Cytology as a screening tool for anal squamous intraepithelial lesion for HIV positive men: 10-year experience in an inner city hospital

Introduction and Background: Both human papillomavirus (HPV) and the human immunodeficiency virus (HIV) are sexually transmitted. High-risk (HR) HPV types are a causal factor in cervical cancer. Persistent HPV infection in this subset of immunocompromised women results in faster disease progression. The study determined the prevalence of HPV genotypes in cervicovaginal secretions of HIV seropositive women and the correlation with CD4 counts and cytology.Method: One hundred, non-pregnant, HIV-positive women of 18 years of age and above were enrolled in this cross-sectional study following approval by the institutional ethical committee. A written consent, questionnaire, followed by sample collection including a Papanicolaou (Pap) smear for cytology was undertaken. Cervicovaginal secretion samples were collected in the Digene® specimen transport medium (STM) (Qiagen Gaithersburg Inc., MD, USA). HPV genotyping was carried out with PCR amplification of a 65-base pair (bp) fragment in the L1 region of the HPV genome using the short PCR fragment (SPF10) primers followed by reverse hybridization by line probe assay (LPA) using the INNOLiPA HPV Genotyping Extra kit (Fujirebio, Belgium). Quantitation of HPV-16 and−18 viral loads (VLs) was done by real-time PCR. Results of Pap smear cytology were correlated with CD4 counts and HPV-16 and−18 VLs.Results: Mean age of the subjects was 34.9 years ± 7.2 years (median 33.0 years, range 24–60 years). HPV was detected in 62 of 93 (66.6%) samples. Twenty (32.25%) of these 62 samples harbored a single HPV genotype. Multiple genotypes (more than two) were detected in 38 (61.3%) samples. HPV-16 was the commonest genotype detected in 26 (27.9%) of all samples and 41.9% of HPV positive samples. Pap smear cytology was reported for 93 women included in the study. Women who had normal cytology were reported as negative for intraepithelial malignancy or lesion (NILM; n = 62; 71.36%), two women had a high-grade squamous intraepithelial lesion (HSIL), low-grade squamous intraepithelial lesion (LSIL; n = 11), atypical squamous cells of undetermined significance (ASCUS; n = 12). Those smears with inadequate material were reported as scant (n = 6). The median CD4 count was 363/cu.mm (range 39–787) in HPV-positive women compared to 423/cu.mm (range 141–996) in those HPV-negative women. Quantitation of HPV-16 and−18 VL was done in duplicate for samples positive by PCR reverse hybridization (INNOLiPA). Of these 20 samples (65%), 12 samples were positive by real-time PCR. The normalized HPV-16 VL ranged between 18 and 240,000 copies/cell. The normalized HPV-18 VL in cervical samples ranged between ~24 and 60,000 copies/cell.Conclusion: HIV-positive women may be infected with multiple genotypes other than HPV-16 and−18. This may have implications on the vaccines available currently which target few specific genotypes only. Studies are required to determine the predictive role of HR HPV genotypes, in significant copy numbers especially in HIV seropositive women. It would be clinically relevant if the HPV VLs, cervical cytology, and CD4 counts are considered into cervical cancer screening programs for triage and follow-up of these women.

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NARROW-BAND IMAGING PREDICTS THE HISTOLOGY OF ANAL SQUAMOUS INTRAEPITHELIAL LESION AND SUPERFICIALLY INVASIVE SQUAMOUS CELL CARCINOMA WITH HIGH ACCURACY

10.1055/s-0039-1681548 ◽

2019 ◽

Author(s):

G Gizzi ◽

V Villani ◽

L Frazzoni ◽

G Tamanini ◽

M La Marca ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Narrow Band ◽

Narrow Band Imaging ◽

High Accuracy ◽

Invasive Squamous Cell Carcinoma ◽

Squamous Intraepithelial Lesion ◽

Anal Squamous Intraepithelial Lesion ◽

Intraepithelial Lesion

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Performance of OncoE6TMCervical Test in detecting cervical precancer lesions in HIV-positive women attending an HIV clinic in Bujumbura, Burundi: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-029088 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029088

Author(s):

Zacharie Ndizeye ◽

Sonia Menon ◽

Jean-Pierre Van Geertruyden ◽

Catherine Sauvaget ◽

Y Jacquemyn ◽

...

