ART is key to clearing oncogenic HPV genotypes (HR-HPV) in anal mucosa of HIV-positive MSM

• Published in: PloS one 2019-10, Vol.14 (10), p.e0224183-e0224183
• Main Authors: Hidalgo-Tenorio, Carmen, Gil-Anguita, Concepción, López Ruz, Miguel Angel, Omar, Mohamed, López-Hidalgo, Javier, Pasquau, Juan
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS (Disease); Anal Canal - drug effects; Anal Canal - virology; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Anus Neoplasms - etiology; Anus Neoplasms - prevention & control; Biology and life sciences; Cancer; Carcinoma; Carcinoma, Squamous Cell - etiology; Carcinoma, Squamous Cell - prevention & control; CD4 antigen; CD8 antigen; Chronic infection; Complications and side effects; Condoms; Cytology; Demographic aspects; Dosage and administration; Drug therapy; Genotypes; Health aspects; Health risks; Highly active antiretroviral therapy; HIV; HIV - drug effects; HIV infections; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - virology; HIV patients; Homosexuality, Male - statistics & numerical data; Human immunodeficiency virus; Human papillomavirus; Humans; Immunization; Incidence; Infection; Longitudinal Studies; Male; Medical diagnosis; Medical research; Medicine and Health Sciences; Middle Aged; MSM (Men who have sex with men); Mucosa; Multivariate analysis; Papillomaviridae - classification; Papillomaviridae - drug effects; Papillomaviridae - genetics; Papillomavirus infections; Papillomavirus Infections - etiology; Papillomavirus Infections - prevention & control; Patient outcomes; Prospective Studies; Risk factors; Sexual behavior; Sexually transmitted diseases; Squamous cell carcinoma; STD; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0224183

Anal squamous cell carcinoma (ASCC) is one of the most frequent non-AIDS-defining neoplasias in HIV patients, mainly in MSM, and it has been associated with chronic infection with high-risk human papilloma virus (HR-HPV). Our main objective was to determine HR-HPV clearance and acquisition rates and related factors and their relationship with the incidence of HSILs and ASCC in anal mucosa of HIV+ MSM. The study included consecutive HIV-infected MSM between May 2010 and December 2018. Data were gathered at baseline and annually on their sexual behavior, CD4 and CD8 levels, plasma HIV viral load, and results of anal cytology, HPV PCR, and high-resolution anoscopy. Out of the 405 patients studied, 34.9% of patients cleared oncogenic genotypes (IQR: 37-69) within 49 months, and 42.9% acquired new genotypes within 36 months (IQR:12-60). In multivariate analysis, clearance was only significantly influenced by the duration of antiretroviral therapy (ART) (OR: 1.016, 95% CI 1.003-1.030). The incidence of HSILs was 30.86/1,000 patient-years and that of ASCC was 81.22/100,000 patient-years; these incidences were not influenced by the acquisition (acquired: 14.9% vs. non-acquired: 10.4%; p = 0.238) or clearance (cleared 11.4% vs. non-cleared: 13.2%; p = 0.662) rates of these viruses. The duration of ART appears to positively affect oncogenic genotype clearance in the anal mucosa of HIV+ MSM, although this clearance does not affect the incidence of HSILs or ASCC. The reduction in HSIL+ rate observed in our patients may be attributable to the bundle of measures adopted at our center.