Marta Ortiz

Influence of age and geographical origin in the prevalence of high risk human papillomavirus in migrant female sex workers in Spain.

Objectives: To estimate the prevalence and risk factors of high risk human papillomavirus (HPV) infection in migrant female sex workers (FSW) according to age and geographical origin. Methods: Cross sectional study of migrant FSW attending a sexually transmitted infection (STI) clinic in Madrid during 2002. Information on sociodemographic characteristics, reproductive and sexual health, smoking, time in commercial sex work, history of STIs, HIV, hepatitis B, hepatitis C, syphilis, and genitourinary infections was collected. High risk HPV Infection was determined through the Digene HPV Test, Hybrid Capture II. Data were analysed through multiple logistic regression. Results: 734 women were studied. Overall HPV prevalence was 39%; 61% in eastern Europeans, 42% in Ecuadorians, 39% in Colombians, 29% in sub-Saharan Africans, and 24% in Caribbeans (p = 0.057). HPV prevalence showed a decreasing trend by age; 49% under 20 years, 35% in 21–25 years,14% over 36 years% (p<0.005). In multivariate analyses, area of origin (p = 0.07), hormonal contraception in women not using condoms (OR 19.45 95% CI: 2.45 to 154.27), smoking, age, and an interaction between these last two variables (p = 0.039) had statistically significant associations with HPV prevalence. STI prevalence was 11% and was not related to age or geographical origin. Conclusions: High risk HPV prevalence in migrant FSW is elevated and related to age, area of origin, and use of oral contraceptives in women not using condoms. These data support the role of acquired immunity in the epidemiology of HPV infection and identifies migrant FSW as a priority group for sexual health promotion.

Oncogenic Human Papillomavirus (HPV) Type Distribution and HPV Type 16 E6 Variants in Two Spanish Population Groups with Different Levels of HPV Infection Risk

ABSTRACT The aim of this study is to determine oncogenic human papillomavirus (HPV) types and HPV type 16 (HPV16) variant distribution in two Spanish population groups, commercial sex workers and imprisoned women (CSW/IPW) and the general population. A multicenter cross-sectional study of 1,889 women from five clinical settings in two Spanish cities was conducted from May to November 2004. Oncogenic HPV infection was tested by an Hybrid Capture II (HC2) test, and positive samples were genotyped by direct sequencing using three different primer sets in L1 (MY09/11 and GP5+/GP6+) and E6/E7. HPV16 variants were identified by sequencing the E6, E2, and L1 regions. Four hundred twenty-five samples were positive for the HC2 test, 31.5% from CSW/IPW and 10.7% from the general population. HPV16 was the most frequent type. Distinct profiles of oncogenic HPV type prevalence were observed across the two populations. In order of decreasing frequency, HPV types 16, 31, 58, 66, 56, and 18 were most frequent in CSW/IPW women, and types 16, 31, 52, 68, 51, and 53 were most frequent in the general population. We analyzed HPV16 intratype variants, and a large majority (78.7%) belonged to the European lineage. AA variants were detected in 16.0% of cases. African variants belonging to classes Af1 (4.0%) and Af2 (1.3%) were detected. Different HPV types and HPV16 intratype variants are involved in oncogenic HPV infections in our population. These results suggest that HPV type distribution differs in CSW/IPW women and in the general population, although further analysis is necessary.

Anal Human Papillomavirus Genotype Distribution in HIV-Infected Men Who Have Sex with Men by Geographical Origin, Age, and Cytological Status in a Spanish Cohort

