Human papillomavirus infection in anal intraepithelial lesions from HIV infected Cuban men

Abstract

Background:An association between HPV infection and progression to anal squamous intraepithelial lesions (ASIL)has been established, specifically in high-risk populations such as HIV-infected men. In this population, anal canceris one of the most common non-AIDS-defining malignancies.Methods:A cross-sectional study to detect anal lesions and HPV infection was performed. Anal mucosa sampleswere collected from 56 HIV-infected men from Cuba. The cytological diagnosis was done according to Bethesda2001 System. HPV DNA detection was determined by qPCR for six high-risk HPV types and end point PCR for low-riskHPV types (6 and 11). The end point PCR with nucleotide sequencing technique was achieved to detect othergenotypes of HPV not included in the qPCR in those samples negative for HPV- 6 and 11 or negative for the sixgenotypes identified in the qPCR.Results:Cytological diagnosis identified 53 of 56 (95%) men with abnormal anal cytology. Among those, 26% (14/53)had atypical squamous cells of undetermined significance (ASC-US), 4% (2/53) had atypical squamous cells ofundetermined significance cannot exclude high-grade lesions (ASC-H), 64% (34/53) had low-grade squamousintraepithelial lesions (LSIL), and 6% (3/53) had high-grade squamous intraepithelial lesions (HSIL). HPV DNAwas detected in 89% (50/56) of men and 79% had at least one of the high-risk HPV types. HPV- 16 was themost common genotype (52%), while HPV-18 was the most frequently detected genotype in men with HSIL.We found statistically significant differences in the HPV viral loads with respect to the cytology results (p=0.0006) and that the practice of receptive anal sex was a risk factor for anal HPV infection (p=0.032).Conclusion:This study shows a high prevalence of ASIL and high-risk HPV infections in the study group andis the first study showing the distribution of HPV genotypes in HIV infected Cuban men with abnormal analcytology. This information may be of importance for local decision makers to improve prevention strategies,including the introduction of HPV vaccine in Cuba.