Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: baseline findings from a cohort studyReportar como inadecuado

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BMC Public Health

, Volume 17, Supplement 3, pp 101–112

First Online: 04 July 2017


BackgroundPersistent high-risk human papillomavirus HR-HPV infection is associated with the development of anogenital cancers, particularly in men living with HIV MLWH. We describe the prevalence of anogenital HPV infection, abnormal anal cytology and anogenital warts AGWs in MLWH in Johannesburg, and explore whether HPV infection and receipt of antiretroviral treatment is associated with detection of abnormal anal cytology and AGWs.

MethodsWe enrolled a cohort of 304 sexually-active MLWH ≥18 years, who completed a questionnaire and physical examination. Genital swabs were collected from all men and intra-anal swabs from 250 82%. Swabs were tested for HPV DNA and genotypes, and anal smears graded using the Bethesda classification. Factors associated with anogenital disease were assessed by logistic regression models.

ResultsTwo thirds were receiving antiretroviral treatment, for a median 33 months IQR = 15–58 and 54% were HIV-virologically suppressed. Only 5% reported ever having sex with men. Among 283 genital swabs with valid results, 79% had any HPV, 52% had HR-HPV and 27% had >1 HR-HPV infection. By comparison, 39% of the 227 valid intra-anal swabs had detectable HPV, 25% had any HR-HPV and 7% >1 HR infection. While most anal smears were normal 51%, 20% had ASCUS and 29% were LSIL. No cases had HSIL or cancer. Infection with >1 HR type adjusted OR aOR = 2.39; 95%CI = 1.02–5.58 and alpha-9 types aOR = 3.98; 95%CI = 1.42–11.16 were associated with having abnormal cytology. Prevalence of AGWs was 12%. Infection with any LR type aOR = 41.28; 95%CI = 13.57–125.62, >1 LR type aOR = 4.14; 95%CI = 1.60–10.69, being <6 months on antiretroviral treatment aOR = 6.90; 95%CI = 1.63–29.20 and having a CD4+ count <200 cells-μL aOR = 5.48; 95%CI: 1.60–18.78 were associated with having AGWs.

ConclusionsIn this population, anogenital HR-HPV infection and associated low-grade disease is common, but severe anal dysplasia was not detected. Findings reinforce the need for HPV vaccination in men for preventing both AGWs and HR-HPV infection. Given the absence of anal HSILs, however, the findings do not support the use of anal screening programmes in this population.

KeywordsAnogenital infection Human papillomavirus Anogenital warts Anal cytology HIV Men South Africa AbbreviationsAGWsanogenital warts

AINanal intraepithelial neoplasia

ARTantiretroviral therapy

ASC-Hatypical squamous cells-high grade lesions cannot be ruled out

ASCUSatypical squamous cells of undetermined significance

HPVhuman papillomavirus


HRAHigh Resolution Anoscopy

HSILhigh-grade squamous intraepithelial lesion

IQRinterquartile range

LMICslow- and middle-income countries


LSILlow-grade squamous intraepithelial lesion

MLWHmen living with HIV

MSMmen who have sex with men

NHLSNational Health Laboratory Service

NILMnegative for intraepithelial malignancy

pHRpossible High Risk

PVLplasma viral load

SDstandard deviation

SSAsub-Saharan Africa

STIsexually transmitted infection

Electronic supplementary materialThe online version of this article doi:10.1186-s12889-017-4354-0 contains supplementary material, which is available to authorized users.

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Autor: Admire Chikandiwa - Lucy Chimoyi - Pedro T Pisa - Matthew F Chersich - Etienne E Muller - Pamela Michelow - Philippe May


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