Keyword(s):

Low Income ◽

Cross Sectional Study ◽

Hiv Positive ◽

Low Grade ◽

Sectional Study ◽

Squamous Intraepithelial Lesion ◽

Cross Sectional ◽

Predictive Values ◽

Hiv Positive Women ◽

Intraepithelial Lesion

ObjectiveNew rapid and low-cost molecular tests for cervical cancer screening, such as the OncoE6 Cervical Test, are emerging and could be alternatives for low-income and middle-income countries. To this end, we evaluated the clinical performance of the OncoE6 Cervical Test in detecting cervical intraepithelial neoplasia (CIN) among HIV-infected women in Bujumbura, Burundi.MethodsFrom June to December 2017, a cross-sectional study was conducted in 680 HIV-positive women at the University Hospital. Women aged 25–65 years who declared having had vaginal intercourse were consecutively recruited, and cervical specimens for OncoE6, liquid-based cytology and human papillomavirus (HPV) genotyping were obtained and visual inspection with acetic acid performed. Thereafter, participants underwent a colposcopic examination. The sensitivity, specificity, and positive and negative predictive values of the different tests were calculated with reference to ‘colposcopic-histological’ diagnoses, and areas under the receiver operating curves of OncoE6 and cytology tests were compared.ResultsThe prevalence of CIN was 4.9%, and OncoE6 positivity was 3.1%. OncoE6 sensitivity varied from poor to low with increasing disease severity (42.1%, 95% CI 19.9% to 64.3% at CIN2+ threshold; and 58.3%, 95% CI 30.4% to 86.2% at CIN3+ threshold). OncoE6 had the highest specificity compared with all other tests used together. The performance of the OncoE6 test was significantly lower compared with cytology at atypical squamous cell of undetermined significance (ASCUS+) cut-off (AUC=0.68 vs 0.85, p=0.03) and low-grade squamous intraepithelial lesion (LSIL+) cut-off (AUC=0.68 vs 0.83, p=0.04) for CIN2+ diagnoses. However, the performance of the OncoE6 test was similar to that of cytology at high-grade squamous intraepithelial lesion (HSIL+) cut-off (AUC=0.68 vs 0.76; p=0.30) for CIN2+ diagnoses and was also similar to that of cytology at all cut-offs (ASCUS+, LSIL+ and HSIL+) for CIN3+ diagnoses (p1=0.76, p2=0.95 and p3=0.50, respectively).ConclusionThe current OncoE6 test proved to be a point-of-care test. However, given its poor performance for CIN2+ diagnoses, we do not recommend it for primary screening. We recommend to enrich it with more oncogenic HPV types, which may improve the performance of the test akin to that of cytology.

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Human Papillomavirus Infections in Cervical Samples From HIV-Positive Women: Evaluation of the Presence of the Nonavalent HPV Genotypes and Genetic Diversity

Frontiers in Microbiology ◽

10.3389/fmicb.2020.603657 ◽

2020 ◽

Vol 11 ◽

Author(s):

Catia Sias ◽

Valerio Guarrasi ◽

Claudia Minosse ◽

Daniele Lapa ◽

Franca Del Nonno ◽

...

Keyword(s):

Human Papillomavirus ◽

Screening Program ◽

Prediction Method ◽

Hiv Positive ◽

Low Grade ◽

Squamous Intraepithelial Lesion ◽

Hpv Dna ◽

Hiv Positive Women ◽

Intraepithelial Lesion ◽

Hpv Types

Non-nonavalent vaccine (9v) Human papillomavirus (HPV) types have been shown to have high prevalence among HIV-positive women. Here, 1444 cervical samples were tested for HPV DNA positivity. Co-infections of the 9v HPV types with other HPV types were evaluated. The HPV81 L1 and L2 genes were used to investigate the genetic variability of antigenic epitopes. HPV-positive samples were genotyped using the HPVCLART2 assay. The L1 and L2 protein sequences were analyzed using a self-optimized prediction method to predict their secondary structure. Co-occurrence probabilities of the 9v HPV types were calculated. Non9v types represented 49% of the HPV infections; 31.2% of the non9v HPV types were among the low-grade squamous intraepithelial lesion samples, and 27.3% among the high-grade squamous intraepithelial lesion samples, and several genotypes were low risk. The co-occurrence of 9v HPV types with the other genotypes was not correlated with the filogenetic distance. HPV81 showed an amino-acid substitution within the BC loop (N75Q) and the FGb loop (T315N). In the L2 protein, all of the mutations were located outside antigenic sites. The weak cross-protection of the 9v types suggests the relevance of a sustainable and effective screening program, which should be implemented by HPV DNA testing that does not include only high-risk types.

