praphan Phanuphak
- Prevention Department, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Joel Palefsky
- University of California San Francisco School of Medicine
| | - Nittaya Phanuphak
- Prevention Department, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Marra E, King A, van Logchem E, van der Weele P, Mooij SH, Heijman T, Meijer CJLM, Verhagen DWM, van der Sande MAB, Schim van der Loeff MF. Anal HPV 16 and 18 viral load: A comparison between HIV-negative and -positive MSM and association with persistence. J Med Virol 2017; 90:76-83. [PMID: 28700080 DOI: 10.1002/jmv.24898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/07/2017] [Indexed: 11/12/2022]
Abstract
Does anal HPV viral load explain the difference in anal HPV persistence between HIV-negative and -positive men who have sex with men (MSM)? MSM ≥18 years were recruited in Amsterdam, the Netherlands, in 2010-2011. Anal self-swabs were collected every 6 months and genotyped (SPF10 -PCR-DEIA-LIPA25 -system). HPV16 and HPV18 load was determined with a type specific quantitative (q)PCR, and compared between HIV-negative and -positive men using ranksum test. Persistence was defined as ≥3 positive samples for the same HPV-type. Determinants of persistent HPV16/18 infection and its association with HPV16/18 load were assessed with logistic regression. Of 777 recruited MSM, 54 and 22 HIV negative men were HPV16 and HPV18 positive at baseline, and 64 and 39 HIV-positive MSM. The geometric mean titer (GMT) of HPV16 was 19.6 (95%CI 10.1-38.0) and of HPV18 8.6 (95%CI 2.7-27.5) DNA copies/human cell. HPV16 and HPV18 load did not differ significantly between HIV-negative and -positive MSM (P = 0.7; P = 0.8, respectively). In multivariable analyses HPV16 load was an independent determinant of HPV16 persistence (OR 1.8, 95%CI 1.3-2.4). No difference in anal HPV viral load was found between HIV-positive and HIV-negative MSM. HPV 16/18 viral load is an independent determinant of type-specific persistence.
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Affiliation(s)
- Elske Marra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Audrey King
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Elske van Logchem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Pascal van der Weele
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sofie H Mooij
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Titia Heijman
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Dominique W M Verhagen
- Department of Internal Medicine, Jan van Goyen Medical Center, Amsterdam, the Netherlands
| | - Marianne A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Hidalgo-Tenorio C, Gil-Anguita C, Ramírez-Taboada J, Esquivias J, López-Ruz MA, Balgahata OM, Javier-Martinez R, Pasquau J. Risk factors for infection by oncogenic human papillomaviruses in HIV-positive MSM patients in the ART era (2010-2016). Medicine (Baltimore) 2017; 96:e8109. [PMID: 28953633 PMCID: PMC5626276 DOI: 10.1097/md.0000000000008109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Squamous cell carcinoma of anus (SCCA) is one of the most frequent non-AIDS-defining diseases in HIV patients, mainly in men who have sex with men (MSM), and it is associated with human papillomavirus (HPV) infection.To determine the prevalence of high-risk HPV (HR-HPV) genotypes, premalignant lesions (HSIL) and SCCA in a cohort of HIV-positive MSM; to study the distribution of HPV genotypes according to anal histology results; and to analyze risk factors for this infection.This prospective single-center study was conducted between May 2010 and September 2016. At the study visit, cotton swabs were used to collect anal samples for cytology study in ThinPrep Pap Test liquid medium (Thin Prep Processor 2000, Hologic Corp, USA), and for HPV PCR (Linear Array HPV Genotyping Test). After, high-resolution anoscopy (HRA) (Zeiss 150 fc) was carried out. Logistic regression analysis was performed to identify risk factors for HR-HPV infection.The study included 319 patients, with mean age of 36.7 years; HR-HPV was detected in 81.3%. The prevalence of HSIL was 13.5% and SCCA was 0.3%. With regard to the distribution of HPV genotypes according to histology results, HPV 16 was the most frequent genotype in normal anal mucosa (26.7%), in LSILs (36.9%), and in HSILs (38%). In multivariate analysis, CD4 nadir < 200 cells/μL was the factor associated with infection by HR-HPV (OR 3.66, 95% CI 1.05%-12.75%).HIV-positive MSM showed a high prevalence of HSIL+ lesions and of infection by oncogenic HPV, which appears to be favored by a deficient immune system. HPV 16 was the most frequently isolated genotype in anal mucosa, regardless of lesion type.
