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1.
Lancet HIV ; 11(9): e598-e606, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39102835

RESUMEN

BACKGROUND: People with HIV have a substantially higher risk of anal cancer than the general population. We aimed to identify risk factors associated with the development of anal cancer among people with HIV to implement more effective and targeted screening strategies. METHODS: We conducted a multicentre retrospective cohort study in 16 hospitals across Catalonia and the Balearic Islands, Spain, between Jan 1, 1998, and Dec 31, 2022. Treatment-naive people with HIV nested in the PISCIS cohort aged 16 years and older with biopsy-proven squamous cell carcinoma of the anus or anal canal were eligible for inclusion. Data were retrieved from every hospital registry and were centrally validated in the PISCIS cohort and the Public Data Analysis for Health Research and Innovation Program. The primary outcome was the incidence rate (IR) of histologically confirmed anal cancer. We used Poisson regression to examine the association between the following risk factors and incidence of anal cancer: age, mode of HIV transmission, nadir CD4 cell count, and time period of HIV diagnosis. FINDINGS: Among 14 238 people with HIV, 107 (0·8%) developed anal cancer, with an overall IR of 72·5 cases per 100 000 person-years (95% CI 59·4-87·6) and median follow-up of 9·5 years (IQR 4·4-15·7). Of these patients with anal cancer, 37 (34·6%) died, of which 24 (64·9%) deaths were related to anal cancer. Incidence was highest among people with HIV with historical nadir CD4 counts of less than 200 cells per µL (IR 105·0 person-years, 95% CI 82·0-132·5) and lowest among those with counts of more than 350 cells per µL (2·9 person-years, 0·1-16·0). Among men who have sex with men (MSM), the IR was 211·5 person-years (95% CI 151·1-211·7) among those with a CD4 count of less than 200 cells per µL, 37·6 person-years (16·2-74·1) among those with a count of 200-350 cells per µL, and 4·8 person-years (0·1-26·9) among those with a count of more than 350 cells per µL. Among people with HIV younger than 30 years, there were no cases of anal cancer among women or men who do not have sex with men, and one case among MSM with a nadir CD4 count of more than 350 cells per µL (IR 4·8 person-years, 95% CI 0·1-26·9). In the multivariable analysis, people with HIV with nadir CD4 counts of more than 350 cells per µL had the lowest risk of developing anal cancer, compared with people with HIV with counts of less than 200 cells per µL (adjusted IR ratio 0·03, 95% CI 0·00-0·25; p=0·0010) or 200-350 cells per µL (0·30, 0·17-0·55; p<0·0001). Compared with people with HIV younger than 30 years, people with HIV aged 60 years and older had an adjusted IR ratio of 27·6 (3·7-206·9; p=0·0010) and people with HIV aged 45-59 years of 21·6 (3·0-156·4; p=0·0020). Compared with individuals diagnosed after 2015, a diagnosis of HIV before 1998 had an adjusted IR ratio of 33·0 (7·9-137·5; p<0·0001). INTERPRETATION: A nadir CD4 count threshold below 350 cells per µL, particularly less than 200 cells per µL, has the potential to identify people with HIV at heightened risk of developing anal cancer. Customised screening strategies that prioritise screening for individuals at high risk with this surrogate marker could maximise available resources. External validation of these data with other cohorts is required before screening recommendations can be updated. FUNDING: Catalan Health Department, Generalitat de Catalunya.


Asunto(s)
Neoplasias del Ano , Infecciones por VIH , Humanos , Neoplasias del Ano/epidemiología , España/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Estudios Retrospectivos , Masculino , Factores de Riesgo , Femenino , Adulto , Persona de Mediana Edad , Incidencia , Recuento de Linfocito CD4 , Carcinoma de Células Escamosas/epidemiología , Adulto Joven
3.
World J Gastroenterol ; 30(28): 3373-3385, 2024 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-39091713

RESUMEN

The perianal disease affects up to one-third of individuals with Crohn's disease (CD), causing disabling symptoms and significant impairment in quality of life, particularly for those with perianal fistulising CD (PFCD). The collaborative effort between gastroenterologists and surgeons is essential for addressing PFCD to achieve fistula closure and promote luminal healing. Limited fistula healing rates with conventional therapies have prompted the emergence of new biological agents, endoscopic procedures and surgical techniques that show promising results. Among these, mesenchymal stem cells injection is a particularly hopeful therapy. In addition to the burden of fistulas, individuals with perianal CD may face an increased risk of developing anal cancer. This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes. Currently, there is no established formal anal screening programme. In this review, we provide an overview of the current state of the art in managing PFCD, including novel medical, endoscopic and surgical approaches. The discussion also focuses on the relevance of establishing an anal cancer screening programme in CD, intending to propose a risk-based surveillance algorithm. The validation of this surveillance programme would be a significant step forward in improving patient care and outcomes.