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Cervical Cancer screening in a tertiary care centre by Pap smear and its clinical correlation

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v2i3.26111 ◽

2019 ◽

Vol 2 (3) ◽

pp. 154-158 ◽

Cited By ~ 1

Author(s):

Gir Dhari Sharma ◽

Rajesh Adhikari ◽

Shyam Sundar Parajuly ◽

Kalpana Gautam Adhikari

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Screening Tool ◽

Precancerous Lesion ◽

Early Marriage ◽

Low Grade ◽

Major Public Health Problem ◽

Squamous Intraepithelial Lesion ◽

Carcinoma Cervix ◽

Intraepithelial Lesion

Introduction: Cervical cancer is one of the common cancers in women and is a major public health problem all over the world. It has significant contribution to high mortality and morbidity. Preinvasive lesions spontaneously regress to normal, remain stable for a long time or progress to higher degree of dysplasia followed by carcinoma cervix. Materials and Method This was a hospital based retrospective study where 456 patients’ records were reviewed. Pap smear was used as the screening tool for the detection of precancerous lesion among the women visiting Western Regional Hospital (WRH), Department of obstetrics and gynecology. Results: Among 456 patients screened, most of them were in the age group of 30-39 years (42.8%) and were of parity 3 (42.8%). Most of them had no risk factors for carcinoma cervix (54.4%). Early marriage accounted for the highest risk of developing precancerous lesion (32.7%). There were no carcinoma detected by Pap smear. The test was negative in 68.9%, Low-grade Squamous Intraepithelial Lesion (LSIL) was detected in 5.9% and 2.9% had High-grade Squamous Intraepithelial Lesion (HSIL). Pap smear was sent for screening purpose in asymptomatic women (37.1%) and among the symptomatic patients vaginal discharge was the most common indication of pap test (34.6%). Conclusion: A Pap smear is reliable, simple, non-invasive, cost effective, and easy screening tool for detection of precancerous lesions in a woman.

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Pulmonary Fungal Involvement in HIV-positive patients in an inner city hospital in New York

The Internet Journal of Pulmonary Medicine ◽

10.5580/14cb ◽

2007 ◽

Vol 7 (2) ◽

Keyword(s):

New York ◽

Inner City ◽

Hiv Positive ◽

City Hospital

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HPV IMMUNOHISTOCHEMICAL TESTING AND CERVICAL DYSPLASIA

Medicine and Pharmacy Reports ◽

10.15386/cjmed-653 ◽

2016 ◽

Vol 89 (2) ◽

pp. 236-240

Author(s):

Daniel Mureşan ◽

Ioana Cristina Rotar ◽

Silvana Apostol ◽

Georgiana Coroiu ◽

Florin Stamatian

Keyword(s):