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Affiliation(s)
| | | | | | - Javier Esquivias
- Department of Pathology, Virgen de las Nieves University Hospital, Granada
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Nowak RG, Ambulos NP, Schumaker LM, Mathias TJ, White RA, Troyer J, Wells D, Charurat ME, Bentzen SM, Cullen KJ. Genotyping of high-risk anal human papillomavirus (HPV): ion torrent-next generation sequencing vs. linear array. Virol J 2017; 14:112. [PMID: 28610586 PMCID: PMC5470268 DOI: 10.1186/s12985-017-0771-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022] Open
Abstract
Background Our next generation sequencing (NGS)-based human papillomavirus (HPV) genotyping assay showed a high degree of concordance with the Roche Linear Array (LA) with as little as 1.25 ng formalin-fixed paraffin-embedded-derived genomic DNA in head and neck and cervical cancer samples. This sensitive genotyping assay uses barcoded HPV PCR broad-spectrum general primers 5+/6+ (BSGP)5+/6+ applicable to population studies, but it’s diagnostic performance has not been tested in cases with multiple concurrent HPV infections. Methods We conducted a cross-sectional study to compare the positive and negative predictive value (PPV and NPV), sensitivity and specificity of the NGS assay to detect HPV genotype infections as compared to the LA. DNA was previously extracted from ten anal swab samples from men who have sex with men in Nigeria enrolled on the TRUST/RV368 cohort study. Two-sample tests of proportions were used to examine differences in the diagnostic performance of the NGS assay to detect high vs. low-risk HPV type-specific infections. Results In total there were 94 type-specific infections detected in 10 samples with a median of 9.5, range (9 to 10) per sample. Using the LA as the gold standard, 84.4% (95% CI: 75.2–91.2) of the same anal type-specific infections detected on the NGS assay had been detected by LA. The PPV and sensitivity differed significantly for high risk (PPV: 90%, 95% CI: 79.5–96.2; sensitivity: 93.1%, 95% CI: 83.3–98.1) as compared to low risk HPV (PPV: 73%, 95% CI: 54.1–87.7; sensitivity: 61.1, 95% CI: 43.5–76.9) (all p < 0.05). The NPV for all types was 92.5% (95% CI: 88.4–95.4). The NPV and specificity were similar for high and low risk HPVs (all p > 0.05). The NGS assay detected 10 HPV genotypes that were not among the 37 genotypes found on LA (30, 32, 43, 44, 74, 86, 87, 90, 91, 114). Conclusions The NGS assay accurately detects multiple HPV infections in individual clinical specimens with limited sample volume and has extended coverage compared to LA. Electronic supplementary material The online version of this article (doi:10.1186/s12985-017-0771-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S. Green St. N9E17, Baltimore, MD, 21201, USA
| | - Nicholas P Ambulos
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S. Green St. N9E17, Baltimore, MD, 21201, USA
| | - Lisa M Schumaker
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S. Green St. N9E17, Baltimore, MD, 21201, USA
| | - Trevor J Mathias
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S. Green St. N9E17, Baltimore, MD, 21201, USA
| | - Ruth A White
- Department of Med Hematology and Oncology, Columbia University, New York, NY, USA
| | - Jennifer Troyer
- National Human Genome Research Institute, Rockville, MD, USA
| | - David Wells
- Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Manhattan E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Søren M Bentzen
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S. Green St. N9E17, Baltimore, MD, 21201, USA
| | - Kevin J Cullen
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S. Green St. N9E17, Baltimore, MD, 21201, USA.
