Essay Example on The Human Papillomavirus

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The Human Papillomavirus HPV is the most common sexually transmitted infection STI in the world and is an identifiable source of 93 of anal carcinomas and 90 of anal condylomata acuminata The HPV and Anal Cancer Foundation 2017 Due to the asymptomatic nature of the virus the prevalence rate of HPV is difficult to determine However a 50 to 80 lifetime exposure and infection rate worldwide has been reported Hathaway 2012 Within the United States alone 80 million individuals are infected with HPV with an estimated 14 million newly diagnosed HPV infections annually The HPV and Anal Cancer Foundation 2017 Research has indicated that much like cervical carcinoma there is a strong association between anal carcinoma and HPV Crawshaw et al 2015 Based on the United States cancer registries from 2008 2010 Saraiya et al 2015 indicated an estimated 1 916 HPV associated anal carcinomas in males Anal intraepithelial neoplasia AIN an HPV related dysplastic change in the cells of the anal canal is a known precursor to anal carcinomas and may be classified as low grade AIN I or high grade AIN II and AIN III dysplasia based on its ability to produce neoplastic transformation Crawshaw et al 2015 Dietrich et al 2015 Low grade AIN is associated with anal condylomata acuminata and therefore is not considered a direct precursor to anal carcinoma 



However high grade AIN is considered a precancerous lesion and may result in anal carcinoma following chronic infection with high risk HPV strains Dietrich et al 2015 Although anal carcinoma is relatively rare rates have increased steadily over the decades Shiels Kreimer Coghill Darragh and Devesa 2015 Within the general population the estimated incidence of anal carcinoma is approximately one per 100 000 Salit et al 2010 The rates are more frequent in HIV positive MSM with a reported incidence of 60 160 per 100 000 and are comparable to rates of cervical carcinoma in females prior to the advent of cervical pap screening Salit et al 2010 Dietrich et al 2015 reported a higher prevalence rate of anal HPV infection 90 and AIN 70 in MSM as well as an 80 to 100 fold increase in anal carcinoma risk in this select population Machalek et al 2012 reported that based on systematic reviews and meta analysis the prevalence of high grade AIN was 29 1 in HIV positive men who have sex with men MSM with an incidence ranging from 8 5 to 15 4 annually Furthermore the progression from a high grade AIN to anal carcinoma has been reported to develop significantly faster in HIV positive patients than in the general population


Dietrich et al 2015 

HIV positive patients have increased prevalence and may exhibit a more aggressive course of HPV disease progression This may be a result of direct interactions between HIV and HPV as well as the presence of an attenuated immune response and chromosomal instability Nahas et al 2009 The use of combination antiviral therapy has reduced HIV related opportunistic infections and mortality Salit et al 2010 Due to antiretroviral management HIV patients have prolonged survival and there is suggestion that because of this prolonged survival increasing rates of anal carcinoma may be realized Nahas et al 2009 As a result of this known association between HPV AIN and anal carcinoma there has been a growing concern that a screening protocol be established for high risk populations such as HIV positive individuals Crawshaw et al 2015 Considering the decrease in cervical carcinomas since the advent of cervical pap testing the use of anal pap cytology has been accepted as a screening method for AIN Crawshaw et al 2015 



The terminology and grading criteria for anal pap cytology is equivalent to that of cervical squamous intraepithelial lesions which makes use of the Bethesda classification system This system differentiates between normal cytology atypical squamous cells of undetermined significance ASCUS low grade squamous intraepithelial lesion LSIL high grade squamous intraepithelial lesion HSIL and squamous cell carcinoma Dietrich et al 2015 While cervical pap cytology exhibits satisfactory sensitivity and specificity the reported overall sensitivity and specificity of anal pap cytology is variable with a reported range from 69 to 93 and 32 to 59 respectively Leeds Fang 2016 Leeds and Fang 2016 reported anal cytology specificity for diagnosing the correct degree of dysplasia was poor with routine reports of low grade dysplasia for lesions that were found to be high grade dysplasia upon histopathology Furthermore the authors indicated that the sensitivity of anal pap cytology is decreased in high risk groups and false negative cytology has been reported as high as 23 in MSM and 45 in HIV positive individuals Therefore the aim of this pilot study was to determine the correlation between anal pap cytology and tissue histology in HIV positive males diagnosed with AIN


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