Clinical and laboratorial study of HPV infection in men infected with HIV

OBJECTIVES: To determine the prevalence of precursor lesions of penile cancer, to establish the concordance of diagnostic techniques (PCR, Hybrid Capture (HC) and peniscopy with acetic acid 5%) in the diagnosis of Human Papilloma Virus (HPV) of the penis of men infected with HIV and to evaluate the influence of the immune status. PATIENTS, METHODS AND RESULTS: 276 men were studied, with a median age of 34.6 years. Prevalence of High Risk HPV, Low Risk HPV and infection with both, according to HC, was 43%, 32% and 22%, respectively. PCR showed 50% of positivity for HPV DNA. Peniscopy was positive in 27% of individuals. Peniscopy showed good specificity and low sensitivity for the detection of penile HPV, and low concordance with PCR. Men with white lesions had a 3.6 higher relative risk of positivity for HPV. The most common clinical lesion observed was vegetation, identified in 29% of patients. PCR and HC techniques showed high sensitivity for HPV DNA and there was an excellent correlation between them. Immunosuppressed individuals with CD4< 200 cells/mm3 had the highest prevalence of pre-malignant lesions that were observed in 10% of the studied individuals. CONCLUSIONS: Peniscopy was important for identification and treatment of subclinical lesions. PCR and HC techniques were sensitive methods for the detection of HPV DNA with high concordance. Severely immunosuppressed individuals showed a higher prevalence of pre-malignant lesions of the penis.

Human papillomavirus (HPV) detection and Papanicolaou cytology in low-resource women in Posadas city, Misiones, Argentina / Detección del virus papiloma humano (HPV) y citología de Papanicolaou en mujeres de bajos recursos de la ciudad de Posadas, Misiones, Argentina

The objective of this study was to determine the prevalence of HPV infection and cervical lesions present in women who attended a health center in a low-resource area of the city of Posadas, Misiones, Argentina. Cervical cell samples (n = 163) were processed for Papanicolaou cytology and HPV-PCR tests. Socio-cultural risk factors were estimated using the odds ratio (OR, CI 95 %). Cervical lesions were detected in 14.7 % of women. The general prevalence of HPV infection was of 38 %. The most common types among the total population were HPV-16 (9.8 %) and HPV-33 (9.3 %). HPV-16 was detected in association with 29.2 % and 6.5 % of women with and without cervical lesions, respectively, the OR being 5.3 (1.8-15.8). Risk factors for HPV-16 infection were a smoking habit and a history of previous sexually-transmitted diseases. These data are important for the implementation of prevention programs, including an appropriate introduction of vaccination and the baseline for virological surveillance in the vaccine era.

El objetivo de este estudio fue determinar la prevalencia de la infección por HPV y de lesiones cervicales en mujeres asistidas en un centro de salud situado en un área de bajos recursos de la ciudad de Posadas, Misiones, Argentina. Las muestras (n = 163) fueron examinadas mediante las pruebas de Papanicolaou y de PCR para HPV. Los factores socio-culturales de riesgo fueron identifcados mediante el cálculo de la odds ratio (OR, IC 95 %). Se detectaron lesiones cervicales en el 14,7 % de las mujeres. La prevalencia de infección por HPV fue de 38 %. Los tipos más frecuentes en la población total fueron HPV-16 (9,8 %) y HPV-33 (9,3 %). El HPV-16 se detectó asociado al 29,2 % y al 6,5 % de las mujeres con lesiones del cuello uterino y sin ellas, respectivamente, con un OR de 5,3 (1,8-15,8). Los factores de riesgo para la infección por HPV-16 fueron el hábito de fumar y el antecedente de enfermedades de transmisión sexual. Estos datos son importantes para la ejecución de los programas de prevención, incluyendo una introducción adecuada de la vacunación y la línea de base para la vigilancia virológica en la era de la vacuna.