Asunto(s)
Neoplasias del Ano , Enfermedad de Crohn , Detección Precoz del Cáncer , Fístula Rectal , Humanos , Neoplasias del Ano/terapia , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/epidemiología , Neoplasias del Ano/patología , Fístula Rectal/terapia , Fístula Rectal/etiología , Fístula Rectal/diagnóstico , Fístula Rectal/epidemiología , Enfermedad de Crohn/terapia , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/epidemiología , Detección Precoz del Cáncer/métodos , Calidad de Vida , Canal Anal/cirugía , Canal Anal/patología , Factores de Riesgo
4.
J Acquir Immune Defic Syndr ; 96(5): 439-446, 2024 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-38985441

RESUMEN

BACKGROUND: Anal cancer is caused by human papillomavirus (HPV), particularly HPV-16, and is preceded by anal high-grade squamous intraepithelial lesions (HSILs). The incidence of anal cancer is highest among men who have sex with men (MSM) living with HIV (MSMLWH) and increases with age. However, most previous studies of anal HPV infection and anal HSIL were performed on men under 50 years old, and relatively little is known about HSIL among older MSMLWH or MSM not living with HIV (MSM-Not-LWH). SETTING: We enrolled MSM who were aged 50+ during 2018-2022 in San Francisco, CA. METHODS: One hundred twenty-nine MSMLWH and 109 MSM-not-LWH participated. All participants had anal HPV DNA testing (Atila Biosystems) and high-resolution anoscopy with a biopsy of visible lesions. RESULTS: Among MSMLWH, 47% had anal HSIL, 19% had HPV-16, and 51% had other oncogenic anal HPV types (excluding HPV-16). Among MSM-not-LWH, 37% had anal HSIL, 22% had HPV-16, and 34% had other oncogenic anal HPV types. Increasing age was not statistically associated with prevalent HSIL, HPV-16, or other oncogenic HPV infections in MSMLWH or MSM-not-LWH. HPV-16 (odds ratio: 45.1, 95% confidence interval: 15.8-129); other oncogenic HPV types (odds ratio: 5.95, 95% confidence interval: 2.74-12.9) were associated with increased odds of anal HSIL, adjusted for age, income, education, and HIV status. CONCLUSION: The prevalence of oncogenic anal HPV, anal HPV-16, and anal HSIL remains very high in older MSMLWH and MSM-not-LWH. With recent evidence showing that treating anal HSIL prevents anal cancer, MSM aged 50+ should be considered for anal cancer screening.


Asunto(s)
Neoplasias del Ano , Infecciones por VIH , Homosexualidad Masculina , Infecciones por Papillomavirus , Lesiones Intraepiteliales Escamosas , Humanos , Masculino , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/complicaciones , Persona de Mediana Edad , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Prevalencia , Lesiones Intraepiteliales Escamosas/virología , Lesiones Intraepiteliales Escamosas/epidemiología , Lesiones Intraepiteliales Escamosas/patología , Neoplasias del Ano/epidemiología , Neoplasias del Ano/virología , Anciano , San Francisco/epidemiología , Canal Anal/virología , Canal Anal/patología , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación
5.
Cancer Epidemiol ; 92: 102612, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39018888

RESUMEN

BACKGROUND: Anal cancer is increasing globally, with a high number of new cases occurring in highly developed countries, including the U.S. The incidence of anal cancer is higher among people living with HIV (PLHIV), and the U.S. South continues to see higher HIV incidence rates and lagging HPV vaccination rates. We aimed to identify factors associated with early onset anal cancer in Alabama which may help explain cancer disparities in the South. METHODS: Using a cross-sectional study design, we examined demographic, clinical, and social characteristics among anal cancer patients stratified by diagnosis age (<50 and ≥50 years) in the Alabama cancer registry between 2012 and 2018. We used Wilcoxon rank sums and Pearson chi-square tests to assess associations between age at diagnosis, demographic (i.e., sex, race, marital status), clinical (i.e., BMI, HIV infection, site, stage, and histological type), and social (i.e. social vulnerability) characteristics, and multivariable logistic regression to estimate the odds of early onset cancer. RESULTS: Among 519 patients with anal cancer in Alabama, 92 (17.7 %) were diagnosed at <50 years. The majority of patients were female (66.5 %) and White (83.4 %). Male sex, Black race, and HIV infection were associated with younger age at diagnosis. Black patients had a 4-fold increased odds of early onset anal cancer compared to White patients (AOR=4.39, CI=1.54-12.49). Black patients disproportionately lived in areas with higher social vulnerability. About 42 % of patients in areas with the highest social vulnerability were diagnosed with stage 3 or 4 cancer. About 8 % of cases were among people aged 35-44 years, which is close to double the proportion of anal cancer cases in this age group in the U.S. (4.7 %). CONCLUSIONS: Patients who are Black, male, and PLHIV may be at higher risk of early onset anal cancer compared to other populations in the South.


