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EDIRORIAL
Year : 2022  |  Volume : 12  |  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 Publication30-Aug-2022

Correspondence Address:
Kusum Verma
Department of Pathology, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi 110 060
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmrp.cmrp_86_22

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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

How to cite this URL:
Verma K. Human high risk papillomavirus infections and neoplasias in human immunodeficiency patients. Curr Med Res Pract [serial online] 2022 [cited 2022 Sep 27];12:143-4. Available from: http://www.cmrpjournal.org/text.asp?2022/12/4/143/355216

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. [1] 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. [2] 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. [3],[4],[5] HIV positive women with severe immunosuppression were five times more likely than HIV negative to have lower genital tract neoplasia. [3]

Wright et al, [4] 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. [5] When the CD4 cell count was less than 200 cells/΅L, HIV positive women had HPV infections more frequently. [5]

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. [6]

Another smaller study from eastern parts of India involved 126 HIV positive males.[7] 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.

[8] in this issue of journal is quite similar to one reported by Gautam et al. [7] 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. [8] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
zur Hausen H. Papillomaviruses and cancer: From basic studies to clinical application. Nat Rev Cancer. 2002;2:342-50.   Back to cited text no. 1
    
2.
Verma K. HPV as a successful modality for screening of cervical cancer. In "preventive oncology". Eds. Ganguly I, Chavan N, Taneja T. FOGSI Focus 2014: 59-63.   Back to cited text no. 2
    
3.
Wright TC Jr, Ellerbrock TV, Chiasson MA, Van Devanter N, Sun XW. Cervical intraepithelial neoplasia in women infected with human immunodeficiency virus: Prevalence, risk factors, and validity of Papanicolaou smears. New York Cervical Disease Study. Obstet Gynecol. 1994;84:591-7.   Back to cited text no. 3
    
4.
Ferenczy A, Coutlée F, Franco E, Hankins C. Human papillomavirus and HIV coinfection and the risk of neoplasias of the lower genital tract: A review of recent developments. CMAJ. 2003;169:431-4.   Back to cited text no. 4
    
5.
Cambrea SC, Aschie M, Resul G, Mitroi AF, Chisoi A, Nicolau AA, et al. HPV and HIV Coinfection in Women from a Southeast Region of Romania-PICOPIV Study. Medicina. 2022; 58:760.   Back to cited text no. 5
    
6.
Wei F, Gaisa MM, D'Souza G, Xia N, Giuliano AR, Hawes SE, et al. Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29,900 men according to HIV status, sexuality, and age: A collaborative pooled analysis of 64 studies. Lancet HIV. 2021;8:e531-e543.   Back to cited text no. 6
    
7.
Gautam A, Chakravarty J, Singh VK, Ghosh A, Chauhan SB, Rai M, et al. Human papillomavirus infection & anal cytological abnormalities in HIV-positive men in eastern India. BMC Infect Dis. 2018;18:692.   Back to cited text no. 7
    
8.
Kakar A, Bakshi P, Tripathi S, Gogia A. Anal cytological abnormalities in human immunodeficiency virus-infected men and prevalence of high-risk human papillomavirus co-infection. Curr Med Res Pract 2022;12:152-6.  Back to cited text no. 8
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