Sexually transmitted infections (STIs)/HIV linked to human papillomavirus (HPV) in precancerous lesions in Cameroonian women

Yıl 2024, Cilt: 41 Sayı: 3, 530 - 536, 30.09.2024

Elisee Libert Embolo Enyegue , Ngono Abondo Floride Enstelle Awalou Halidou Mogo Cyrille Bruno Koanga Mogtomo Martin Luther

Öz

Cervical precancerous lesions signify cellular changes in the cervix linked to an escalated risk of cancer. These lesions often evolve towards malignancy influenced by various factors, including sexually transmitted infections (STIs), irrespective of human papillomavirus (HPV) presence. STIs represent a substantial global public health concern, affecting both sexes, with over 30 pathogens, comprising bacteria, viruses, and parasites, capable of causing STIs. The clinical presentation of these pathogens varies significantly. This study aimed to delineate the microbial profile within HPV-containing precancerous lesions. A prospective cross-sectional descriptive study was conducted in Cameroon's central region, particularly in the Endom district. Among 343 patients screened, 225 women were enrolled based on positive HPV cervical smear results. Cervical cell lesions were analyzed using the Papanicolaou technique, while parasitological and microbiological methods were utilized to identify other microbes. HPV genotypes were determined via multiplex PCR. The study revealed 65 HIV-positive and HPV-positive individuals (18.96%); 40 HIV-negative and HPV-positive individuals (11.65%); 25 HIV-positive and HPV-negative individuals (7.29%); and 213 HIV-negative and HPV-negative individuals (62.10%). Various cervical lesions were identified, including Low-grade Lesions (LSILs) (21%) and High-grade lesions (HSILs) (16%). Trichomonas vaginalis (TV) (51%), Candida albicans (CA) (28%), Herpes simplex (HS) (2%), Gardnerella vaginalis (GV) (17%), Aspergillus (A) (2%), and HIV were the primary infectious agents identified in these precancerous lesions, with significant distribution (P<0.005), suggesting their role as risk factors for precancerous lesions (OR=13.89, 95% CI 6.87-21.60). Multiple HPV genotypes were characterized in the same precancerous lesions, with approximately 25% (85) of women harboring either Low_Risk (LR) (6, 11) or High_Risk (HR) (16, 18, 45, 58) HPV genotypes (P<0.001). Coinfections such as HPV/TV/CA and HPV/HIV/TV were prevalent, indicating their potential as associated risk factors for precancerous lesions. Coinfections with other microbes, typically associated with cervicitis, appear to facilitate HPV infection. These findings contribute to understanding the microbial landscape of cervical samples and underscore the importance of integrated care approaches for HIV-positive individuals with HPV-related lesions.

Anahtar Kelimeler

Precancerous lesions, HPV, Coinfections, Cervical cytology, Microbial composition