ABSTRACT Knowledge of human papillomavirus (HPV) type distribution in populations at risk for anal cancer is needed. Here, we describe the anal HPV genotype distribution in a large Spanish cohort (Cohort of the Spanish HIV Research Network HPV [CoRIS-HPV]) of HIV-positive men who have sex with men (MSM) according to geographical origin, age, and cytological status. A cross-sectional analysis of baseline data from 1,439 HIV-infected MSM (2007 to 2012) was performed. Anal HPV genotyping was performed using the Linear Array HPV genotyping test. Descriptive analyses of subject characteristics, prevalences, and 95% confidence intervals (CI) were performed. The global prevalences of HPV, high-risk HPV (HR-HPV), and low-risk HPV (LR-HPV) types were 95.8%, 83.0%, and 72.7%, respectively. Among the HR-HPV types, HPV16 was the most common, followed by HPV59, -39, -51, -18, and -52. The prevalence of multiple HR-HPV infections was 58.5%. There were no differences in the crude analyses between Spanish and Latin-American MSM for most HPV types, and a peak in prevalence for most HPV types was seen in patients in their late thirties. Globally and by specific HPV groups, men with abnormal anal cytologies had a higher prevalence of infection than those with normal cytologies. This study has the largest number of HIV-positive MSM with HPV genotype data analyzed according to cytological status as far as we know. The information gained from this study can help with the design of anal cancer prevention strategies in HIV-positive patients.

Higher prevalence of human papillomavirus infection in migrant women from Latin America in Spain.

Objectives: To estimate prevalence and determinants of high risk (HR) human papillomavirus (HPV) by country of origin in women attending a family planning centre (FPC) in Alicante, Spain. Methods: Cross sectional study of all women attending a FPC from May 2003 to January 2004. An ad hoc questionnaire was designed and data were collected prospectively. HR HPV infection was determined through the Digene HPV test, Hybrid Capture II, and positive samples for PCR were directly sequenced. Data were analysed through multiple logistic regression. Results: HR HPV prevalence in 1011 women was 10% (95% CI: 8.2 to 12). Compared to Spaniards (prevalence 8.2%) HR HPV prevalence in Colombians was 27.5% (OR: 4.24 95% CI: 2.03 to 8.86), 23.1% in Ecuadoreans (OR: 3.35 95% CI: 1.30 to 8.63), and 22.73% in women from other Latin American countries (OR: 3.29 95% CI: 1.17 to 9.19). Women with more than three lifetime sexual partners had an increased risk of HR HPV infection (OR 3.21 95% CI: 2.02 to 5.10). The higher risk of HR HPV infection was maintained in Latin American women in multivariate analyses that adjusted for age, number of lifetime sexual partners, and reason for consultation. The commonest HPV types in women with normal cervical smears were HPV-18 (20%), HPV-16 (14%) and HPV-33 (11%). Conclusions: Prevalence of HR HPV is more than three times higher in Latin Americans than in Spaniards. Latin American women’s HPV prevalence resembles more that of their countries of origin. It is essential that health service providers identify these women as a priority group in current cervical screening programmes

What Drives the Number of High-Risk Human Papillomavirus Types in the Anal Canal in HIV-Positive Men Who Have Sex With Men?

We estimated the effect of sexual behavior, age, and immunodeficiency on the number of high-risk human papillomavirus (HR-HPV) types in the anal canal among human immunodeficiency virus-positive men who have sex with men (MSM). Anal samples were genotyped with the Linear Array HPV Genotyping Test, and risk factors were investigated with Poisson regression. Of 586 MSM, 69% were Spanish, and 25.6% were Latin American; the median age was 34.9 years (interquartile range [IQR], 30.1-40.8). The median number of recent sex partners was 6 (IQR, 2-24 sex partners), and the median CD4(+) T-cell count was 531.5 cells/mm(3) (IQR, 403-701 cells/mm(3)). The prevalence of any and multiple HR-HPV infections was 83.4% and 60.5%, respectively. The most common types were HPV-16 (42%), HPV-51 (24%), HPV-39 (23.7%), and HPV-59 (23.5%). Age had a statistically significant, nonlinear association with the number of types, with the highest number detected around 35 years of age (P < .001). The number of recent sex partners had a statistically significant, fairly linear association on the log scale (P = .033). The high prevalence of HR-HPV types is associated with recent sexual behavior and age.