Prevalencia de papilomavirus humano (HPV) tipo 6, 11, 16 y 18 en la ciudad de Buenos Aires: implicancias en la implementación de vacunas profilácticas / Prevalence of human papillomavirus (HPV-6-11, -16 and -18) in the city of Buenos Aires: epidemiology and vaccination

Introducción: el cáncer cervical es uno de los cáncer más comunes que afectan mujeres en países en desarrollo. Es provocado por la infección persistente del Papilomavirus Humano (HPV). En los últimos años se ha lanzado al mercado una vacuna cuadrivalente contra los HPV de bajo y alto riesgo (HPV-6, 11, 16 y 18), otra vacuna, bivalente para HPV-16 y 18, también ha sido introducida al mercado. En el presente trabajo se evaluó si los tipos de HPV cubiertos por las vacunas profilácticas son los más prevalentes en nuestro país, así como la utilidad de los métodos de detección viral por ADN como herramienta para el diagnóstico en mujeres asintomáticas. Materiales y métodos: éste protocolo se encuentra aprobado por el Comité de Docencia e Investigación (CODEI) del Hospital Gral. de Agudos "C.G. Durand" y por el consejo de Etica de la USAL. Todos los participantes dieron consentimiento escrito voluntario antes de participar del mismo. Se analizaron biopsias cervicales obtenidas en el Servicio de Tocoginecología de dicho Hospital, las cuales fueron agrupadas en 4 categorías: Grupo Control (ctrl.) n= 27, Grupo de lesiones de bajo grado (CIN I) n = 22, Grupo de lesiones de mediano y alto grado (CIN II/III) n = 30, Grupo de carcinomas cervicales (CC) n = 35. El ADN fue extraído por métodos estándar. La determinación de presencia de HPV se realizó mediante PCR específica con cebadores MY09/MY11. La tipificación de ADN específico de HPV-6, -11, -16 y -18 se realizó con PCR multiplex específica. Resultados y conclusiones: hemos observado una alta incidencia de la infección con HPV-16 en todos los grupos analizados (52% p< 0,0001), y varias muestras mostraron coinfección entre HPVs de alto riesgo, y entre HPVs de bajo y alto riesgo (6,85%, p< 0,001 vs. HPV16). Estos resultados, sumados al hecho que el 17,8 % de las muestras no mostró infección con los citados tipos de HPV, sugieren que la prevalencia de los tipos virales cubiertos por las vacunas es menor a la esperada...

Introductions: Cervical cancer is one of the most frequent cancers that affect women in developing countries. It is caused by persistent infection with Human Papillomavirus (HPV). In the last years a cuadrivalent vaccine against High-risk HPVs (HPV-6, -11, -16 and -18) has been launched into the market; another vaccine, bivalent for HPV-16 and -18, has also been introduced intro the market. In the present work we evaluated if HPV types covered by these vaccines are actually the most prevalent in our country, as well as the utility of DNA-based viral detection essays as a diagnosis tool in asymptomatic women. Materials and Methods: this protocol has been approved by the Hospital Durand's Teaching and Ethics committee (CODEI) and by the Ethics committee of USAL. All pariticipants gave voluntary informed consent before being included in the study. we analyzed cervical biopsies obtained in Gynecology Service of Hospital Durand, which were grouped into 4 categories: Control group (ctrl.) n = 27, low grade cervical lesions group (CIN I) n = 22, high grade cervical lesions group (CIN II/III) n = 30, cervical carcinomas (CC) n = 35. DNA was extracted by standard methods. Viral HPV presence was evaluated by specific PCR with MY09/MY11 primers. Viral-specific DNA determination of HPV-6, -11, -16 and -18 was evaluated by specific multiplex PCR. Results and conclusions: We observed a high incidence of and several samples showd co-infection between High-risk HPVs, and between high and low-risk HPVs (6.85%, p< 0.001 vs. HPV16). These results, plus the fact that almost 17.8% of the samples shown no expression of HPV types covered by the vaccines, suggest that the prevalence of HPV-6,-11, -16 and -18 is lower than expected in Buenos Aires city.