Asunto(s)
Neoplasias del Ano , Humanos , Masculino , Femenino , Persona de Mediana Edad , Alabama/epidemiología , Estudios Transversales , Neoplasias del Ano/epidemiología , Adulto , Infecciones por VIH/epidemiología , Incidencia , Factores de Edad , Factores de Riesgo , Sistema de Registros/estadística & datos numéricos , Anciano
6.
J Infect Dis ; 230(1): 55-60, 2024 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-39052708

RESUMEN

We assessed cumulative detection and determinants of anal high-grade squamous intraepithelial lesions (HSILs) in men who have sex with men living with human immunodeficiency virus and who underwent 3 visits over 2 years, with cytology and high-resolution anoscopy, within the ANRS-EP57-APACHES study. The cumulative HSIL detection rate was 33% (134 of 410), of which 48% HSILs were detected at baseline. HSIL detection varied considerably by center (from 13% to 51%). The strongest HSIL determinants were baseline human papillomavirus 16 (adjusted odds ratio, 8.2; 95% confidence interval, 3.6-18.9) and p16/Ki67 (4.6 [2.3-9.1]). Repeated annual cytology and high-resolution anoscopy improved HSIL detection but did not fully compensate for between-center heterogeneity.


Asunto(s)
Neoplasias del Ano , Infecciones por VIH , Homosexualidad Masculina , Infecciones por Papillomavirus , Lesiones Intraepiteliales Escamosas , Humanos , Masculino , Infecciones por VIH/complicaciones , Lesiones Intraepiteliales Escamosas/virología , Lesiones Intraepiteliales Escamosas/patología , Francia/epidemiología , Adulto , Neoplasias del Ano/virología , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/epidemiología , Neoplasias del Ano/patología , Persona de Mediana Edad , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Estudios de Seguimiento , Canal Anal/virología , Canal Anal/patología , Papillomavirus Humano 16/aislamiento & purificación , Minorías Sexuales y de Género
7.
J Natl Cancer Inst ; 116(9): 1508-1512, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-38837335

RESUMEN

Squamous cell carcinoma of the anus (SCCA) incidence has been rising in the United States, particularly among older adults (≥65 years). We estimated the impact of this rise on future burden (through 2035) using age-period-cohort modeling. The SCCA burden (cases/year) is expected to rise, reaching approximately 2700 among men and approximately 7000 among women in 2031-2035 (burden during 2016-2020 among men and women was approximately 2150 and approximately 4600), with most cases 65 years of age or older (61% in men and 70% in women in 2031-2035; from 40% and 46% in 2016-2020). SCCA incidence (per 100 000) is projected to rise among older men aged 65-74, 75-84, and 85 years or older (5.0, 4.9, and 4.3 in 2031-2035 vs 3.7, 3.8, and 3.4 in 2016-2020, respectively) and women (11.2, 12.6, and 8.0 in 2031-2035 vs 8.2, 6.8, and 5.2 in 2016-2020, respectively). The projected rise in SCCA burden among older adults is troubling and highlights the importance of improving early detection and clinical care.


Asunto(s)
Neoplasias del Ano , Carcinoma de Células Escamosas , Humanos , Estados Unidos/epidemiología , Masculino , Anciano , Femenino , Neoplasias del Ano/epidemiología , Incidencia , Anciano de 80 o más Años , Carcinoma de Células Escamosas/epidemiología , Persona de Mediana Edad , Programa de VERF , Adulto , Costo de Enfermedad
8.
Viruses ; 16(6)2024 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-38932197

RESUMEN

HPV16 is responsible for approximately 60% and 90% of global HPV-induced cervical and oropharyngeal cancers, respectively. HPV16 intratype variants have been identified by HPV genome sequencing and classified into four phylogenetic lineages (A-D). Our understanding of HPV16 variants mostly derives from epidemiological studies on cervical cancer (CC) in which HPV16 B, C, and D lineages (previously named "non-European" variants) were mainly associated with high-grade cervical lesions and cancer. Although a predominance of HPV16 lineage A (previously named "European variants") has been observed in head and neck squamous cell carcinoma (HNSCC), epidemiological and in vitro biological studies are still limited for this tumor site. Next Generation Sequencing (NGS) of the entire HPV genome has deepened our knowledge of the prevalence and distribution of HPV variants in CC and HNSCC. Research on cervical cancer has shown that certain HPV16 sublineages, such as D2, D3, A3, and A4, are associated with an increased risk of cervical cancer, and sublineages A4, D2, and D3 are linked to a higher risk of developing adenocarcinomas. Additionally, lineage C and sublineages D2 or D3 of HPV16 show an elevated risk of developing premalignant cervical lesions. However, it is still crucial to conduct large-scale studies on HPV16 variants in different HPV-related tumor sites to deeply evaluate their association with disease development and outcomes. This review discusses the current knowledge and updates on HPV16 phylogenetic variants distribution in HPV-driven anogenital and head and neck cancers.


