P12-18HPV-RELATED LESIONS IN ANAL AND CERVIX PAP-SMEARS IN HIV+-PATIENTS UNDER ANTI-RETROVIRAL TREATMENT. INTEREST OF CYTOLOGY COUPLED TO RAPID HPV PCR.

10. HPV testing
H. Nassereddine 1, L. Bienvenu 1, L. Deschamps 1, C. Davitian 2, L. Abramowitz 3, D. Benabderrahmane 3, A. Couvelard 1, C. Charpentier 4, T. Lehy 1, F. Walker 1.
1(1) Pathology Department Hospital Bichat Claude Bernard, 46 rue Henri Huchard, 75877, Paris, France (France), 2(2) Gynecology Department, SMIT Hospital Bichat Claude Bernard, 46 rue Henri Huchard, 75877, Paris (France), 3(3) Proctology Department, Hospital Bichat Claude Bernard, 46 rue Henri Huchard, 75877, Paris (France), 4(4) Viroloy Department, Hospital Bichat Claude Bernard, 46 rue Henri Huchard, 75877, Paris (France)

Background / Objectives

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.


Methods

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).


Results

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%).


Conclusion

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.


References