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allied
academies
International Conference on
FAMILY MEDICINE AND FAMILY PHYSICIANS
October 16-17, 2017 | Toronto, Canada
Arch Gen Intern Med 2017 | Volume 1 Issue 3
Background:
Persistent high-risk human papillomavirus
(HR-HPV) infection is associated with the development
of anogenital cancers, particularly in men living with HIV
(MLWH). We describe the prevalence of anogenital HPV
infection, abnormal anal cytology and anogenital warts
(AGWs) in MLWH in Johannesburg, and explore whether HPV
infection and receipt of antiretroviral treatment is associated
with detection of abnormal anal cytology and AGWs.
Methods:
We enrolled a cohort of 304 sexually-active
MLWH≥18 years, who completed a questionnaire and
physical examination. Genital swabs were collected from
all men and intra-anal swabs from 250 (82%). Swabs were
tested for HPV DNA and genotypes, and anal smears graded
using the Bethesda classification. Factors associated with
anogenital disease were assessed by logistic regression
models.
Results:
Two-thirds were receiving antiretroviral treatment,
for a median 33 months (IQR=15-58) and 54% were HIV-
virologically suppressed. Only 5% reported ever having sex
with men. Among 283 genital swabs with valid results, 79%
had any HPV, 52% had HR-HPV and 27% had >1 HR-HPV
infection. By comparison, 39% of the 227 valid intra-anal
swabs had detectable HPV, 25% had any HR-HPV and 7%>1
HR infection. While most anal smears were normal (51%),
20% had ASCUS and 29% were LSIL. No cases had HSIL or
cancer. Infection with >1 HR type (adjusted OR [aOR]=2.39;
95%CI=1.02-5.58) and alpha-9 types (aOR=3.98; 95%CI=1.42-
11.16) were associated with having abnormal cytology.
Prevalence of AGWs was 12%. Infection with any LR type
(aOR=41.28; 95%CI=13.57-125.62), >1 LR type (aOR=4.14;
95%CI=1.60-10.69), being <6 months on antiretroviral
treatment (aOR=6.90; 95%CI=1.63-29.20) and having a CD4+
count <200 cells/μL (aOR=5.48; 95%CI: 1.60-18.78) were
associated with having AGWs.
Conclusions:
In this population, anogenital HR-HPV infection
and associated low-grade disease is common, but severe
anal dysplasia was not detected. Findings reinforce the need
for HPV vaccination in men for preventing both AGWs and
HR-HPV infection. Given the absence of anal HSILs, however,
the findings do not support the use of anal screening
programmes in this population.
e:
achikandiwa@wrhi.ac.zaPrevalence of anogenital Hpv infection, related disease and risk factors among Hiv-infected men in inner-
city Johannesburg, South Africa: Baseline findings from a cohort study
Chikandiwa Admire¹, Chimoyi Lucy¹, Pisa Pedro T¹, Chersich Matthe F¹,Muller Etienne E³, Michelow Pamela⁴, 5, Mayaud Philippe ¹, ² and Delany-Moretlwe
Sinead¹
¹Wits RHI, Johannesburg, South Africa
2London School of Hygiene and Tropical Medicine, UK
³National Institute for Communicable Diseases, South Africa
4
University of the Witwatersrand, South Africa
5
National Health laboratory Services, South Africa