Papilomavirus y Factores asociados a Neoplasia Intraepitelial Cervical de Alto Grado en Cauca, Colombia / Papillomavirus and factors associated with high-risk, cervical intra-epithelial neoplasia in Cauca, Colombia

Objetivo: Evaluar el papel de los principales factores de riesgo asociados a lesiones intraepiteliales escamosas de alto grado en mujeres del Departamento del Cauca, Colombia. Metodología: Después de la firma de un consentimiento informado, las mujeres fueron encuestadas para la obtención de datos socio-demográficos y de estilo de vida. Adicionalmente, de cada mujer se obtuvo una biopsia cervical para diagnóstico histopatológico (casos) y una muestra de células exfoliadas (casos y controles) para posterior extracción de ADN y detección de papilomavirus (VPH) por reacción en cadena de la polimerasa (PCR). Un total de 98 casos y 109 controles, apareados por edad y procedencia, fueron reclutados para este estudio. Resultados: El estudio confirma la asociación entre VPH y el riesgo de neoplasia cervical (OR=19,0; IC95 por ciento=8,20-44,2). Los datos sugieren que la multiparidad (OR=4,1; IC95 por ciento=1,62-10,6) y la exposición a carcinógenos presentes en el humo de leña (OR=7,3; IC95 por ciento=3,00-19,4) son importantes co-factores de riesgo dada la presencia de VPH. Conclusiones: Estos resultados brindan información valiosa a las instituciones de salud pública para desarrollar mejores programas de promoción y prevención de neoplasia cervical.

Design and methods of the evaluation of an HPV-based cervical cancer screening strategy in Mexico: The Morelos HPV Study

OBJECTIVE: The purpose of this paper is to describe the design and methodology of the Morelos HPV Study. The main objective of this study is to examine the use of two different methods for obtaining HPV DNA specimens, self-collected vaginal and clinician-collected cervical, to detect pre-invasive cervical lesions and cancer. MATERIAL AND METHODS: This study was conducted within the regular population-based framework of the Mexican Institute of Social Security (IMSS) cervical cancer screening program in Morelos. A total of 7,868 women were recruited between May and October 1999 and are representative of the population of women attending cervical cancer screening services at the 23 IMSS clinics in the state of Morelos in 1999. Women were provided with a detailed description of the study before signing an informed consent form. Basic data were obtained from all participants using a standard IMSS registration form. During the initial recruitment visit, a randomly selected subsample of 1,069 participants were interviewed to collect additional information about cervical cancer risk factors, acceptability of the HPV and Pap tests, as well as patient costs. Before the pelvic exam, participants were asked to provide a self-collected vaginal specimen for HPV testing. All participants underwent a pelvic examination that involved collecting a cervical sample for the Pap smear and a clinician-collected HPV specimen. Data were evaluated from 7,732 women with complete information for the three tests. The 1,147 women who received at least one positive result (Pap, self- and/or clinician-HPV tests) were invited to return for a colposcopic examination. During colposcopy, biopsies were taken as appropriate, to histologically confirm a diagnosis of cervical intraepithelial neoplasia (CIN) 2/3 or invasive cancer. A total of 1,015 women attended colposcopy, and 101 women received a histologically-confirmed CIN 2/3 or cervical cancer diagnosis. CONCLUSIONS: The initial enrollment activities of the Morelos HPV study are the basis for a prevalent case-control study and a prospective cohort study that will investigate the natural history of HPV infections and determine if an HPV-based screening strategy is a safe and cost-effective alternative to Pap screening.

Aspectos epidemiológicos do câncer cervical / Epidemiological aspects of cervical cancer

Foi efetuada revisäo dos aspectos epidemiológicos do câncer cervical, um dos mais freqüentes em mulheres de países em desenvolvimento. No Brasil a incidência varia de 23,7/100.000, em Porto Alegre, a 83,2/100.000, em Recife. Nos Estados Unidos a incidência em 1978 foi de 6,8/100.0000 entre as mulheres brancas e de 14,7/100.000 entre as negras. Várias observaçöes sugerem a hipótese de que o câncer cervical esteja relacionado com algum aspecto da atividade sexual, possivelmente algum agente transmitido por via venérea. As evidências têm implicado o papilomavirus humano (HPV) como o principal agente etiológico deste câncer. Vários trabalhos foram analisados quanto à validade desta hipótese etiológica, mostrando que há uma relaçäo entre HPV e o câncer cervical. Foram analisados os fatores de risco mais conhecidos, tais como o comportamento sexual, o tabagismo e a contracepçäo, diante de várias possibilidades etiológicas existentes