braz j infect dis.2016;20(1):111–112
ww w . e l s e v i e r . c o m / l o c a t e / b j i d
The Brazilian Journal of
INFECTIOUS DISEASES
Letter to the Editor
High frequency of human papillomavirus type 53 in oral cavity of asymptomatic HIV-infected people
DearEditor,
Humanpapillomavirus(HPV) hasbeen associatedwiththe benign and malign diseases of the oral cavity, being con- sidereda cofactorinhumanimmunodeficiency virus (HIV) acquisition.1GiventheincreasedriskforHPV-associatedoral diseasesinHIV-positivepatients,screeningofHPVinhealthy oralmucosaofthesepatientsmightbeusefulforepidemiol- ogy,preventivehealthmeasures,andtreatmentoptions.
Inthisway,weconductedadescriptive,case–controlstudy in 197 individuals aged from 18 to 75 years and asymp- tomatic for oral lesions. The target group consisted of 77 HIV-positiveindividualswhoattendedattheUniversityHos- pital’sambulatory,NiteróiCity,RiodeJaneiro,Brazil,between 2009and 2010. Thecontrol group included 120 volunteers fromUniversityHospital’sblooddonorsservice,locatedinthe
Table1–OccurrenceoforalHPVgenotypesinHIV-positiveandnegativepeople.
HPVgenotypes HPVgenotypesfrequency Oddsratio(95%CI) 2
HIV+N(%) HIV−N(%) p-Value
Lowrisk
6 11(14.3) 33(27.5) 0.43(0.20–0.93) 0.021
11 6(7.8) 0.0 1.08(1.01–1.15) 0.003
13 1(1.3) 0.0
72 0.0 1(0.8)
Highrisk
18 1(1.3) 1(0.8)
52 0.0 1(0.8)
Probablehighrisk
53 17(22.1) 1(0.8) 33.72(4.38–259.4) 0.000
82 2(2.6) 0.0
Undeterminedrisk
32 0.0 1(0.8)
71 0.0 2(1.7)
84 0.0 1(0.8)
Beta-papillomavirus
110 1(1.3) 0.0
120 2(2.6) 0.0
Co-infections 15(89.1) 5(10.9) 3.96(1.30–12.09) 0.021
Unidentifiedtypes 20(26.0) 11(9.2) 3.47(1.55–7.75) 0.002
Negativesamples 31(40.3) 74(61.7)
samecity.TheEthicsCommitteeoftheCollegeofMedicine of the University provided ethical clearance forthe proto- col and informed consent, under the registration 357.085.
Demographicandbehavioral datawerecollected througha structuredquestionnaire.ForHIV-positivepeople,CD4counts were determined and plasma HIV-1 RNAlevels were mea- sured. An oral mucosal sample was harvested from all participants.TheDNAextractedwassubmittedtoPCRassay forHPVdetectionusingMY09/11consensusprimersandHPV positivesamplesweretypifiedbyrestrictionfragmentlength polymorphism analysis (RFLP) orautomated sequencing. A databankwasgeneratedintheSPSS-18statisticalpacketto identifyassociations betweenvariantsand thepresenceof HPV.
RegardingHIVinfectionstatus,68.4%ofpatientshadunde- tectableHIVviralload,76.6%reportedHIVdiagnosticmore
112
braz j infect dis.2016;20(1):111–112than4fouryearsprior,and88.3%wereundergoingantiviral therapy.Atthetimeofourstudy,90.9%ofpatientshadabove 200CD4+cells/mL.DemographicvariablesdidnotaffectHPV infectioninHIVpositiveornegativepeople.However,oralHPV infectionwassignificantlyassociatedwithHIV-positiveindi- viduals (59.7% versus38.3%,p=0.004). Table1 displaysthe spectrumofHPVgenotypesfoundinoralcavityfrom both populations.Theyarecategorizedaccordingtothecriterion basedontheriskforcervicalcancer.2
HPVgenotypesdifferedinHIVpositiveandnegativepeo- ple,inspiteofnononcogenictypeshavepredominatedinboth groups.Thetypesthatcouldnotbeidentifiedbyperformed techniques were significantly higher in the group infected withHIV,beingthreetimeshigherinthosewhohadreceived HIVdiagnosislessthan4yearsprior(p=0.045).Itcanbethat lowimmunity,yetnotrecoveredbyantiretroviraltreatment, hasfavoredtheacquisitionofunidentifiedHPVgenotypes.