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Palefsky J. Human papillomavirus infection and its role in the pathogenesis of anal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2017. [DOI: 10.1053/j.scrs.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
OBJECTIVE Untreated advanced HIV infection alters the gut microbiota, but it is unclear whether antiretroviral therapy (ART) reverses these changes. We compared the composition of the rectal microbiota among three groups of men who have sex with men (MSM): HIV-uninfected, untreated HIV, and ART-treated HIV-infected. DESIGN A cross-sectional study was conducted among 130 MSM (55 HIV-uninfected, 41 untreated HIV, and 34 ART-treated HIV) in Abuja, Nigeria. METHODS Bacterial 16S rRNA genes were amplified from rectal swabs, sequenced and clustered into Genera-level operational taxonomic units. Alpha diversity was quantified using the Shannon index and compared among groups using the Kruskal-Wallis test; associations with other scale variables were quantified using Spearman's rank correlation (Rs). The relative abundance of the top 15 taxa was compared according to HIV infection/treatment status using the Wilcoxon rank sum test. RESULTS HIV-treated MSM had a decrease in a commensal phylum, Bacteroidetes (P < 0.01). Alpha diversity was positively correlated with viral loads (Rs = 0.32, P < 0.01). Statistically significant shifts in relative abundance of rectal microbiota for the HIV-treated group included a decrease in the most abundant bacteria, Prevotella (P = 0.02) and an increase in pathogenic bacteria, Peptoniphilus (P = 0.04), Finegoldia (P = 0.01), Anaerococcus (P = 0.03), and Campylobacter (P = 0.03) compared with the other groups. CONCLUSION Untreated HIV infection does not significantly alter the rectal microbiota, whereas prior treatment is associated with a shift toward a more pathogenic pattern of microbiota. Treatment with an antibiotic, co-trimoxazole, in conjunction with ART may have contributed to this shift.
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Dhumale SB, Sharma S, Gulbake A. Ano-Genital Warts and HIV Status- A Clinical Study. J Clin Diagn Res 2017; 11:WC01-WC04. [PMID: 28274028 DOI: 10.7860/jcdr/2017/24610.9171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Ano-Genital Warts (AGW) like other Sexually Transmitted Diseases (STD) is associated with Human Immunodeficiency Virus (HIV) infection. This study of AGW was done in HIV positive and HIV negative patients. AIM To study the risk factors and clinical presentations of ano-genital warts in HIV positive and negative patients. MATERIALS AND METHODS A comparative, cross-sectional, descriptive study of 25 HIV positive and 25 HIV negative (n=50) AGW patients between 15-60 years of both sex was conducted in Dr. D. Y. Patil Hospital and Research Centre from July 2014 to July 2016. RESULTS Significant association of HIV positivity (p<0.05) was observed between age group of 15-30 years and HIV negative status (p<0.05) in age group of 31-45 years. HIV positive status significantly higher in patients with self-admitted multiple sexual partners (p<0.01), homosexuality (p<0.05) and presentation with anal warts (p<0.01). HIV negative status correlated significantly with single sexual partner admission (p<0.01) and hetero-sexuality (p<0.05). Gender did not show significant association with number of sexual partners or HIV positivity. Extra-genital or only genital warts had no association with HIV status. Co-STDs though more in number in ser-positive group, did not show any significant association with HIV positivity (p>0.05). No patient presented with changes of malignancy. Four were adolescents below 19 years. Two patients had atypical presentations of giant condylomata i.e., Buschke-Lowenstein Tumour (BLT). CONCLUSION HIV positivity was significantly associated with the risk factors of age below 30 years, homo sexuality and multiple sexual partners. Anal warts were significantly common in HIV positive patients. Four adolescents with AGW underline the need for high risk behaviour counselling. No patient had malignant ano-genital warts. Follow up of these patients with Human Papilloma Virus (HPV) sub-typing is necessary.
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Affiliation(s)
| | - Shimpa Sharma
- Professor, Department of Medicine, D.Y. Patil Medical College , Kolhapur, Maharastra, India
| | - Arvind Gulbake
- Assistant Professor, Center for Interdisciplinary Research, D.Y. Patil University , Kolhapur, Maharastra, India
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