Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
Effect of human immunodeficiency virus infection and immunosuppression on the detection of human papillomavirus and the development of anal squamous intraepithelial lesions.
Diss Abstr Int [B]; 54(8):4100 1994. Unique Identifier : AIDSLINE ICDB/95606447 Critchlow CW; Univ. of Washington
Abstract:
A small pilot study was first conducted among 145 consecutive homosexual men seeking HIV serologic testing to evaluate the feasibility of potential studies of human immunodeficiency virus (HIV) infection, detection of anal human papillomavirus (HPV) and anal squamous intraepithelial neoplasia (ASIL). Anal HPV DNA was detected in 8 (31%) of 26 HIV seropositive men and in 10 (8%) of 119 HIV seronegative men (Odds Ratio = 5.8, 95% Confidence Interval (CI) = 1.8-18.9, adjusted for history of sexually transmitted disease and current anorectal symptoms). Detection of anal HPV DNA appeared to increase with prevalence of symptoms associated with immunosuppression. A larger cohort study was then conducted among 205 HIV seropositive and 154 HIV seronegative men attending the Seattle-King County Department of Public Health AIDS Prevention Clinic in order to examine the association between HIV infection and pattern of detection of anal HPV DNA. Men were evaluated every 4-6 months, undergoing a standardized interview, examination, collection of specimens for detection of HPV DNA, and lymphocyte subset analysis to assess level of immune function. The 3-year cumulative prevalence of HPV DNA detected by polymerase chain reaction was 98% among HIV seropositive men and 86% among HIV seronegative men (p less than 0.001). The 3-year cumulative prevalence of HPV DNA detected at higher levels (by Southern transfer hybridization) was 69% among HIV seropositive men and 40% among HIV seronegative men (p less than 0.001). HIV infected men were also more likely than were HIV seronegative men to have persistent HPV infection, defined as two consecutive positive HPV tests (Relative Risk = 3.0, 95% CI = 1.8, 5.2). The sub-cohort of men with cytologically negative findings at enrollment (138 HIV seropositive and 122 HIV seronegative) were also evaluated to assess the risk of developing high grade anal neoplasia as a function of HIV infection. Men were followed for an average of 17.3 months. Compared with HIV seronegative men, HIV seropositive men were 2.5 (95% CI = 1.1, 6.0) times more likely to develop high grade ASIL, although immunosuppressed men with CD4 counts below 500/ul were 5.1 (95% CI = 2.0, 13.0) times more likely to develop high grade disease. Furthermore, men with HPV 16 or 18 detected without DNA amplification were 6.8 (95% CI = 2.0, 22.8) times more likely to develop high grade ASIL than were HIV seronegative men. These findings suggest that the increased risk of anal disease among HIV seropositive men is most likely due to increased HPV replication resulting from changes in immune function. (Full text available from University Microfilms International, Ann Arbor, MI, as Order No. AAD94-01415)
Keywords: Anus Neoplasms/ETIOLOGY/*MICROBIOLOGY DNA/*METABOLISM Human HIV Infections/*COMPLICATIONS HIV Seropositivity Male Papillomavirus, Human/*GENETICS Papovaviridae Infections/*COMPLICATIONS Tumor Virus Infections/*COMPLICATIONS THESIS 950430
M9541142
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Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