Asunto(s)
Neoplasias de Cabeza y Cuello , Papillomavirus Humano 16 , Infecciones por Papillomavirus , Filogenia , Humanos , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/epidemiología , Neoplasias de Cabeza y Cuello/virología , Neoplasias de Cabeza y Cuello/genética , Neoplasias de Cabeza y Cuello/epidemiología , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/clasificación , Femenino , Variación Genética , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/epidemiología , Genoma Viral , Neoplasias del Ano/virología , Neoplasias del Ano/epidemiología , Masculino , Carcinoma de Células Escamosas de Cabeza y Cuello/virología , Carcinoma de Células Escamosas de Cabeza y Cuello/genética
9.
J Med Virol ; 96(6): e29747, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38895783

RESUMEN

This study aimed to provide comprehensive clinical screening data for anal intraepithelial neoplasia (AIN). This study included 312 patients who underwent high-resolution anoscopy (HRA) examinations between January 1, 2020 and April 15, 2024. Clinical data, including demographic information, clinical history, cytology/high-risk human papilloma virus (hrHPV) results, and HRA records, were analyzed. The median age of all patients was 42 years (interquartile range: 33-52 years). Approximately 26.3% reported a history of VIN2/3+, 13.5% had a history of VaIN2/3+, 29.8% had a history of CIN2/3+, 44.6% had persistent cervical HPV16 infection, and 12.5% had immune suppression. Among the 312 patients, 14.4% were diagnosed with AIN2/3, 25.0% with AIN1 and 60.6% were normal. Anal cytological abnormalities were found in 41.3% of all patients, with a significantly higher rate in AIN2/3 patients than in ≤AIN1, 71.1% versus 36.3%, p < 0.001. The hrHPV positivity rate was 89.7%, with HPV16 being the most prevalent. The complete agreement rate for HRA impressions was 79.5%. Multi-variable analysis revealed immune suppression (odds ratio [OR]: 3.47, 95% confidence interval [CI]: 1.42-8.5) and VIN2/3+ (OR: 2.82, 95% CI: 1.27-6.28) were independent risk factors for AIN2/3. Abnormal cytology results (OR: 3.3, 95% CI: 1.52-7.17) and anal HPV16 infection (OR: 3.2, 95% CI: 1.26-8.12) demonstrated similar ORs for AIN2/3. Early screening for AIN2/3+ is crucial in Chinese women with lower genital tract precancerous and cancerous lesions, particularly in those with VIN2/3+ and immune suppression.


Asunto(s)
Neoplasias del Ano , Carcinoma in Situ , Detección Precoz del Cáncer , Infecciones por Papillomavirus , Humanos , Femenino , Persona de Mediana Edad , Adulto , China/epidemiología , Neoplasias del Ano/virología , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/epidemiología , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/epidemiología , Detección Precoz del Cáncer/métodos , Carcinoma in Situ/epidemiología , Carcinoma in Situ/virología , Carcinoma in Situ/diagnóstico , Factores de Riesgo , Papillomavirus Humano 16/aislamiento & purificación
10.
J Natl Cancer Inst ; 116(8): 1319-1332, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38720565

RESUMEN

BACKGROUND: People with HIV at highest risk of anal cancer include gay, bisexual, and other men who have sex with men and transgender women aged 35 years or older as well as other people with HIV aged 45 years or older. Identifying and treating precancerous lesions can reduce anal cancer incidence in these groups. We assessed the prevalence of anal cytology and access to high-resolution anoscopy among people with HIV overall and in those individuals at highest risk. METHODS: Data were obtained from the Centers for Disease Control and Prevention's Medical Monitoring Project, a population-based survey of people with HIV aged 18 years and older, and a supplemental Medical Monitoring Project facility survey. We report weighted percentages of people with HIV receiving anal cytology during the past 12 months, access to high-resolution anoscopy, and characteristics of HIV care facilities by availability of high-resolution anoscopy. RESULTS: Overall, 4.8% (95% confidence interval [CI] = 3.4% to 6.1%) of people with HIV had undergone anal cytology in the prior 12 months. Only 7.7% (95% CI = 5.1% to 10.6%) of gay, bisexual, and other men who have sex with men as well as transgender women 35 years of age or older and 1.9% (95% CI = 0.9% to 2.9%) of all other people with HIV aged 45 years and older had anal cytology. Prevalence was statistically significantly low among people with HIV with the following characteristics: non-Hispanic or Latino, Black or African American, high school education or less, heterosexual orientation, and living in southern Medical Monitoring Project states. Among people with HIV, 32.8% (95% CI = 28.0% to 37.7%) had no access to high-resolution anoscopy on-site or through referral at their care facility; 22.2% (95% CI = 19.5% to 24.9%) had on-site access; 45.0% (95% CI = 41.5% to 48.5%) had high-resolution anoscopy available through referral. Most facilities that received Ryan White HIV/AIDS Program funding, cared for more than 1000 people with HIV, or provided on-site colposcopy also provided high-resolution anoscopy on-site or through referral. CONCLUSIONS: Rates of anal cytology and access to high-resolution anoscopy were low among people with HIV, including those individuals at highest risk of anal cancer. Our data may inform large-scale implementation of anal cancer prevention efforts.


