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HPV

HPV. Saverio G Parisi Università degli Studi di Padova. Malattie Sessualmente Trasmesse…. Candida Chlamydia trachomatis HBV Herpes (HSV, CMV, EBV, HHV6, HHV8) HIV Neisseria gonorrhoeae Sifilide Tricomonas Vaginosi batterica …………………. Malattie Sessualmente Trasmesse…. HPV.

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HPV

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  1. HPV Saverio G Parisi Università degli Studi di Padova

  2. Malattie Sessualmente Trasmesse…. Candida Chlamydia trachomatis HBV Herpes (HSV, CMV, EBV, HHV6, HHV8) HIV Neisseria gonorrhoeae Sifilide Tricomonas Vaginosi batterica …………………..

  3. Malattie Sessualmente Trasmesse….HPV Sono stati identificati più di 100 tipi; circa 40 infettano la regione ano-genitale. Questi sono stati classificati in tipi a basso rischio, associati con verruche ano-genitali e displasia moderata, e tipi ad alto rischio, associati con displasia di alto grado e cancro ano-genitale. Le infezioni ano-genitali da HPV sono la più comune infezione sessualmente trasmessa: La maggioranza delle infezioni sono asintomatiche o subcliniche e divengono non determinabili con il tempo.

  4. Cancer % associated with certain HPV types Cervical° >99% Vaginal* 50% Vulvar* >50% Anal >70% Penile 50% Oropharyngeal 20% Nonmelanoma skin/cutaneous squamous cell § 90% HPV has been definitely associated with human cancers ° most common cancer in developing countries * includes cancer and intraepithelial neoplasia § immunocompromised patients

  5. Duration of HAART use was not significantly associated with a decreased risk of anal cancer Anal cancer among HIV+ is primarily a disease of younger men (median age 42y in this study). This mirrors other studies [Chiao 2008, Piketty 2008] among HIV-positive persons with median ages of 43–49 years and among transplant recipients [Penn 1986]. These ages are significantly younger than the age of occurrence (generally, the sixth decade) among HIV-uninfected persons. Among the general population, only 12% of anal cancers occur at an age of less than 44 years [Horner 2009]; In this study 63% of cases occurred in this age category.

  6. Among persons 18–49 years of age, the standardized rate of anal cancer was 95 per 100 000 person-years in this HIV cohort as compared with 0.47 in the general population [Joseph 2008]. This suggests that HIV-infected persons may have a shorter time to the development of anal cancer than the general population; immunosuppression and persistent coinfection may accelerate the rate of progression from HPV to cancer. The estimated latency from time of HPV infection to cancer is 5–40 years in general population [Diamond 2005]. Although the time period among HIV-infected persons has not yet been defined, it may be significantly shorter.

  7. I reali tassi di prevalenzaed incidenza dell’infezione e delle varie manifestazioni cliniche sono di difficile valutazione, in ragione della diversa diffusione, anche nel mondo occidentale, dei programmi di screening nella donna e della differente sensibilità nei vari paesi alla notifica di questa patologia ai sistemi di sorveglianza. Risulta difficile stimare l’infezione senza correlato anatomo-patologico e l’entità del fenomeno nel maschio, che non è sottoposto a programmi di prevenzione e viene diagnosticato solamente in occasione di manifestazioni clinicamente rilevabili. In Italia, dal 1991 al 2005, sono stati segnalati all’ Istituto Superiore di Sanità 26491 casi di condilomi genitali, il 74,1% dei quali nel sesso maschile.

  8. HPV infection was present in 97.9% of the 247 participants at baseline.Most patients (90.9%) were infected with multiple HPV types, with a median number of 5 types per sample (range, 0–18).The median number of high-risk HPVtypes was 3 per sample (range, 0–12) The most prevalent genotypes were HPV-16 (38.2%), HPV-6 (35.3%),HPV-42 (28.6%), HPV-18 (24.5%), HPV-11 (23.2%),HPV-52 (21.6%), HPV-45 (21.2%), and HPV-84 (21.2%)Prevalent HPV-16 infections had the lowest clearance rate and a mean retention time of 36 months

  9. A comparative study in HIV+ and HIV-ve adults showed that HIV+ individuals were more likely - to have an oral HPV infection (25.3 vs. 7.6%), - to be infected with a HR HPV type (13.7 vs. 4.5%), - to be infected with multiple HPV types (5.8 vs. 1.5%). Oral mucosa abnormalities such as leukoplakia, erythroplakia, and papillomas were also more frequent in HIV+. In multiple logistic regression, the odds of oral HPV infection in HIV+ patients increased with low CD4 cell counts (<200 cells/ml), HSV-2 seropositivity, mucosa abnormalities, and more than one oral sex partner within the last year

  10. HPV infection is associated with a subset of oral squamous cell carcinoma (OSCC), especially those arising from the base of the tongue and tonsils. Although the incidence of HPV-unrelated OSCCs associated with tobacco and alcohol use has been shown to decline over the last decades, OSCCs related to HPV significantly increased, particularly among white men and at youngerages [Chaturvedi 2008]. This seems to be a result of changes in sexual behaviors. Given the standardized incidence ratios of 2.32 for OSCCs in HIV+ persons, attention should be paid to this particular type of oral cancer, especially in HIV+ MSM [Grulich 2007].

  11. HPV infection in HIV infected Man who Have sex with Man (MSM) and correlation with HHV8 sheddingICAAC 2008To evaluate HPV genotypes circulation and persistence or re-infection over time in different sampling sites among HIV-MSMTo evaluate other co-infections, i.e. HHV8 oral shedding and syphilis

  12. MethodsSamples obtained from rectal mucosa (RS) and pharyngeal-swabs (PhS) of 166 MSM HIV-pts, prospectively recruited from December 2007 to August 2009, were studied for presence of HPV-DNA.Amplification products were sequenced by in-house method using ABI PRISM 3130 XL.Exclusion criteria were being already diagnosed or treated for HPV-anal lesions.In paired samples HHV8-DNA oral shedding was studied.

  13. A study including 166 subjects was performed to investigate the frequency and persistence over a 6-month interval

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