title: Distribution of human papillomavirus genotypes, assessment of HPV 16 and 18 viral load and anal related lesions in HIV positive patients: a cross-sectional analysis.
abstract: Natural history of anal intraepithelial neoplasia and anal cancer is not fully understood. Factors associated with cytological abnormalities and predictors of progression to high-grade anal intraepithelial neoplasia still deserve investigation. The aim of this cross-sectional study was to assess the prevalence of HPV types, the relationship between HPV genotypes, HPV 16/18 viral load and cytological abnormalities in male and female HIV-infected patients. One hundred and twenty-two (72.6%) patients were infected with HPV, 75 (61%) had multiple HPV infection, and 94 (77%) had high-risk HPV infection. The most frequently identified HPV types were HPV 16 (64%), HPV 6 (39%), HPV 18 (31%), HPV 53 (14.7%), HPV 33 (10.6%), HPV 11 (8.2%), HPV 70 (5.7%), and HPV 61 (4.9%). The HPV types which were most frequently found in combination were HPV 6 + 16 (9.8%), 6 + 16 + 18 (8.2%), 16 + 18 (6.6%), 6 + 18 (4.9%), 16 + 33 (3.3%), 16 + 53 (3.3%). Median HPV16 and 18 viral loads were 6.1 log10 copies/10(6) cells [IQR 5.0-7.3] and 6.1 log10 copies/10(6) cells [IQR 5.7-6.0], respectively. Male gender (P = 0.03, OR: 1.2 [1.0-1.4]) and homo/bisexual transmission routes (P = 0.044, OR: 1.4 [1.0-1.9]) were associated with HPV 16 infection. An HPV 16 viral load cut-off ≥5.3 log10 copies/10(6) cells and a CD4+ cell count ≤200/µl were independent factors associated with abnormal cytology. In the absence of national consensus guidelines, a strict regular follow-up at shorter intervals is recommended for HIV-infected patients with abnormal cytology, especially low grade squamous intraepithelial lesions, an HPV 16 viral load ≥5.3 log/10(6) cells and a CD4+ cell count ≤200/µl.
authors.affiliation: Department of Clinical Microbiology IHU and CNRS-URMITE, UMR 7278 Timone University Hospital Marseille, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Tamalet
authors.forename: Veronique
authors.initials: V
authors.lastname: Obry-Roguet
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Ressiot
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bregigeon
authors.forename: Jean
authors.initials: J
authors.lastname: Del Grande
authors.forename: Isabelle
authors.initials: I
authors.lastname: Poizot-Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D001005:Anus Neoplasms / Q000473:pathology* / Q000821:virology; D002278:Carcinoma in Situ / Q000473:pathology* / Q000821:virology; D003430:Cross-Sectional Studies; D003584:Cytological Techniques; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D019562:Viral Load; D055815:Young Adult
keywords: HPV type 16; anal cytology; human papillomavirus genotypes; intraepithelial anal neoplasia; oncogenic HPV viral load