Asunto(s)
Neoplasias del Ano , Infecciones por VIH , Humanos , Masculino , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Neoplasias del Ano/epidemiología , Neoplasias del Ano/patología , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/virología , Persona de Mediana Edad , Adulto , Prevalencia , Estados Unidos/epidemiología , Detección Precoz del Cáncer/métodos , Canal Anal/patología , Canal Anal/virología , Accesibilidad a los Servicios de Salud , Adulto Joven , Anciano , Adolescente , Citodiagnóstico/métodos , Personas Transgénero/estadística & datos numéricos , Proctoscopía , Minorías Sexuales y de Género/estadística & datos numéricos , Tamizaje Masivo/métodos , Citología
11.
J Low Genit Tract Dis ; 28(3): 305-309, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38709111

RESUMEN

ABSTRACT: We investigated factors associated with "worse than usual" anal health among gay and bisexual men aged ≥35 years recruited to a longitudinal study of anal human papillomavirus infection/lesions from September 2010 to August 2015.Among 616 participants (median age 49 years; 36% HIV-positive), 42 (6.8%) reported worse than usual anal health in the last 4 weeks. Associated factors included spending less time with gay friends (odds ratio [OR] = 2.25, 95% CI = 1.06-4.77), most time "feeling down"(OR = 9.17, 95% CI = 2.94-28.59), reduced libido (OR = 2.90, 95% CI = 1.52-5.52), current anal symptoms (OR = 6.55, 95% CI = 2.54-16.90), recent anal wart diagnosis (OR = 4.33, 95% CI = 1.98-9.49), and fear of developing anal cancer (OR = 9.34, 95% CI = 4.52-19.28).Concerns regarding anal health should be routinely discussed by clinicians, and potentially associated psychosocial, physical, and sexual issues further explored.


Asunto(s)
Homosexualidad Masculina , Humanos , Masculino , Estudios Transversales , Persona de Mediana Edad , Adulto , Estudios Longitudinales , Anciano , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/complicaciones , Neoplasias del Ano/epidemiología
12.
J Natl Cancer Inst ; 116(9): 1450-1458, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-38713084

RESUMEN

BACKGROUND: Anal cancer risk is elevated among people with HIV. Recent anal cancer incidence patterns among people with HIV in the United States and Canada remain unclear. It is unknown how the incidence patterns may evolve. METHODS: Using data from the North American AIDS Cohort Collaboration on Research and Design, we investigated absolute anal cancer incidence and incidence trends nationally in the United States and Canada and in different US regions. We further estimated relative risk compared with people without HIV, relative risk among various subgroups, and projected future anal cancer burden among American people with HIV. RESULTS: Between 2001 and 2016 in the United States, age-standardized anal cancer incidence declined 2.2% per year (95% confidence interval = ‒4.4% to ‒0.1%), particularly in the Western region (‒3.8% per year, 95% confidence interval = ‒6.5% to ‒0.9%). In Canada, incidence remained stable. Considerable geographic variation in risk was observed by US regions (eg, more than 4-fold risk in the Midwest and Southeast compared with the Northeast among men who have sex with men who have HIV). Anal cancer risk increased with a decrease in nadir CD4 cell count and was elevated among those individuals with opportunistic illnesses. Anal cancer burden among American people with HIV is expected to decrease through 2035, but more than 70% of cases will continue to occur in men who have sex with men who have HIV and in people with AIDS. CONCLUSION: Geographic variation in anal cancer risk and trends may reflect underlying differences in screening practices and HIV epidemic. Men who have sex with men who have HIV and people with prior AIDS diagnoses will continue to bear the highest anal cancer burden, highlighting the importance of precision prevention.


Asunto(s)
Neoplasias del Ano , Infecciones por VIH , Humanos , Neoplasias del Ano/epidemiología , Neoplasias del Ano/virología , Masculino , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Incidencia , Femenino , Persona de Mediana Edad , Adulto , Canadá/epidemiología , Estados Unidos/epidemiología , Factores de Riesgo , Homosexualidad Masculina/estadística & datos numéricos , América del Norte/epidemiología , Anciano
13.
Rev Med Liege ; 79(S1): 45-48, 2024 May.
Artículo en Francés | MEDLINE | ID: mdl-38778649

RESUMEN

Although rare, around 2 % of digestive tumours, anal canal tumours remain a pathology that should not be neglected. These are frequently underdiagnosed due to the affected region and the symptoms that can be confused with more common and benign pathologies such as haemorrhoids or anal fissures. The treatment of these tumours is mainly based on radio-chemotherapy to avoid heavy surgical treatment which remains the salvage option. This article aims to review the epidemiology, diagnosis, management, monitoring and future developments for these cancers.