Prevalence of undiagnosed HIV infection in the general population having blood tests within primary care in Madrid, Spain

Objective To estimate the prevalence of undiagnosed HIV infection in men and women aged 16–80 years, having blood tests within primary care in Madrid, Spain. Methods A serosurvey to monitor vaccine-preventable diseases in the general population aged 16–80 years was conducted in 2008–2009. Eligible individuals were those having blood tests. The blood extraction centres, the primary sampling units, were chosen in proportion to the size and socio-economic characteristics of the target population, aiming for a sample size of 5355 subjects with equal sex distribution within five age bands. Migrants aged 16–40 years were oversampled. Previous HIV diagnoses were excluded. Prevalence rates of HIV infection with 95% CIs were estimated allocating weights inverse to their probability of selection. Results Overall, 3695 subjects agreed to participate, yielding a response rate of 69%, similar for men (66%) and women (73%); individuals recruited at healthcare centres or by telephone; and for all age groups except those aged ≥60 (57%) years. HIV infection was diagnosed in 12 subjects (0.35%; 95% CI 0.13 to 0.57); prevalence, higher in men (0.51%; 95% CI 0.12 to 0.89) than in women (0.20%; 95% CI 0.00 to 0.44); participants from other countries (0.61%; 95% CI 0.03 to 1.18) as compared with Spanish born (0.30%; 95% CI 0.06 to 0.53) and aged 21–30 years (0.65%; 95% CI 0.01 to 1.29), or 31–40 years (0.71%; 95% CI 0.02 to 1.41). None of the differences were statistically significant. Most of the 12 subjects were under follow-up for medical conditions; 11 had visited the primary care clinic in the preceding month. Conclusion The prevalence of undiagnosed HIV infection is very high and calls for strategies to unveil occult HIV infection.

Prevalence of beta and gamma human papillomaviruses in the anal canal of men who have sex with men is influenced by HIV status

BACKGROUND Mucosal high-risk human papillomavirus (HPV) types benefit differently from the immunocompromised status of the host. So far it is not known whether a similar scenario holds for the large group of the β and γ cutaneous HPV types that appear to be present at several anatomical sites. METHODS The presence of β (n=43) and γ (n=30) HPVs in the anal samples of 66 HIV-positive and 153 HIV-negative anonymized men who have sex with men (MSM) was determined by multiplex PCR, using type-specific primers and bead-based hybridization (Luminex technology). RESULTS The prevalence of β and γ HPV infection was 65.6% and 68.2%, respectively, among HIV-positive MSM and 59.1% and 57.7%, respectively, among HIV-negative MSM. β-2 and γ-10 were found to be the most prevalent species in both groups. The prevalence of infection with HPV types of the species β-1 (P=0.02), β-3 (P=0.002), γ-6 (P=0.002), and γ-7 (P=0.02) was higher in HIV-positive than HIV-negative men. In contrast, the β-2 species was equally distributed in the two groups, while the γ-10 species was slightly affected by HIV status. CONCLUSIONS These findings provide evidence that impairment of the hosts immune surveillance impacts β and γ HPV infections differently.

Anal squamous intraepithelial lesions are frequent among young HIV-infected men who have sex with men followed up at the Spanish AIDS Research Network Cohort (CoRIS-HPV)

The aim of our study was to determine the baseline prevalence of anal squamous intraepithelial lesions (SIL) and associated risk factors in HIV‐infected men who have sex with men (MSM) in a Spanish ongoing multicenter cohort. CoRIS‐HPV started in 2007, nested in the Spanish AIDS Research Network Cohort (CoRIS). Anal liquid cytology testing was performed. High‐risk human papillomavirus (HR‐HPV) infection was determined, and positive samples were genotyped. We analyzed all subjects up to April 2011. Multivariate logistic regression analyses were performed. A total of 551 subjects with baseline anal liquid cytologies were analyzed; 37.0% negative for intraepithelial lesion, 9.0% atypical squamous cells of uncertain significance (ASCUS), 41.0% low‐grade SIL, 4.0% high‐grade SIL and 9.0% inadequate. Prevalence of anal SIL (excluding ASCUS) in valid samples (n = 450) was 54.7% (95% confidence interval [CI] = 49.9–59.3). Globally HR‐HPV prevalence was 81.7% (95% CI = 78.0–85.2). Multiple infections (≥2 HR‐HPV genotypes) were documented in 77.7% (95% CI = 73.1–82.0). The only risk factor associated with anal SIL was the number of HR‐HPV types; MSM with five or more HR‐HPV genotypes had an odds ratio (OR) of anal SIL seven times greater (OR = 7.4; 95% CI = 2.8–19.6) than those with one HR‐HPV genotype. No associations were found for age, educational level, smoking, geographical origin, CD4 T‐cell count, antiretroviral treatment or number of sexual partners. The prevalence of anal SIL in young HIV‐positive MSM is high, and the main risk factor is multiple infections with HR‐HPV types.

