Prevalence of anal HPV infection in solid-organ transplant patients prior to immunosuppression
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BACKGROUND Skin cancers are more common in organ transplant recipients than in the general population. OBJECTIVE The objective of this study was establish the historical link between organ transplantation, immunosuppression, and the development of skin cancer. METHODS The pertinent literature in cutaneous oncology and transplantation is reviewed. RESULTS There is a historical link between organ transplants, immunosuppression, and the subsequent development of skin cancers. CONCLUSIONS Organ transplant recipients have more skin cancer than those in the general population and this is temporally related to their degree of immunosuppression.
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Background. In the United States, anal cancer in men who have sex with men (MSM) is more common than cervical cancer in women. Human papillomavirus (HPV) is causally linked to the development of anal and cervical cancer. In women, cervical HPV infection peaks early and decreases after the age of 30. Little is known about the age-specific prevalence of anal HPV infection in human immunodeficiency virus (HIV)-negative MSM. Methods. We studied the prevalence and determinants of anal HPV infection in 1218 HIV-negative MSM, 18–89 years old, who were recruited from 4 US cities. We assessed anal HPV infection status by polymerase chain reaction. Results. HPV DNA was found in the anal canal of 57% of study participants. The prevalence of anal HPV infection did not change with age or geographic location. Anal HPV infection was independently associated with receptive anal intercourse (odds ratio [OR], 2.0; P < .0001) during the preceding 6 months and with >5 sex partners during the preceding 6 months (OR, 1.5; P < .0001). Conclusions. Urban, HIV-negative MSM have a stable, high prevalence of anal HPV infection across all age groups. These results differ substantially from the epidemiologic profile of cervical HPV infection in women. This may reflect differences between these populations with respect to the number of new sex partners after the age of 30 and may explain the high incidence of anal cancer in MSM.
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The success of organ transplantation owes much to improvements in the immunosuppressive regimens that prevent or suppress allograft rejection. Nevertheless, the potent immunosuppressive drugs that are now in general use increase susceptibility to infection and cancer and can also have adverse effects not directly related to immunosuppression.Conventional immunosuppressive agents affect not only immune cells but also other cells. Glucocorticoids, for example, can cause a myriad of side effects,1 but these harmful actions are often minimized by combining glucocorticoids with other immunosuppressive medications. In use since the early days of transplantation, small-molecule immunosuppressive drugs act by targeting DNA or proteins . . .
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Solid organ transplantation has revolutionised medical care by providing a definitive cure for a wide spectrum of end-stage medical conditions. This treatment, however, does not come without complications and poses the risks of rejection, life-threatening infection, malignancies and recurrent organ failure, with significant impacts on patient outcomes. One of the major challenges involved in optimising post-transplant outcomes is managing the immune system's response to the transplanted graft and preventing organ rejection. This is mainly accomplished through the use of immunosuppressant agents, which have become a mainstay of treatment for a majority of post-transplant patients. This article, the first of two parts, discusses the concept of immunosuppression and its importance in the care of patients who have received an organ transplant. It focuses on the pathophysiologic mechanisms involved in transplant rejection and discusses the pharmacologic aspects of immunosuppression and its implications for patient care.
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In US men, the incidence of anal cancer, the primary cause of which is human papillomavirus (HPV) infection, has increased almost 3-fold in 3 decades; however, little is known about the epidemiology of anal HPV infection, especially in heterosexual men. In 2 US cities, behavioral data and anal biological specimens were collected from 253 men who acknowledged having engaged in sexual intercourse with a woman during the preceding year. On the basis of DNA analysis, overall prevalence of anal HPV infection was found to be 24.8% in 222 men who acknowledged having had no prior sexual intercourse with men. Of the men with anal HPV infection, 33.3% had an oncogenic HPV type. Risk factors independently associated with anal HPV were lifetime number of female sex partners and frequency of sex with females during the preceding month. These results suggest that anal HPV infection may be common in heterosexual men.
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Background. Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. Methods. Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. Results. Low CD4 count (<350 cells/mm3) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28–10.40 and OR, 4.24; 95% CI, 1.16–15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43–5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. Conclusions. We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression.
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Human papillomavirus (HPV) is the most common sexually transmitted virus with approximately 80% of sexual active people getting infected at least once in their life. Some HPV types have carcinogenic potential and are therefore considered high-risk HPV types. This thesis reports on different aspects related to anal HPV infection and HPV-related disease in specific risk groups, being HIV-positive men who have sex with men and female sex workers. Incidence, prevalence, clearance, HPV antibody positivity and anal HPV viral load are studied for anal HPV infection. Also aspects of pre-stage anal cancer, called anal high-grade squamous intraepithelial lesions (HSIL) are studied in this thesis. These include the quality of screening for anal HSIL, risk factors and prediction of anal HSIL among HIV-positive men who have sex with men. Lastly, prevention of anal HPV infection and anal HPV-related diseases is discussed in studies on HPV vaccination intention among both men as well as female sex workers. In conclusion anal HPV infection and related disease is common and preventable, but hard to treat.
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Abstract Anal high-risk human papillomavirus (hr-HPV) infection is widely considered a cause of anal cancer. However, epidemiological data are quite limited in Japan. This study investigated anal HPV infections and cytological abnormalities among MSM with or without HIV infection. Anal swabs were obtained, and cytological results were examined. Hybrid capture-based methodology was used for hr-HPV genotyping. The exclusion criterion was a history of vaccination against HPV. 644 subjects participated, and the overall prevalence of hr-HPV was 59.7% (95% CI 54.7–62.3), HIV-infected had higher prevalence than HIV-uninfected (68.9% vs 40.6%) p < .001. Among hr-HPV-infected participants, 82.8% (312/377) were infected with at least one of 9 valent vaccine-covered hr-HPV genotypes. From regression analysis, detection of abnormal cytology correlated positively with HIV infection (OR 2.17 [95% CI 1.51–3.13]), number of hr-HPV genotypes infected (OR 1.83 [1.59–2.10]), history of STI (OR 1.58 [1.14–2.22]) and No. of lifetime sexual partners (OR 1.56 [1.10–2.21]), albeit multivariate analysis identified the number of detected hr-HPV genotypes (adjusted OR 1.78 [1.54–2.06]) as the independent risk factor for abnormal cytology. High rates of anal hr-HPV infection, especially 9-valent HPV vaccine-preventable hr-HPV were detected among our MSM participants in Japan. HPV vaccination should also be encouraged for MSM in Japan.
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