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Open Access Highly Accessed Research article

Anal and oral human papillomavirus (HPV) infection in HIV-infected subjects in northern Italy: a longitudinal cohort study among men who have sex with men

Saverio G Parisi1*, Mario Cruciani2, Renzo Scaggiante3, Caterina Boldrin1, Samantha Andreis1, Federico Dal Bello1, Silvana Pagni1, Andrea Barelli4, Andrea Sattin3, Carlo Mengoli1 and Giorgio Palù1

Author Affiliations

1 Department of Histology, Microbiology and Medical Biotechnology, Padua University, Via Gabelli 63, 35100 Padova, Italy

2 Center of Preventive Medicine and HIV Outpatient Clinic, ULSS 20, via Germania 20, 37135 Verona

3 Infectious Diseases Unit, Padova Hospital, via Ospedale 1, 35100 Padova

4 Infectious Diseases Unit, Venezia Mestre Hospital, via Paccagnella 11, 30100 Venezia Mestre

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BMC Infectious Diseases 2011, 11:150  doi:10.1186/1471-2334-11-150

Published: 25 May 2011

Abstract

Background

A study including 166 subjects was performed to investigate the frequency and persistence over a 6-month interval of concurrent oral and anal Human Papillomavirus (HPV) infections in Human Immunodeficiency Virus (HIV)-infected men who have sex with men (MSM).

Methods

Patients with no previously documented HPV-related anogenital lesion/disease were recruited to participate in a longitudinal study. Polymerase chain reaction (PCR) was performed to detect HPV from oral and anal swabs and to detect Human Herpes Virus 8 (HHV-8) DNA in saliva on 2 separate specimen series, one collected at baseline and the other collected 6 months later. A multivariate logistic analysis was performed using anal HPV infection as the dependent variable versus a set of covariates: age, HIV plasma viral load, CD4+ count, hepatitis B virus (HBV) serology, hepatitis C virus (HCV) serology, syphilis serology and HHV-8 viral shedding. A stepwise elimination of covariates with a p-value > 0.1 was performed.

Results

The overall prevalence of HPV did not vary significantly between the baseline and the follow-up, either in the oral (20.1 and 21.3%, respectively) or the anal specimens (88.6 and 86.3%). The prevalence of high-risk (HR) genotypes among the HPV-positive specimens was similar in the oral and anal infections (mean values 24.3% and 20.9%). Among 68 patients with either a HR, low-risk (LR) or undetermined genotype at baseline, 75% had persistent HPV and the persistence rates were 71.4% in HR infections and 76.7% in LR infections. There was a lack of genotype concordance between oral and anal HPV samples. The prevalence of HR HPV in anus appeared to be higher in the younger patients, peaking (> 25%) in the 43-50 years age group. A decrease of the high level of anal prevalence of all genotypes of HPV in the patients > 50 years was evident. HHV-8 oral shedding was positively related to HPV anal infection (p = 0.0046). A significant correlation was found between the persistence of HHV-8 shedding and HIV viral load by logistic bivariate analysis (Odds Ratio of HHV-8 persistence for 1-log increase of HIV viral load = 1.725 ± 0.397, p = 0.018).

Conclusions

A high prevalence of HPV infection was found in our cohort of HIV-infected MSM, with a negative correlation between anal HPV infection and CD4 cell count.