Prevalence and determinants of high-risk human papillomavirus (HPV) infection and cervical cytological abnormalities in imprisoned women.

The aim of the study was to estimate the prevalence and risk factors associated with infection by high-risk human papillomavirus (HR-HPV) in cervix and squamous intra-epithelial lesions (SIL) in imprisoned women. This was done by a cross-sectional study of imprisoned women attending the gynaecological clinic in Foncalent prison in Alicante, Spain. The study period was from May 2003 to December 2005. HR-HPV infection was determined through Digene HPV Test, Hybrid Capture II (HC-II). HPV typing was determined by multiplex nested PCR assay combining degenerate E6/E7 consensus primers. Multiple logistic regression modelling was used for the analysis of associations between variables where some were considered possible confounders after checking for interactions. A total of 219 women were studied. HR-HPV prevalence was 27.4% and prevalence of SIL was 13.3%. HIV prevalence was 18%, higher in Spaniards than in migrant women (24.6% vs. 14.3%, P<0.05). In multivariate analyses, risk factors for HPV infection were younger age (P for trend=0.001) and tobacco use (OR 2.62, 95% CI 1.01-6.73). HPV infection (OR 4.8, 95% CI 1.7-13.8) and HIV infection were associated with SIL (OR 4.8, 95% CI 1.6-14.1). The commonest HPV types were HPV16 (29.4%), HPV18 (17.6%), HPV39 (17.6%) and HPV68 (17.6%). The prevalence of both HR-HPV infection and SIL in imprisoned women found in this study is high. Determinants for each of the outcomes studied were different. HPV infection is the most important determinant for SIL. A strong effect of HIV co-infection on the prevalence of SIL has been detected. Our findings reinforce the need to support gynaecological clinics in the prison setting.

Prevalence and Risk Factors of High-Risk Human Papillomavirus in Female Sex Workers in Spain: Differences by Geographical Origin

OBJECTIVE To study the influence of socioeconomic variables, lifestyles, and sexual behaviors on the prevalence of high-risk human papillomavirus (HR-HPV) infection in female sex worker (FSW) according to their geographic origin in Alicante, Spain. METHODS This is a cross-sectional study of 549 FSW attending an AIDS information and prevention center from May 2003 to December 2004. Face-to-face interviews were carried out. HR-HPV was determined through Digene HR-HPV Test. Hybrid Capture II-positive samples (Digene Corp., Gaithersburg, MD) for PCR were directly sequenced. Data were analyzed using multiple logistic regression. RESULTS HR-HPV prevalence was 28% in Spaniards, 32% in Latin Americans, 32% in Eastern Europeans, 16% in sub-Saharan Africans, and 65% in North Africans (p=0.04). Lower HR-HPV prevalence was associated with higher age, higher education, and higher body mass index (BMI) (p values for trend<0.05). In multivariate analyses, the effects of geographical origin, age, and education were maintained, together with time in sex work; women engaged for >1 year had a lower HR-HPV prevalence (OR 0.57, 95% CI 0.36-0.91) compared with those engaged <1 year. HR-HPV-16 was the most common type (n=23, 24%), followed by HR-HPV-18 and HR-HPV-31, (n=11, 11%), respectively. CONCLUSIONS HR-HPV prevalence is very high in FSW and varies by geographic origin. Women of younger age and lower education level and those engaged in sex work for <1 year showed the highest prevalence, making them a priority group for cervical cancer prevention programs.