Syndemic synergy of HPV and other sexually transmitted pathogens in the development of high-grade anal squamous intraepithelial lesions

Autor: W. Martin Kast, James Flexman, Michael Phillips, Dugald McCallum, Jenny McCloskey, Martyn A. French
Rok vydání: 2017
Předmět:
Male
Oncology
High-risk HPV
Anal Carcinoma
Human immunodeficiency virus (HIV)
Anal Canal
Uterine Cervical Neoplasms
Disease
medicine.disease_cause
Sexual and Gender Minorities
0302 clinical medicine
Syndemic
030212 general & internal medicine
Papillomaviridae
Chlamydia
Hybrid capture
Age Factors
virus diseases
Middle Aged
Anus Neoplasms
3. Good health
Infectious Diseases
030220 oncology & carcinogenesis
Female
Squamous Intraepithelial Lesions of the Cervix
Carcinoma in Situ
Papanicolaou Test
Adult
medicine.medical_specialty
Adolescent
HSIL
Sexual Behavior
Sexually Transmitted Diseases
Article
lcsh:Infectious and parasitic diseases
Young Adult
03 medical and health sciences
Sex Factors
Virology
Internal medicine
medicine
Humans
Anal cancer
lcsh:RC109-216
Anal warts
In patient
Homosexuality
Male
Aged
Gynecology
business.industry
Papillomavirus Infections
HIV
Uterine Cervical Dysplasia
medicine.disease
business
Sexually transmissible infections
Zdroj: Papillomavirus Research
Papillomavirus Research, Vol 4, Iss, Pp 90-98 (2017)
ISSN: 2405-8521
DOI: 10.1016/j.pvr.2017.10.004
Popis: Background Anal intraepithelial neoplasia is associated with high-risk human papillomavirus (hrHPV) as a precursor to anal cancer. However, factors other than hrHPV are likely to be involved and further study of cofactors is required because of the possibility of syndemic interactions. Methods Three hundred and fourteen patients underwent 457 operations. Histopathology and hrHPV testing using the Digene Hybrid Capture 2 (HC 2) method were performed. Demographic factors and sexually transmissible infections (STIs) were recorded. Results Results showed that hrHPV alone was associated with HSIL (OR = 4.65, p < 0.001). None of the other STIs were alone associated with HSIL but amplification of risk was found when hrHPV infection occurred with HIV (OR = 11.1); syphilis (OR = 5.58); HSV 2 (OR = 7.85); gonorrhoea (OR = 6.45) and some other infections. Conclusions These results suggest that hrHPV is a sufficient cause of anal HSIL. Seropositivity for HIV, HSV 2, T. pallidum, HBV and HCV and a history of gonorrhoea or chlamydia exert a powerful amplifying factor increasing the risk of HSIL above the risk with hrHPV alone. Other co-factors which are associated with an increased risk of HSIL are increased age, male gender, MSM behaviour and self-reported history of more than 50 sexual partners. This pattern of disease in patients with warts is characteristic of a syndemic with potential serious increased risk of anal carcinoma.
Highlights • High-risk HPV is a necessary and sufficient cause of progression from LSIL to HSIL. • HIV, HSV 2, HBV and HCV are associated with an amplified risk of hrHPV induced HSIL. • Gonorrhoea, chlamydia, and syphilis are associated with increased odds HSIL. • HSIL shows syndemic interaction patterns with STIs and behavioural/social factors.
Databáze: OpenAIRE
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