The connection between HPV and HIV. Viral infections in HIV-infected people. “If my partner has HPV and I don’t, that means he cheated on me.”

HUMAN PAPILLOMA VIRUS (HPV). HISTORY OF RESEARCH AND RELATIONSHIP TO HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Karp Tatyana Dmitrievna

2nd year student, Department of Medical Biophysics, FEFU, Russian Federation, Vladivostok

Reva Galina Vitalievna

scientific supervisor, Ph.D. honey. Sciences, Professor FEFU, Russian Federation, Vladivostok

Currently, more than 120 types of papillomaviruses have been identified, of which 70 types are described in detail. It has been established that papilloma viruses have type and tissue specificity, which means that each type is capable of infecting tissue specific to its localization. For example, HPV type 1 causes plantar warts, HPV type 2 causes common warts, HPV type 3 causes flat warts, etc.

Human papillomavirus (HPV) belongs to subgroup A of the papovirus family (Papoviridae). HPV has a spherical shape with a diameter of up to 55 nm. The capsid has a cubic type of symmetry, forms a geometric figure - an icosahedron, built from 72 capsomeres. The HPV genome is presented as a cyclically closed double-stranded DNA with a molecular weight of 3-5 mD. Isolated DNA has infectious and transforming properties. One of the DNA strands is considered coding and contains information about the structure of viral proteins. One coding chain contains up to 10 open reading frames, which, depending on their location in the genome, divide early and late.

The HPV virion contains two layers of structural proteins, designated by the letter E. The early region includes the E1, E2 genes, which are responsible for viral replication. The E4 gene is involved in the process of maturation of viral particles. HPVs of high oncogenic risk encode the synthesis of capsid proteins E5, E6 and E7, which are involved in malignant transformation. E6/p53 and E7/Rv1 interactions lead to cell cycle distortion with loss of control over DNA repair and replication. Thus, polymorphism of the gene encoding p53 is a genetic predisposition for the active development of HPV with subsequent malignancy of the cell. Late genes L1 and L2 encode viral capsid proteins.

Internal proteins connected to DNA are cellular histones, and capsid proteins are type-specific antigens. HPV reproduction occurs in the nuclei of cells, where viral DNA is present in the form of an episome. This is the first feature that distinguishes HPV from other oncogenic DNA viruses that can integrate their genome into the DNA of a transformed cell.

The second feature of HPV is that the viral gene responsible for the replication of cellular DNA can be transcribed, causing the host cell to divide along with the HPV, which leads to a productive type of inflammation, regardless of the ability of the host cell to regulate the expression of the viral genome.

The HPV genome contains hormonal receptors for progesterone and glucocorticoid hormones, which explains the dependence of the course of PVI on the woman’s hormonal homeostasis.

The International Agency for Research on Cancer classifies HPV 16, 31, 51, and 18 as “carcinogenic to humans,” while HPV 66 is classified as “possibly carcinogenic.”

Multivariate analysis suggests that the number of sexual partners during a lifetime plays a decisive role in HPV infection. This reinforces the idea that the most appropriate age for HPV vaccination is before sexual activity. Living with a partner had a protective effect against high-risk HPV infection.

The connection between HPV and HIV. After 30 years of the HPV epidemic, there are about 2 new infections for each treatment and no effective vaccine. New measures with a biologically targeted co-factor for HIV infection are needed. Links have been established between sexually transmitted infections, especially herpes simplex virus type 2, and the acquisition of HIV. A number of recent studies have documented the link between human papillomavirus (HPV) and HIV infection.

HPV is the main cause of cervical cancer, quickly acquired after the onset of sexual activity, infections with several genotypes are similar. This makes HPV a common sexually transmitted infection (STI) worldwide. There are approximately 40 HPV genotypes that affect the human genital tract, and they are divided into 2 groups depending on their oncogenic potential: high-risk oncogenic and low-risk non-oncogenic genotypes. Symptoms of infection appear rarely and, as a rule, in the form of anogenital condyloma. There are two effective vaccines that offer protection against HPV. The bivalent vaccine is directed against HPV types 16, 18, and the quadrivalent vaccine against HPV types 16,18, 6, 11. Evidence has been provided that both vaccines have cross-effects against types for which there is no vaccine (especially HPV 31,33 and 45).

Accumulating, assessing, and synthesizing existing evidence linking HPV to HIV acquisition could provide scientists with an important resource for assessing the potential role of HPV in the HIV pandemic. The purpose of the study was to accumulate and evaluate observational data that trace the relationship between HPV prevalence and HIV infections, and to estimate the proportion of HIV infections caused by HPV infections.

This systematic review of the literature provides the first summary of published data on the association between the prevalence of HPV infection and HIV acquisition. 7 out of 8 studies showed a connection between these infections; a high proportion of HIV infections are associated with any HPV genotype. Summarizing the studies in women, an almost twofold increase in the risk of HIV infection was found in the presence of HPV genotypes; the same association was found in two studies in men.

