Prevalence of low (LSIL) and high (HSIL) grade squamous intraepithelial lesions with oncogenic-HPVs (Human Papilloma Virus) was studied in successive HIV (Human Immunodeficiency Virus) + patients under anti-retroviral treatment.This was done in anal and/or cervical Pap smears with rapid PCR technique detection of oncogenic-HPVs types.
Anal and/or cervical cytologies (Ilsa technique) were obtained under colposcopy and/or anoscopy in 238 subjects recruited during 6 months. Bethesda classification was associated with Rapid PCR (Cepheid) to detect HPV16, both HPVs18 /45, P3 (HPV31,35,33,52,58), P4 (HPV51,59), P5 (HPV39,68,56,66).
59 anal smears were obtained in 48 patients: 42 men (88%) and 6 women (12%) (10 patients had several anal smears or both margin and canal samples). Median age was 42 years (26-72). Oncogenic-HPVs prevalence was 73% (N=35 patients). P3 group slightly predominated in patients (N=22 patients; 22 smears) while HPV16 was present in 23 anal smears (N=17 patients). In fact, mutiviral lesions existed in 21 smears (N=19 patients) exhibiting frequently HPV16. 11 smears showed HPVs18/45 (N=11patients), 9 smears P4 (N=9 patients) and 9 smears P5 (N=8) types. In four patients, anoscopy and cytology were negative while HPV was present. 3 smears showed ASCUS (Atypical Squamous Cells of Undetermined Significance) (5%), one showed ASCH (Atypical Squamous Cell evocating High grade
lesion) (2%), 23 showed LSIL (39%) and 12 showed HSIL (20%). 17 smears showed no abnormality (29%). 3 smears were non contributive (5%).
195 cervical smears were obtained in 190 women (5 patients had 2 separate cervical smears). Median age was 45 years (23-79). Oncogenic-HPVs prevalence was 38% (N=72 patients).
P3 predominated in cervical smears (N= 36 women, 37 smears). 13 smears showed HPV16 (N=13 women), 16 smears showed HPVs18/45 (N=16 women), 15 smears P4 (N=15 women) and 22 smears P5 (N=21 women) types. Multiviral lesions were noted in 21 patients. 14 smears showed ASCUS (7%), 50 showed LSIL (26%) and 12 showed HSIL (6%). None showed ASCH. 117 smears showed no abnormality (60%). 2 smears were non contributive (1%).
In this HIV+ immunocompetent population under highly active anti-retroviral treatment, the prevalence of oncogenic HPVs lesions remained at high level. Oncogenic-HPV prevalence was higher in anus (73%) than in cervix (38%). Rapid PCR (1 hour) linked to cytology eliminated non-HPV related ASCUS (inflammatory lesions). In four patients, anoscopy and cytology were negative while oncogenic-HPV was present allowing appropriate patient follow-up.