HPV Type Distribution in Benign, High-Grade Squamous Intraepithelial Lesions and Squamous Cell Cancers of the Anus by HIV Status

SIMPLE SUMMARY: Human papillomavirus (HPV)-associated cancers, such as anal cancer, are a major risk among people living with HIV (PLWH). High-risk (HR) HPVs are the causal agent of anal precancer and cancer. However, there is a paucity of data regarding the HPV genotypes that cause especially anal cancers and pre-cancers in PLWH. In this study we characterize the specific HPV types in anal tissues, including benign, pre-cancer, and cancer samples from PLWH, and compare them to similar samples from HIV-negative individuals. The results from our study suggest that a broader range of HPV types may play a role in anal cancer in PLWH than in HIV-negative individuals. Proposed screening approaches that include HPV testing might need to differ by HIV status, with extended HPV genotyping included for PLWH. ABSTRACT: The incidence of anal cancer is increasing, especially in high-risk groups, such as PLWH. HPV 16, a high-risk (HR) HPV genotype, is the most common genotype in anal high-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) in the general population. However, few studies have described the distribution of HR HPV genotypes other than HPV 16 in the anus of PLWH. HPV genotyping was performed by DNA amplification followed by dot-blot hybridization to identify the HR and low-risk (LR) genotypes in benign anal lesions (n = 34), HSIL (n = 30), and SCC (n = 51) of PLWH and HIV-negative individuals. HPV 16 was the most prominent HR HPV identified, but it was less common in HSIL and SCC from PLWH compared with HIV-negative individuals, and other non-HPV 16 HR HPV (non-16 HR HPV) types were more prevalent in samples from PLWH. A higher proportion of clinically normal tissues from PLWH were positive for one or more HPV genotypes. Multiple HPV infection was a hallmark feature for all tissues (benign, HSIL, SCC) of PLWH. These results indicate that the development of anal screening approaches based on HPV DNA testing need to include non-16 HR HPVs along with HPV 16, especially for PLWH. Along with anal cytology, these updated screening approaches may help to identify and prevent anal disease progression in PLWH.