The link between HPV prevalence and increased risk of HIV infection is biologically plausible. It has been shown that the E7 protein of HPV type 16 reduces the number of epithelial adhesion molecules, namely E-cadherin (cell adhesion is the connection of cells with each other, which leads to the formation of certain correct types of histological structures specific to these types of cells. The specificity of cell adhesion is determined by the presence on the cell surface of cell adhesion proteins - integrins, cadherins, etc.).

This potentially increases the permeability of HIV in the genitals. The cells lining the genital tract contain Langerhans cells, which can internalize HIV, preventing further spread of the infection. The immune response to HPV is mediated by T lymphocytes, which may increase the risk of HIV infection because T lymphocytes are the primary target cells for HIV. An increase in the number of these cells was seen in HPV-infected cervical tissue. There was also an increase in the cytokine IL-Iβ, which activates the promoter region of the HIV genome, in women with abnormal cervical cytology infected with HPV.

To summarize, studies in women have shown a strong association between HPV prevalence and HIV infection. The HPV vaccine is highly effective in the primary prevention of HPV and subsequent cervical cancer and genital warts. The results presented in this study need to be refined to evaluate the potential of the HPV vaccine to influence HIV incidence.

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2. Cristina Giambi, Serena Donati, Francesca Carozzi, Stefania Salmaso, Silvia Declich, Marta L Ciofi degli Atti, Guglielmo Ronco, Maria P Alibrandi, Silvia Brezzi, Natalina Collina, Daniela Franchi, Amedeo Lattanzi, Maria C Minna, Roberto Nannini, Elena Barretta, Elena Burroni, Anna Gillio-Tos, Vincenzo Macallini, Paola Pierotti, and Antonino Bella - A cross-sectional study to estimate high-risk human papillomavirus prevalence and type distribution in Italian women aged 18–26 years. 02/07/2012, US National Library of Medicine National Institutes of Health. ]Electronic resource] - Access mode. - URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599585/ (access date: 11/1/2014).
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Keywords

annotation scientific article on fundamental medicine, author of the scientific work - Marochko K.V., Artymuk N.V.

Target. To determine the incidence and characteristics of human papillomavirus infection in women infected with the human immunodeficiency virus (HIV). Materials and methods. A cross-sectional study was conducted among 150 women aged from 25 to 59 years (average age 37.3 ± 8.0 years) in prison (FKU IK No. 35, Mariinsk). We collected clinical and anamnestic data, analyzed medical documentation, and took material from the cervical canal to identify deoxyribonucleic acid (DNA) of the human papillomavirus (HPV) of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51 , 52, 56, 58, 59) by real-time polymerase chain reaction (PCR). Results. High oncogenic risk HPV was detected in 58.2% of HIV-infected women and in 23% of cases in patients without HIV infection χ2=24.13, p<0,001). Среди ВИЧ-позитивных женщин преобладали 16-й, 39-й и 52-й генотипы, достоверно чаще встречался 39-й генотип (р=0,026) и сочетание ≥ 4 генотипов ВПЧ (р=0,043). ВИЧ-инфицированные женщины с меньшей длительностью течения ВИЧ и принимающие антиретровирусную терапию (АРВТ), были реже инфицированы human papillomavirus high carcinogenic risk (HPV-HR) (p<0,05). Заключение. Данное исследование показало, что ВИЧ-позитивные женщины чаще инфицированы ВПЧ высокого канцерогенного риска, имеют сочетанную инфекцию, и из всех генотипов статистически значимо чаще у них встречается ВПЧ39. ВИЧ-инфицированным женщинам необходимо объяснять, что прием антиретровирусной терапии способствует снижению риска инфицирования ВПЧ.

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Aim. To determine the prevalence and features of human papillomavirus (HPV) infection in human immunodeficiency virus (HIV)-infected women.Materials and Methods. We recruited 150 imprisoned women aged 25 to 59 years (mean age 37.3 ± 8.0) following clinical examination and analysis of medical documentation including HIV status. Identification of high-risk HPV strains (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) was carried out using real-time polymerase chain reaction. Results. High-risk HPV strains, particularly HPV-16, -39, and -52, were detected in 58.2% of HIV-infected and 23% of HIV-negative women (p< 0.001). Furthermore, the combination of ≥ 4 HPV genotypes was more prevalent in HIV-infected women (p = 0.043). Strikingly, HIV-infected women with shorter duration of HIV-infection and/or taking antiretroviral treatment were less frequently infected with high-risk HPV (p < 0.05).Conclusions. A significant proportion of HIV-positive women is infected with HPV-16, -39, -52, or combination of ≥ 4 HPV strains.

Text of scientific work on the topic “Features of human papillomavirus infection in women infected with the human immunodeficiency virus”

VOLUME 2, No. 3 functional

DOI 10.23946/2500-0764-2017-2-3-35-41

FEATURES OF PAPILLOMAVIRUS INFECTION IN WOMEN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS

MAROCHKO K.V., ARTYMUK N.V.

