Prevalence of anal Human Papillomavirus (HPV) infection and

Prevalence of anal Human Papillomavirus (HPV) infection and Prevalence of anal Human Papillomavirus (HPV) infection and - Start

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Prevalence of anal Human Papillomavirus (HPV) infection and




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Presentations text content in Prevalence of anal Human Papillomavirus (HPV) infection and

Slide1

Prevalence of anal Human Papillomavirus (HPV) infection and anal squamous intraepithelial lesions (SIL) in a Cohort of Brazilian HIV-infected women

Beatriz Grinsztejn1, Ruth Khalili Friedman1, Valdilea Veloso1, Monica Derrico1, Cynthia B. Cunha1, Carina Barillo1, Brenda Hoagland1, Sandra Wagner1, Angela C.V. de Andrade1, Andrea Cytryn1, José Eduardo Levi2, Thais Heinke3, Janice Mery C. de Oliveira Coelho1, Paula Mendes Luz1, Jose Ricardo Coutinho11 Fundação Oswaldo Cruz – Instituto de Pesquisa Clínica Evandro Chagas/IPEC, Rio de Janeiro, State of Rio de Janeiro, Brazil.2 Laboratório de Virologia - Instituto de Medicina Tropical, Universidade de São Paulo, State of São Paulo, Brazil.3 Salomão Zoppi Diagnósticos

Abstract no.

WEPDB0103

Slide2

Background

Anal cancer in specific populations, such as people living with HIV/AIDS, has been increasing at alarming rates.

The incidence of anal carcinoma (AC) has been increasing despite the implementation of ART, which has not been shown to consistently alter the course of HPV-associated

anogenital

disease

Slide3

Methods

Study Design and Population

: Cross-sectional study conducted in the IPEC-

Fiocruz

HIV+ women cohort in active follow-up between January 2011 and December 2012. Women aged ≥18 years without a history of anal cancer were accessed.

Data Collection

: Structured interviews were performed to access

sociodemographic

characteristics and risk behaviors; data on HIV-related parameters and medical conditions were captured from the medical charts.

All procedures were performed after obtaining IRB approval and written informed consent from study participants.

Slide4

Methods

Anal Liquid-based Cytology:

Samples

collected in

ThinPrep

™ solution. Results reported according to Bethesda criteria;

HPV Testing using

PapilloCheck

:

HR-HPV: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 26, 53, 66,

70, 73, 82

LR-HPV: 6, 11, 40, 42, 43, 44/55

Anal examination and High Resolution

Anoscopy

(HRA):

Performed

for women with an abnormal cytology result and/or visible

hypercromic

lesions on anal margin. Biopsies were performed as clinically required.

Slide5

Methods

Statistical Analysis:

Anal HPV testing results, cytology results and the frequency of histological AIN and anal cancer (margin and/or canal) were calculated as simple proportions.

Women who had normal cytology and no visible lesions were considered as negative for AIN. Histological results were considered for the final diagnostic.

If multiple biopsies were obtained, the highest grade was used to denote the lesion status at that visit.

The STATA/SE 10.1 software package was used in the analysis.

Slide6

Results

Characteristics of participants in the IPEC/FIOCRUZ Women`s Cohort (N=816)

CharacteristicsTotalaAge ≥ 40. years - N (%)497 (60.9)Median (IQR)41.5 (34.6-48.6)Skin color non white - N (%)298 (36.9)No. of sexual partners in past 6 months - N (%)0235 (29)1531 (65.6)≥ 243 (5.3)Median (IQR)1 (0-1)Receptive anal intercourse in past 6 months - N (%)163 (20.3)Current smoker - N (%)172 (21.2)

Slide7

Results

Characteristics of participants in the IPEC/FIOCRUZ Women`s Cohort (N=816)

Characteristics TotalNadir CD4+ cell count. cells/mm3 – Median (IQR) 219 (103-326) Baseline CD4+ cell count. cells/mm3 – Median (IQR)Combined antiretroviral therapy (cART) 595 (408-837) 629 (77,1%) Time under cART (months) Mean (SD)90.4 (64.0)Median (IQR)77.5 (32.7-149)

< 200

45.8%

Slide8

Results

CytologyN (%)No lesions571 (70)ASC-US111 (13.6)ASC-H11 (1.3)LSIL88 (10.8)HSIL35 (4.3)Total816 (100)

Anal cytology was abnormal in 245/816 (30%) women:

Of these, 204 (83.3%) were submitted to HRA.

Slide9

Results

Prevalence of anal histological HPV-related lesions.

HPV-related lesions N (%)Totala (n = 775)AIN 141 (5.3)21 (2.7)34 (4.4)55 (7.0)AIN 2AIN 3AIN2+

a 41 women were not considered as they presented abnormal cytology results and did not come to HRA.

Among all women with histological AIN2+, 7.3%, 70.9% and 21,8%

had lesions only in the anal margin, only in the anal canal and in

both sites, respectively.

Slide10

*

Total of women with available HPV genotyping results

Prevalence of High risk HPV genotypes in all women (N=717)*

Slide11

*

Total of women with available HPV genotyping results

Prevalence of Low Risk HPV genotypes in all women (N=717)*

Slide12

Conclusions

The prevalence of abnormal anal cytology was high. Prevalence of histological AIN2+ may be underestimated as women with normal cytology were not referred to HRA.

Systematic screening for HPV-related anal lesions among women is warranted and may impact the increasing incidence of anal cancer, although a screening algorithm is not yet defined.

HIV+ women

may

benefit from the HPV vaccines already available. However, further studies are needed to investigate the role of other HPV types involved in high grade HPV-related lesions among HIV-infected women in developing countries.


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