Bien que rares (environ 2 % des tumeurs digestives), les tumeurs du canal anal restent une pathologie à ne pas négliger. Elles sont souvent sous-diagnostiquées en raison de la région touchée et de la symptomatologie non spécifique, et confondues avec des pathologies plus fréquentes et bénignes comme des hémorroïdes ou des fissures anales. Le traitement de ces tumeurs repose principalement sur la radio-chimiothérapie, afin d'éviter une prise en charge chirurgicale lourde qui reste l'option de sauvetage. Cet article a pour but de passer en revue l'épidémiologie, le diagnostic, la prise en charge, le suivi et les futurs développements pour ces cancers.


Asunto(s)
Neoplasias del Ano , Humanos , Neoplasias del Ano/terapia , Neoplasias del Ano/epidemiología , Neoplasias del Ano/diagnóstico
14.
Viruses ; 16(5)2024 04 26.
Artículo en Inglés | MEDLINE | ID: mdl-38793561

RESUMEN

The human papillomavirus is the most common sexually transmitted infection in the world. Most HPV infections clear spontaneously within 2 years of infection; however, persistent infection can result in a wide array of diseases, ranging from genital warts to cancer. Most cases of cervical, anal, and oropharyngeal cancers are due to HPV infection, with cervical cancer being one of the leading causes of cancer death in women worldwide. Screening is available for HPV and cervical cancer, but is not available everywhere, particularly in lower-resource settings. HPV infection disproportionally affects individuals living with HIV, resulting in decreased clearance, increased development of cancer, and increased mortality. The development of the HPV vaccine has shown a drastic decrease in HPV-related diseases. The vaccine prevents cervical cancer with near 100% efficacy, if given prior to first sexual activity. Vaccination uptake remains low worldwide due to a lack of access and limited knowledge of HPV. Increasing awareness of HPV and access to vaccination are necessary to decrease cancer and HPV-related morbidity and mortality worldwide.


Asunto(s)
Papillomaviridae , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino , Humanos , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/complicaciones , Vacunas contra Papillomavirus/administración & dosificación , Femenino , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Papillomaviridae/patogenicidad , Neoplasias/virología , Vacunación , Neoplasias del Ano/prevención & control , Neoplasias del Ano/virología , Neoplasias del Ano/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , Infecciones por VIH/prevención & control , Neoplasias Orofaríngeas/virología , Neoplasias Orofaríngeas/prevención & control , Masculino , Virus del Papiloma Humano
15.
J Int AIDS Soc ; 27(5): e26242, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38695517

RESUMEN

INTRODUCTION: Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored. METHODS: Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits. RESULTS: A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03-18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57-29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27-14.14), syphilis infection (aHR 4.67, 95% CI 1.10-19.90) and CD4 count <350 cells/mm3 (aHR 3.09, 95% CI 1.28-7.48). CONCLUSIONS: With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.


Asunto(s)
Infecciones por VIH , Homosexualidad Masculina , Lesiones Intraepiteliales Escamosas , Personas Transgénero , Humanos , Tailandia/epidemiología , Masculino , Adulto , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Prevalencia , Personas Transgénero/estadística & datos numéricos , Incidencia , Femenino , Homosexualidad Masculina/estadística & datos numéricos , Lesiones Intraepiteliales Escamosas/epidemiología , Lesiones Intraepiteliales Escamosas/patología , Adulto Joven , Neoplasias del Ano/epidemiología , Papillomaviridae/aislamiento & purificación , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Estudios de Cohortes , Biopsia , Genotipo , Canal Anal/patología , Canal Anal/virología
16.
Int J Cancer ; 155(2): 251-260, 2024 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-38577820

RESUMEN

Human papillomavirus (HPV) proteins may elicit antibody responses in the process toward HPV-related malignancy. However, HPV seroepidemiology in noncervical HPV-related cancers remains poorly understood, particularly in populations with a high prevalence of human immunodeficiency virus (HIV). Using a glutathione S-transferase-based multiplex serology assay, antibodies against E6, E7 and L1 proteins of HPV16 and HPV18 were measured in sera of 535 cases of noncervical HPV-related cancers (anal (n = 104), vulval (n = 211), vaginal (n = 49), penile (n = 37) and oropharyngeal (n = 134)) and 6651 non-infection-related cancer controls, from the Johannesburg Cancer Study that recruited Black South African with newly diagnosed cancer between 1995 and 2016. Logistic and Poisson regression models were used to calculate adjusted odds ratios (aOR) and prevalence ratios (aPR) and 95% confidence intervals (CI) in cases versus controls. HPV16 E6 was more strongly associated with noncervical HPV-related cancers than HPV16 L1 or E7, or HPV18 proteins: anal (females (HPV16 E6 aOR = 11.50;95%CI:6.0-22.2), males (aOR = 10.12;95%CI:4.9-20.8), vulval (aOR = 11.69;95%CI:7.9-17.2), vaginal (aOR = 10.26;95%CI:5.0-21), penile (aOR = 18.95;95%CI:8.9-40), and oropharyngeal (females (aOR = 8.95;95%CI:2.9-27.5), males (aOR = 3.49;95%CI:1.8-7.0)) cancers. HPV16-E6 seropositivity ranged from 24.0% to 35.1% in anal, vulval, vaginal and penile cancer but was significantly lower (11.2%) in oropharyngeal cancer. After adjustment for HIV, prevalence of which increased from 22.2% in 1995-2005 to 54.1% in 2010-2016, HPV16 E6 seropositivity increased by period of diagnosis (aPR for 2010-2016 vs. 1995-2006 = 1.84;95%CI:1.1-3.0). Assuming HPV16 E6 seroprevalence reflects HPV attributable fraction, the proportion of certain noncervical-HPV-related cancers caused by HPV is increasing over time in South Africa. This is expected to be driven by the increasing influence of HIV.