High Risk ◽

Human Papilloma Virus ◽

Immunohistochemical Staining ◽

Screening Tool ◽

Cervical Dysplasia ◽

High Grade ◽

Hpv Testing ◽

Squamous Intraepithelial Lesion ◽

Papilloma Virus ◽

Intraepithelial Lesion

Background and aim. HPV (Human Papilloma Virus) infection represents a necessary condition for cervical carcinogenesis. The purpose of this study was to evaluate the efficiency of HPV testing using an immunohistochemical staining kit with implications upon both diagnosis and treatment of cervical intraepithelial neoplasia (CIN).Methods. Seventy-nine patients and eighty-six controls were enrolled in the study. Each patient had completed a physical examination, gynecological examination with cervical sampling using a liquid-based cytology system and also colposcopy. The cervical samples were analyzed according to Bethesda terminology and HPV-HR immunohistochemical staining was performed. In all the patients with high-grade lesion a surgical excision procedure was performed followed by pathological examination of the specimen. The collected data were analyzed using statistical software.Results. The colposcopic examination has detected acetowhite modifications of the cervical epithelium in 47% of patients with ASC-US (Atypical squamous cells of undetermined significance) in 71% of patients with LSIL (Low grade squamous intraepithelial lesion) and in 100% of patients with HSIL ( High grade squamous intraepithelial lesion). The biopsy confirmed the diagnosis of LSIL in 27% of biopsy specimens in patients with ASC-US and in 79.99% of patients with LSIL respectively. In all patients with HSIL the diagnosis was CIN II or higher. The percentage of HPV-HR (Human Papilloma Virus – High Risk) positivity porportionaly increased with the severity of cytological diagnosis: 30% in ASC-US, 42.86% in LSIL and 75% in HSIL patients. The sensitivity of detection of HPV-HR was 50% with CI 95% [17.45;82.55] for ASC-US, 77.77% with CI 95% [51.91;92.62] for LSIL and 81.81% with CI 95% [58.99;94.00] for HSIL.Conclusion. HPV testing can be an important screening tool for cervical dysplasia. The HPV testing targeting high risk types is indicated for ASC-US and LSIL triage. The present work sustains the idea of introducing HPV testing as a primary screening tool for cervical cancer.

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S1980 Resolution of High-Grade Anal Squamous Intraepithelial Lesion With Antibiotics Proposes a New Role for Syphilitic Infection in Potentiation of HPV-Associated ASCC

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000781452.92695.31 ◽

2021 ◽

Vol 116 (1) ◽

pp. S866-S866

Author(s):

Lea M. Sedghi ◽

Jennifer S. Do ◽

Kenji Yoshida ◽

Carolyn Cafro ◽

Yvonne L. Kapila ◽

...

Keyword(s):

High Grade ◽

Squamous Intraepithelial Lesion ◽

Anal Squamous Intraepithelial Lesion ◽

Intraepithelial Lesion

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Perianal squamous cell carcinoma with high-grade anal intraepithelial neoplasia in an HIV-positive patient using highly active antiretroviral therapy: case report

Sao Paulo Medical Journal ◽

10.1590/s1516-31802007000500009 ◽

2007 ◽

Vol 125 (5) ◽

pp. 292-294 ◽

Cited By ~ 2

Author(s):

Sergio Carlos Nahas ◽

Caio Sergio Rizkallah Nahas ◽

Edesio Vieira da Silva Filho ◽

Jose Eduardo Levi ◽

Fabio Cesar Atui ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Case Report ◽

Anal Canal ◽

Squamous Cell ◽

Highly Active Antiretroviral Therapy ◽

Hiv Positive ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Highly Active ◽

Intraepithelial Lesion

CONTEXT: Highly active antiretroviral therapy (HAART) has turned human immunodeficiency virus (HIV) infection into a chronic condition, and this has led to increased incidence of anal dysplasia among HIV-positive patients. Routine anal evaluation including the anal canal and perianal area is recommended for this population, especially for patients infected by oncogenic human papillomavirus (HPV) types. CASE REPORT: A 54-year-old homosexual HIV-positive man presented with a six-year history of recurrent perianal and anal warts. He had previously undergone incomplete surgical excision and fulguration in another institution on two occasions. He had been using HAART over the past two years. He presented some condylomatous spreading lesions occupying part of the anal canal and the perianal skin, and also a well-demarcated slightly painful perianal plaque of dimensions 1.0 x 1.0 cm. Both anal canal Pap smears and biopsies guided by high-resolution anoscopy revealed high-grade squamous intraepithelial lesion. Biopsies of the border of the perianal plaque also revealed high-grade squamous intraepithelial lesion. HPV DNA testing of the anus detected the presence of HPV-16 type. The patient underwent local full-thickness excision of the lesion. Histological analysis on the excised tissue revealed high-grade squamous intraepithelial lesion with one focus of microinvasive squamous cell cancer measuring 1 mm. No lymph vessel or perineural invasion was detected. The patient showed pathological evidence of recurrent anal and perianal high-grade squamous intraepithelial lesions at the sixth-month follow-up and required further ablation of those lesions. However no invasive squamous cell carcinoma recurrence has been detected so far.

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