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Epidemiology of anal HPV in men in the region of Barretos/SP and proposal screening and follow-up protocol for primary and secondary prevention of condylomatosis in MSM/HIV

Abstract

Anal HPV infection is very common in men who have sex with men, (MSM), especially among the population living with HIV. Infection with multiple types of HPV is common and leads to a higher risk of progression to low and high risk anal intraepithelial lesions. HPV types 6 and 11 are the most commonly found in anal lesions, but types 16 and 18 are more related to anal cancer, as well as to cervical cancer. HPV infection is the major risk factor associated with anal cancer being detectable in approximately 60% of intraepithelial high risk of anal lesions. There is not, in our region, data on the actual incidence/prevalence of this disease in this population (MSM/HIV) or on HPV types related to anal infection. Similarly, there is, to date, no established protocol for screening of this population or follow-up for individuals already treated. A protocol in this model, which could be low-cost and effective for early detection of the disease or recurrence, would decrease treatment costs. In the MSM population living with HIV in Barretos region / SP: 1) assess the prevalence of anal HPV infection and anal condyloma; 2) evaluate the most frequent types of the virus involved in the infection and in the presence and recurrence of warts; 3) compare the prevalence of HPV infection in patients with and without detectable condyloma; 4) compare the types of HPV, relating them to the presence of clinical or subclinical detectable disease; 5) assess the rate of recurrence or persistence of anal HPV infection after surgical treatment for anal condyloma; 6) evaluate follow-up protocol for tracking appearance and recurrence of anal condyloma by anal cytology and high resolution anoscopy. 120 individuals will be included in 2 groups with 60 subjects each: MSM living with HIV with anal condyloma and MSM living with HIV without anal condyloma. The groups will be subject to follow-up protocol after treatment and screening, respectively. Collection of anal cytology and high-resolution anoscopy will be performed in the medical consultations (initial, 60, 180 and 360 days after first consultation or after surgical treatment). The analysis of material collected by anal cytology will be analyzed by linear array (s), providing data on type (s) of HPV involved in the infection. High-resolution anoscopy can detect subclinical lesions in the case of positive cytology to HPV. Analysis of the incidence of anal HPV infection in susceptible population (MSM living with HIV) in the region of Barretos/SP and analysis of virus types most commonly involved in this infection. Development of a low cost and efficient protocol for screening of subclinical lesions for anal HPV infection in high-risk population, reducing the incidence of these injuries and reducing the need for surgical treatment. (AU)