Asunto(s)
Anticuerpos Antivirales , Infecciones por VIH , Proteínas Oncogénicas Virales , Infecciones por Papillomavirus , Humanos , Masculino , Femenino , Sudáfrica/epidemiología , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/inmunología , Persona de Mediana Edad , Adulto , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Proteínas Oncogénicas Virales/inmunología , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Papillomavirus Humano 16/inmunología , Anciano , Neoplasias Orofaríngeas/virología , Neoplasias Orofaríngeas/epidemiología , Estudios Seroepidemiológicos , Estudios de Casos y Controles , Papillomavirus Humano 18/inmunología , Neoplasias de la Vulva/virología , Neoplasias de la Vulva/epidemiología , Neoplasias de la Vulva/sangre , Neoplasias del Pene/virología , Neoplasias del Pene/epidemiología , Neoplasias del Pene/sangre , Neoplasias del Ano/virología , Neoplasias del Ano/epidemiología , Neoplasias del Ano/sangre , Neoplasias Vaginales/virología , Neoplasias Vaginales/epidemiología , Población Negra , Proteínas Represoras/inmunología , Neoplasias/epidemiología , Neoplasias/virología , Neoplasias/sangre , Neoplasias/inmunología , Virus del Papiloma Humano
17.
J Low Genit Tract Dis ; 28(3): 300-304, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38661377

RESUMEN

OBJECTIVES: This study aimed to determine if immune inflammatory markers (neutrophil lymphocyte ratio [NLR], platelet lymphocyte ratio [PLR], and prognostic nutritional index [PNI]) correlate with anal cancer risk in people living with HIV and to compare these markers with the CD4/CD8 ratio. MATERIALS AND METHODS: This is a regional retrospective cohort study of veterans living with HIV who were screened for or diagnosed with anal neoplasia or cancer from 2001 to 2019. The NLR, PLR, PNI, and CD4/CD8 ratio within 1 year of anal pathology results were computed. Patients with anal cancer were compared to patients without anal cancer. Regression modeling was used to estimate the odds of developing anal cancer. RESULTS: Three hundred thirty-four patients were included (37 with anal cancer, 297 without anal cancer). In patients with anal cancer, NLR and PLR were higher (2.17 vs 1.69, p = .04; 140 vs 110, p = .02, respectively), while PNI and CD4/CD8 ratio were lower (44.65 vs 50.01, p < .001; 0.35 vs 0.80, p < .001, respectively). On multivariate logistic regression modeling, only PNI (odds ratio, 0.90; p = .001) and CD4/CD8 ratio (odds ratio, 0.05; p < .001) were associated with increased anal cancer risk. CONCLUSIONS: Although NLR and PLR independently correlate with anal cancer risk, when controlling for other risk predictors, only PNI and CD4/CD8 ratio were statistically significant biomarkers for anal cancer. The CD4/CD8 ratio is the strongest immune inflammatory marker that predicts risk of anal cancer among veterans living with HIV.


Asunto(s)
Neoplasias del Ano , Infecciones por VIH , Veteranos , Humanos , Neoplasias del Ano/epidemiología , Masculino , Infecciones por VIH/complicaciones , Persona de Mediana Edad , Estudios Retrospectivos , Femenino , Veteranos/estadística & datos numéricos , Relación CD4-CD8 , Adulto , Factores de Riesgo , Neutrófilos , Anciano , Biomarcadores/sangre , Pronóstico
18.
Hum Vaccin Immunother ; 20(1): 2334001, 2024 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-38557433