Kaynakça

• B. J. Monk et al., “Integration of immunotherapy into treatment of cervical cancer: Recent data and ongoing trials,” Cancer Treat. Rev., vol. 106, p. 102385, May 2022, doi: 10.1016/j.ctrv.2022.102385.
• E. Saitoh, K. Saika, T. Morisada, and D. Aoki, “Status of cervical cancer screening among adolescents and young adults (AYA) in Japan,” Int. J. Clin. Oncol., vol. 27, no. 3, pp. 473–480, Mar. 2022, doi: 10.1007/s10147-021-02100-w.
• B. Santella et al., “Microbiota and HPV: The role of viral infection on vaginal microbiota,” J. Med. Virol., vol. 94, no. 9, pp. 4478–4484, Sep. 2022, doi: 10.1002/jmv.27837.
• P. Tsikouras et al., “Cervical cancer: screening, diagnosis and staging,” J. BUON Off. J. Balk. Union Oncol., vol. 21, no. 2, pp. 320–325, 2016.
• V. Ortiz-de la Tabla and F. Gutiérrez, “Cervicitis: Etiology, diagnosis and treatment,” Enfermedades Infecc. Microbiol. Clin. Engl. Ed, vol. 37, no. 10, pp. 661–667, Dec. 2019, doi: 10.1016/j.eimc.2018.12.004.
• E. Cc, A. Nr, E. Ib, and O. C, “Predominance of cervicitis agents with minimal testing rate within the student population in Benin city, Nigeria,” J. Obstet. Gynaecol. J. Inst. Obstet. Gynaecol., vol. 39, no. 6, Aug. 2019, doi: 10.1080/01443615.2019.1584888.
• J. Hanna et al., “Molecular epidemiology and sociodemographic risk factors for sexually transmitted infections among women in Lebanon,” BMC Infect. Dis., vol. 20, no. 1, p. 375, May 2020, doi: 10.1186/s12879-020-05066-8.
• F. P. Carneiro et al., “Cervical Cytology of Samples with Ureaplasma urealyticum , Ureaplasma parvum , Chlamydia trachomatis , Trichomonas vaginalis , Mycoplasma hominis , and Neisseria gonorrhoeae Detected by Multiplex PCR,” BioMed Res. Int., vol. 2020, pp. 1–10, Jul. 2020, doi: 10.1155/2020/7045217.
• R. Fowler, E. V. Maani, C. J. Dunton, D. P. Gasalberti, and B. W. Jack, “Cervical Cancer,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2024. Accessed: Mar. 01, 2024. (Online). Available: http://www.ncbi.nlm.nih.gov/books/NBK431093/
• A. Mitra et al., “Cervical intraepithelial neoplasia disease progression is associated with increased vaginal microbiome diversity,” Sci. Rep., vol. 5, p. 16865, Nov. 2015, doi: 10.1038/srep16865.
• R. M. Brotman, “Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective,” J. Clin. Invest., vol. 121, no. 12, pp. 4610–4617, Dec. 2011, doi: 10.1172/JCI57172.
• M. E. Salive, “Multimorbidity in older adults,” Epidemiol. Rev., vol. 35, pp. 75–83, 2013, doi: 10.1093/epirev/mxs009.
• L. K. Smith, C. Pope, and J. L. Botha, “Patients’ help-seeking experiences and delay in cancer presentation: a qualitative synthesis,” Lancet Lond. Engl., vol. 366, no. 9488, pp. 825–831, Sep. 2005, doi: 10.1016/S0140-6736(05)67030-4.
• J. Holt-Lunstad, T. B. Smith, and J. B. Layton, “Social relationships and mortality risk: a meta-analytic review,” PLoS Med., vol. 7, no. 7, p. e1000316, Jul. 2010, doi: 10.1371/journal.pmed.1000316.
• E. E. E. Libert et al., “Variables Affecting the Development and Progression of Precancerous Lesions in the Cameroon Women Population,” Int. Res. J. Oncol., pp. 148–158, Dec. 2022.
• P. E. Castle et al., “A comparison of screening tests for detection of high-grade cervical abnormalities in women living with HIV from Cameroon,” Infect. Agent. Cancer, vol. 15, p. 45, Jul. 2020, doi: 10.1186/s13027-020-00311-w.
• J. S. Smith et al., “Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update,” Int. J. Cancer, vol. 121, no. 3, pp. 621–632, Aug. 2007, doi: 10.1002/ijc.22527.
• G. B. Lazenby et al., “An association between Trichomonas vaginalis and high-risk human papillomavirus in rural Tanzanian women undergoing cervical cancer screening,” Clin. Ther., vol. 36, no. 1, pp. 38–45, Jan. 2014, doi: 10.1016/j.clinthera.2013.11.009.
• S. C. Masha, E. Wahome, M. Vaneechoutte, P. Cools, T. Crucitti, and E. J. Sanders, “High prevalence of curable sexually transmitted infections among pregnant women in a rural county hospital in Kilifi, Kenya,” PLOS ONE, vol. 12, no. 3, p. e0175166, Mar. 2017, doi: 10.1371/journal.pone.0175166.
• H.-W. Chi et al., “Candida albicans versus nonalbicans bloodstream infections: the comparison of risk factors and outcome,” J. Microbiol. Immunol. Infect. Wei Mian Yu Gan Ran Za Zhi, vol. 44, no. 5, pp. 369–375, Oct. 2011, doi: 10.1016/j.jmii.2010.08.010.
• M. Javanbakht et al., “Prevalence and Factors Associated with Trichomonas vaginalis Infection among High-risk Women in Los Angeles,” Sex. Transm. Dis., vol. 40, no. 10, pp. 804–807, Oct. 2013, doi: 10.1097/OLQ.0000000000000026.
• S. de Sanjose et al., “Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study,” Lancet Oncol., vol. 11, no. 11, pp. 1048–1056, Nov. 2010, doi: 10.1016/S1470-2045(10)70230-8.
• M. Xu and Y. Wang, “Clinical characteristics, HPV involvement, and demographic risk factors in women with cervical intraepithelial neoplasia complicated by vaginal intraepithelial neoplasia,” BMC Womens Health, vol. 24, no. 1, p. 220, Apr. 2024, doi: 10.1186/s12905-024-03030-1.
• D. H. Adler, “The Impact of HAART on HPV-Related Cervical Disease,” Curr. HIV Res., vol. 8, no. 7, pp. 493–497, Oct. 2010.
• E. Gillet et al., “Association between bacterial vaginosis and cervical intraepithelial neoplasia: systematic review and meta-analysis,” PloS One, vol. 7, no. 10, p. e45201, 2012, doi: 10.1371/journal.pone.0045201.