|Year : 2022 | Volume
| Issue : 4 | Page : 143-144
Human high risk papillomavirus infections and neoplasias in human immunodeficiency patients
Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
|Date of Web Publication||30-Aug-2022|
Department of Pathology, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi – 110 060
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Verma K. Human high risk papillomavirus infections and neoplasias in human immunodeficiency patients. Curr Med Res Pract 2022;12:143-4
Since the publication of landmark paper by zur Hausen, infections by high risk papillomavirus (HPV) in pathogenesis of preneoplastic and neoplastic lesions of uterine cervix has assumed an important role.  Detection of high risk HPV is used both as screening tool as well as planning treatment strategies in female population. Fourteen high risk HPV types have been identified, of which type 16 and 18 account for almost 70% of cases.  Usually HPV infections are self-limiting and clear by themselves from the body. In small percentage of cases, HPV may persist and this leads to development of preneoplastic and neoplastic lesions of uterine cervix.
Persistence of HPV infection is seen in many more immunocompromised individuals as compared to immunocompetent persons. This is borne out by large number of studies from different parts of the world where they have demonstrated a high incidence of preneoplastic and neoplastic lesions when HPV infection occurs in HIV positive women. ,, HIV positive women with severe immunosuppression were five times more likely than HIV negative to have lower genital tract neoplasia. 
Wright et al,  compared 400 HIV positive females with 307 HIV negative females and reported high risk of HPV related neoplasms of vulva and Anus in HIV positive females. Similar data was published from Romania.  When the CD4 cell count was less than 200 cells/΅L, HIV positive women had HPV infections more frequently. 
Over the years, high risk HPV infection has also been linked to neoplasms of female lower genital tract, Anal canal and oropharynx. In males, HPV is also linked to penile cancers.
In present day, Anal smears cytology in HIV positive patients is being recommended and supported by world literature to determine prevalence of HPV infection in anal smears from men. A large analysis was done by systematic review of 93 eligible studies involving 29,900 men. They further divided
men by sexual behaviour into men having sex with women (MSW) and men having sex with men (MSM) and HIV status into HIV positive and HIV negative. High risk HPV infections were seen in 6.9%, 26.9%; 41.2% and 74.3% in HIV negative MSW, HIV positive MSW, HIV negative MSM and HIV positive MSM groups. Commonest HPV type was 16. 
Another smaller study from eastern parts of India involved 126 HIV positive males. Anal Pap smear More Details and HPV-DNA testing was done. Most prevalent HPV type was 16 and cytological abnormalities were reported in 60 of 95 (63.15%) males where anal smears were available. The present study by Kakar et al.
 in this issue of journal is quite similar to one reported by Gautam et al.  High risk HPV infection was seen in 23/56 (41.07%) HIV positive males. No further genotyping was done as the authors had used hybrid capture II system. Low grade cytological abnormalities were in 28.57% of males.
Figures reported by Kakar et al.  are similar to the study from eastern India. The lessons learnt from all the published data point to introducing Anal smears cytology for all HIV positive males and especially those with homosexual behaviour and low CD4 cell counts. This would help in picking up preneoplastic cellular abnormalities and institution of treatment at an early stage. HPV vaccination of girls is now part of national vaccination programmes in many countries. HPV vaccination of boys would be of benefit in preventing Anal HPV infections. More data needs to be generated regarding usefulness of HPV vaccination in boys.
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Conflicts of interest
There are no conflicts of interest.
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