RESUMEN

In 2020, there were approximately 50,865 anal cancer cases and 36,068 penile cancer cases worldwide. HPV is considered the main causal agent for the development of anal cancer and one of the causal agents responsible for the development of penile cancer. The aim of this epidemiological, descriptive, retrospective study was to describe the burden of hospitalization associated with anal neoplasms in men and women and with penis neoplasms in men in Spain from 2016 to 2020. The National Hospital Data Surveillance System of the Ministry of Health, Conjunto Mínimo Básico de Datos, provided the discharge information used in this observational retrospective analysis. A total of 3,542 hospitalizations due to anal cancer and 4,270 hospitalizations due to penile cancer were found; For anal cancer, 57.4% of the hospitalizations occurred in men, and these hospitalizations were also associated with significantly younger mean age, longer hospital stays and greater costs than those in women. HIV was diagnosed in 11.19% of the patients with anal cancer and 1.74% of the patients with penile cancer. The hospitalization rate was 2.07 for men and 1.45 for women per 100,000 in anal cancer and of 4.38 per 100,000 men in penile cancer. The mortality rate was 0.21 for men and 0.12 for women per 100,000 in anal cancer and 0.31 per 100.000 men in penile cancer and the case-fatality rate was 10.07% in men and 8,26% in women for anal cancer and 7.04% in penile cancer. HIV diagnosis significantly increased the cost of hospitalization. For all the studied diagnoses, the median length of hospital stays and hospitalization cost increased with age. Our study offers relevant data on the burden of hospitalization for anal and penile cancer in Spain. This information can be useful for future assessment on the impact of preventive measures, such as screening or vaccination in Spain.


Asunto(s)
Neoplasias del Ano , Infecciones por VIH , Infecciones por Papillomavirus , Neoplasias del Pene , Masculino , Humanos , Femenino , Neoplasias del Pene/epidemiología , Estudios Retrospectivos , Canal Anal , España/epidemiología , Hospitalización , Neoplasias del Ano/epidemiología , Infecciones por VIH/complicaciones , Infecciones por Papillomavirus/epidemiología
19.
J Natl Cancer Inst ; 116(7): 1173-1177, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38429996

RESUMEN

We estimated the population-level incidence of human papillomavirus (HPV)-positive oropharyngeal, cervical, and anal cancers by smoking status. We combined HPV DNA genotyping data from the Centers for Disease Control and Prevention's Cancer Registry Sentinel Surveillance System with data from the Kentucky Cancer Registry and Behavioral Risk Factor Surveillance System across smoking status. During 2004-2005 and 2014-2015 in Kentucky, most cases of oropharyngeal (63.3%), anal (59.7%), and cervical (54.9%) cancer were among individuals who ever smoked. The population-level incidence rate was higher among individuals who ever smoked than among those who never smoked for HPV-positive oropharyngeal (7.8 vs 2.1; adjusted incidence rate ratio = 2.6), cervical (13.7 vs 6.8; adjusted incidence rate ratio = 2.0), and anal (3.9 vs 1.6; adjusted incidence rate ratio = 2.5) cancers. These findings indicate that smoking is associated with increased risk of HPV-positive oropharyngeal, cervical, and anal cancers, and the population-level burden of these cancers is higher among individuals who ever smoked.


Asunto(s)
Neoplasias del Ano , Neoplasias Orofaríngeas , Infecciones por Papillomavirus , Fumar , Neoplasias del Cuello Uterino , Humanos , Neoplasias Orofaríngeas/virología , Neoplasias Orofaríngeas/epidemiología , Neoplasias del Ano/epidemiología , Neoplasias del Ano/virología , Femenino , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/complicaciones , Masculino , Incidencia , Persona de Mediana Edad , Fumar/epidemiología , Fumar/efectos adversos , Adulto , Anciano , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/epidemiología , Sistema de Registros , Kentucky/epidemiología , Papillomaviridae/aislamiento & purificación , Papillomaviridae/genética , Factores de Riesgo , Virus del Papiloma Humano
20.
Semin Nephrol ; 44(1): 151494, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38538455

RESUMEN

Kidney transplantation is the ideal treatment modality for patients with end-stage kidney disease, with excellent outcomes post-transplant compared with dialysis. However, kidney transplant recipients are at increased risk of infections and cancer because of the need for immunosuppression. Kidney transplant recipients have approximately two to three times greater risk of developing cancer than the general population, and cancer is a major contributor to morbidity and mortality. Most of the increased risk is driven by viral-mediated cancers such as post-transplant lymphoproliferative disorder, anogenital cancers, and Kaposi sarcoma. Nonmelanoma skin cancer is the most frequent type of cancer in kidney transplant recipients, likely due to an interaction between ultraviolet radiation exposure and decreased immune surveillance. Occurrence of the more common types of solid organ cancers seen in the general population, such as breast, prostate, lung, and colorectal cancers, is not, or is only mildly, increased post-transplant. Clinical care and future research should focus on prevention and on improving outcomes for important immunosuppression-related malignancies, and treatment options for other cancers occurring in the transplant setting.


Asunto(s)
Trasplante de Riñón , Neoplasias , Neoplasias Cutáneas , Humanos , Trasplante de Riñón/efectos adversos , Neoplasias/epidemiología , Neoplasias/etiología , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etiología , Sarcoma de Kaposi/epidemiología , Sarcoma de Kaposi/etiología , Trastornos Linfoproliferativos/epidemiología , Trastornos Linfoproliferativos/etiología , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/cirugía , Terapia de Inmunosupresión/efectos adversos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etiología , Neoplasias del Ano/epidemiología , Neoplasias del Ano/etiología , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/etiología , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/etiología , Factores de Riesgo , Receptores de Trasplantes
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