AsignificantassociationwasfoundbetweenHPV53and HIVinfection,and the riskforit in thewomen oralcavity wasaboutsixtimeshigherthaninmen(p=0.001).Concurrent oralHPVinfectionswerelikelytobemorecommoninHIV- positivepatientsthaninthehealthindividuals(Table1).When participantslivingornotwithHIVinfectionweregroupedto evaluatetheseoutcomes(N=197),weverifiedthatwomencar- riedout asignificanthighpercentageofmultipleinfections (p=0.005).
ThesignificantrelationshipbetweenoralHPV53andHIV- infectedwomenmustbeconsidered.Inaformerstudy,our researchgroup detected HPV53 amongthe most frequent types found in cervical samples of HIV-infected women.3 Despiteboth studiesmay notbelinkedbecause theywere conductedwithdifferentHIV-infectedpopulations,theypoint outtheHPV53prevalenceinbothoralandgenitalsitesofthe HIV-infectedwomeninaparticulargeographicarea.Martins etal.4alsoreportedtheHPV53asthemostfrequentlygeno- typeamongcervicalscrapesfromHIV-positivewomeninthe northeasternBrazil.Inthesameway,Palefskyetal.5observed incervicalsamplesamongtheHIV-positivewomenthatsome lowandprobableriskHPVtypes,includingHPV53,weresig- nificantlymorecommonamongthosewithlowerCD4levels, andthesealsospannedtherangeofoncogenicrisk.Therefore, theresultsdescribedinthepresentstudycouldsuggestahigh spreadofHPV53genotypeamongHIV-infectedpopulationby oral/genitaltransmission.
Conflicts of interest
Theauthorsdeclarenoconflictsofinterest.
Acknowledgements
ThisworkwassupportedbyConselhoNacionaldeDesenvolvi- mento Científico e Tecnológico (CNPq No. 303560/2012-6),
Pro-Reitoria de Pesquisa e Pós-Graduac¸ão da Universi- dade Federal Fluminense (PROPP-UFF), and Fundac¸ão de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, No. E-26/111.255/2014). We thank the Plataforma de Sequenciamento de DNA of the Universidade Federal Fluminense and André Victor Barbosa for his technical assistance.
r e f e r e n c e s
1.ChaturvediAK,MadeleineMM,BiggarRJ,EngelsEA.Riskof humanpapillomavirus-associatedcancersamongpersons withAIDS.JNatlCancerInst.2009;101:1120–30.
2.Mu ˜nozN,BoschFX,deSanjoséS,etal.InternationalAgency forResearchonCancerMulticenterCervicalCancerStudy Group.Epidemiologicclassificationofhumanpapillomavirus typesassociatedwithcervicalcancer.NEnglJMed.
2003;348:518–27.
3.Melgac¸oFG,RosaML,AugustoEF,etal.Humanpapillomavirus genotypesdistributionincervicalsamplesfromwomenliving withhumanimmunodeficiencyvirus.ArchGynecolObstet.
2011;283:809–17.
4.MartinsAE,Lucena-SilvaN,GarciaRG,etal.Prevalenceof humanpapillomavirusinfection,distributionofviraltypes andriskfactorsincervicalsamplesfromhuman
immunodeficiencyvirus-positivewomenattendingthree humanimmunodeficiencyvirus-acquiredimmunedeficiency syndromereferencecentresinnortheasternBrazil.MemInst OswaldoCruz.2014;109:738–47.
5.PalefskyJM,MinkoffH,KalishLA,etal.Cervicovaginalhuman papillomavirusinfectioninhumanimmunodeficiencyvirus-1 (HIV)-positiveandhigh-riskHIV-negativewomen.JNatCancer Inst.1999;91:226–36.
Carolina Oliveira Silvaa, Larissa Silva Santosa, Olga Maria Diniz Pereirab, KátiaMartins LopesAzevedoc, Ledy Horto SantosOliveiraa,∗
aDepartmentofMicrobiologyandParasitology,UniversidadeFederal Fluminense,RiodeJaneiro,RJ,Brazil
bBlood Bank, HospitalUniversitárioAntonioPedro, Universidade FederalFluminense,RiodeJaneiro,RJ,Brazil
cInfectiousandParasiticDiseasesService,UniversidadeFederalFlu- minense,RiodeJaneiro,RJ,Brazil
∗Correspondingauthorat:DepartmentofMicrobiologyandPara- sitology,FluminenseFederalUniversity,RuaProf.ErnaniMelo, 101CEP24210-130,Niterói,RiodeJaneiro,Brazil.
E-mailaddress:[email protected](L.H.S.Oliveira).
Received16September2015 Accepted2October2015
Availableonline15December2015
1413-8670/©2015ElsevierEditoraLtda.Allrightsreserved.
http://dx.doi.org/10.1016/j.bjid.2015.10.006
