Papillomavirus Research (Dec 2020)
Multiple HPV infections among men who have sex with men engaged in anal cancer screening in Abuja, Nigeria
- Rebecca G. Nowak,
- Lisa M. Schumaker,
- Nicholas P. Ambulos,
- Nicaise Ndembi,
- Wuese Dauda,
- Chinedu H. Nnaji,
- Andrew Mitchell,
- Trevor J. Mathias,
- Paul Jibrin,
- Teresa M. Darragh,
- Oluwole Olaomi,
- Trevor A. Crowell,
- Stefan D. Baral,
- Manhattan E. Charurat,
- Søren M. Bentzen,
- Joel M. Palefsky,
- Kevin J. Cullen,
- Manhattan Charurat,
- Julie Ake,
- Aka Abayomi,
- Sylvia Adebajo,
- Stefan Baral,
- Trevor Crowell,
- Charlotte Gaydos,
- Sosthenes Ketende,
- Afoke Kokogho,
- Jennifer Malia,
- Olumide Makanjuola,
- Nelson Michael,
- Nicaise Ndemb,
- Rebecca Nowak,
- Oluwasolape Olawore,
- Zahra Parker,
- Sheila Peel,
- Habib Ramadhani,
- Merlin Robb,
- Cristina Rodriguez-Hart,
- Eric Sanders-Buell,
- Elizabeth Shoyemi,
- Sodsai Tovanabutra,
- Sandhya Vasan
Affiliations
- Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA; Corresponding author. Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, 725 W. Lombard Street, Baltimore, MD, 21201, USA.
- Lisa M. Schumaker
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Nicholas P. Ambulos
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Nicaise Ndembi
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Wuese Dauda
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Chinedu H. Nnaji
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Andrew Mitchell
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Trevor J. Mathias
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Paul Jibrin
- National Hospital, Abuja, Nigeria
- Teresa M. Darragh
- Department of Pathology, University of California, San Francisco, CA, USA
- Oluwole Olaomi
- National Hospital, Abuja, Nigeria
- Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Stefan D. Baral
- Johns Hopkins School of Public Health, Baltimore, MD, USA
- Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Søren M. Bentzen
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Joel M. Palefsky
- Department of Medicine, University of California, San Francisco, CA, USA
- Kevin J. Cullen
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Manhattan Charurat
- University of Maryland, Baltimore, USA
- Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Aka Abayomi
- International Centre for Advocacy for the Right to Health, Abuja, Nigeria
- Sylvia Adebajo
- Maryland Global Initiatives Corporation, Abuja, Nigeria
- Stefan Baral
- Johns Hopkins University, Baltimore, USA
- Trevor Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Charlotte Gaydos
- Johns Hopkins University, Baltimore, USA
- Sosthenes Ketende
- Johns Hopkins University, Baltimore, USA
- Afoke Kokogho
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; HJF Medical Research International, Abuja, Nigeria
- Jennifer Malia
- Department of Laboratory Diagnostics and Monitoring, Walter Reed Army Institute of Research, Silver Spring, USA
- Olumide Makanjuola
- The Initiative for Equal Rights, Lagos, Nigeria
- Nelson Michael
- Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, USA
- Nicaise Ndemb
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Rebecca Nowak
- University of Maryland, Baltimore, USA
- Oluwasolape Olawore
- Johns Hopkins University, Baltimore, USA
- Zahra Parker
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Sheila Peel
- Department of Laboratory Diagnostics and Monitoring, Walter Reed Army Institute of Research, Silver Spring, USA
- Habib Ramadhani
- University of Maryland, Baltimore, USA
- Merlin Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Cristina Rodriguez-Hart
- New York City Department of Health and Mental Hygiene, Long Island City, USA
- Eric Sanders-Buell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Elizabeth Shoyemi
- Population Council Nigeria, Lagos, Nigeria
- Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Sandhya Vasan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Journal volume & issue
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Vol. 10
p. 100200
Abstract
Background: Anal precancers and cancers can be detected during screening with high-resolution anoscopy (HRA). The sensitivity of HRA depends on the burden and duration of human papillomavirus (HPV) among those screened as well as anoscopist proficiency, which is highly correlated with prior screening experience. Our objective was to compare the identification and type of HPV and the likelihood of HRA-detected precancer for men who have sex with men (MSM) undergoing their first HRA-screening in Nigeria. Methods: MSM were recruited from an HIV test-and-treat cohort, TRUST/RV368, into a new anal cancer screening program. Anal swabs obtained during screening underwent Ion Torrent next-generation sequencing using barcoded HPV PCR broad-spectrum primers 5+/6+ to detect up to 161 HPVs. All high-risk (HR) HPVs and the most abundant low-risk (LR)-HPVs were evaluated as type-specific infections with some categorized as belonging to a multiple infection. HRA screening results included benign, low-grade squamous intraepithelial lesions (LSIL), or HSIL as detected by cytology or histology. Multivariable logistic regression was used to assess the association of HPV and other cofactors with any SIL. Results: Among 342 MSM, 60% were HIV-infected, 89% were under 35 years of age, and 51% had 8 or more years since anal coital debut. Of those with SIL, 89% had LSIL and only 11% had HSIL. Prevalence of any HPV and high-risk (HR)-HPV was 92% and 74%, respectively. The most prevalent genotypes in rank order were HPV6 (31%), HPV16 (23%), HPV42 (20%), HPV11 (18%), HPV45 (18%), and HPV51 (17%). For multiple HR-HPVs, 31% had a single HR-HPV, 32% had 2-3, and 10% had 4 or more. Low-risk HPVs, type 6 and/or 11, were common (42%) and were significantly associated with SIL (adjusted odds ratio [aOR]:1.8, 95% confidence interval [CI]: 1.1–3.1) together with perianal warts (aOR:6.7, 95% CI: 3.3–13.5). In contrast, HR-HPV and multiple HR-HPVs were not significantly associated with SIL (all p > 0.05). Conclusions: Detection of HSIL was low. Although HR-HPV was abundant, HSIL development also depends on the duration of HR-HPV infections and the anoscopist's level of experience. As our cohort ages and the anoscopist becomes more skilled, detection of HSIL will likely improve.