Federal State Budgetary Educational Institution of Higher Education "Kemerovo State Medical University", Ministry of Health of Russia, Kemerovo, Russia

ORIGINAL ARTICLE

FEATURES OF PAPILLOMAVIRUS INFECTION IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED WOMEN

KRISTINA V. MAROCHKO, NATALIA V. ARTYMUK

Kemerovo State Medical University, (22a, Voroshilova Street, Kemerovo, 650056), Russian Federation

Target. To determine the incidence and characteristics of human papillomavirus infection in women infected with the human immunodeficiency virus (HIV).

Materials and methods. A cross-sectional study was conducted among 150 women aged from 25 to 59 years (average age 37.3 ± 8.0 years) in prison (FKU IK No. 35, Mariinsk). Clinical and anamnestic data were collected, medical documentation was analyzed, material was taken from the cervical canal to identify deoxy-ribonucleic acid (DNA) of the human papillomavirus (HPV) of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51 , 52, 56, 58, 59) by real-time polymerase chain reaction (PCR).

Results. High oncogenic risk HPV was detected in 58.2% of HIV-infected women and in 23% of cases in patients

without HIV infection x2=24.13, p<0,001). Среди ВИЧ-позитивных женщин преобладали 16-й, 39-й и 52-й генотипы, достоверно чаще встречался 39-й генотип (р=0,026) и сочетание >4 HPV genotypes (p=0.043). HIV-infected women with shorter HIV duration and taking antiretroviral therapy (ART) were less likely to be infected with high-risk human papillomavirus (HPV-HR) (p<0,05).

Conclusion. This study showed that HIV-positive women are more often infected with HPV of high carcinogenic risk, have a co-infection, and of all genotypes, HPV39 is statistically significantly more common in them. HIV-infected women should be taught that taking antiretroviral therapy helps reduce the risk of HPV infection.

Key words: human papillomavirus, HPV testing, HIV.

Aim. To determine the prevalence and features of human papillomavirus (HPV) infection in human immunodeficiency virus (HlV)-infected women.

Materials and Methods. We recruited 150 imprisoned women aged 25 to 59 years (mean age 37.3 ± 8.0) following clinical examination and analysis of medical documentation including

HIV status. Identification of high-risk HPV strains ^ English

(16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) was carried out using real-time polymerase chain reaction.

Results. High-risk HPV strains, particularly HPV-16, -39, and -52, were detected in 58.2% of HIV-infected and 23% of HIV-negative women (p< 0.001). Furthermore, the combination of > 4

HPV genotypes were more prevalent in HIV-infected women (p = 0.043). Strikingly, HIV-infected women with shorter duration of HIV-infection and/or taking antiretroviral treatment were less frequently infected with high-risk HPV (p< 0.05).

Conclusions. A significant proportion of HIVpositive women is infected with HPV-16, -39, -52, or combination of > 4 HPV strains.

Keywords: human papillomavirus, HPV testing, human immunodeficiency virus.

Introduction

Cervical cancer (CC) in almost 100% of cases is associated with high-risk human papillomavirus (HPV-HR), and human papillomavirus infection is the most common sexually transmitted infection. One of the risk factors for HPV infection and the development of cervical cancer (CC) is HIV infection. In 1988, it was found that among HIV-infected women, the incidence of cervical cancer is 5 times higher than in HIV-negative patients. At a young age (up to 30 years), cervical cancer ranks first among the causes of death in HIV-infected women. At the end of 2015, the number of HIV-infected people in Russia increased to 1,008,675 people, and the HIV epidemic moved from a concentrated to a generalized stage in 20 regions of our country. Thus, HIV infection has spread beyond risk groups (injecting drug users, commercial sex workers, homosexual men). Almost every 200th Russian woman is infected with HIV (334,987 HIV-positive women at the beginning of 2016), and the HIV infection rate among pregnant women in the regions exceeded 1%.

In women with HIV infection, spontaneous elimination of HPV occurs much less frequently (0P=0.46; 95%CI; p<0,001), с увеличением возраста распространенность ВПЧ-ин-фекции не снижается как в общей популяции . Распространенность ВПЧ и тяжесть церви-кальной интраэпителиальной неоплазии шейки матки (CIN) коррелирует с уровнем иммуносу-прессии: чем ниже количество CD4+, тем выше риск заражения ВПЧ и прогрессии CIN . Имеются данные, что и ВПЧ увеличивает риск инфицирования ВИЧ в 2-3 раза среди обоих полов . У ВИЧ-инфицированных женщин достоверно выше частота встречаемости ВПЧ-ВР (40%-70%.), чаще присутствует сочетание нескольких генотипов ВПЧ-ВР и в 3-5 раз быстрее происходит развитие CIN и РШМ. Насколько положительно/отрицательно влияет

The use of antiretroviral therapy (AR-VT) on the incidence of HPV infection has not been studied enough, and existing data are contradictory.

Purpose of the study

To determine the incidence and characteristics of human papillomavirus infection in women infected with HIV.

Materials and methods

A cross-sectional study was conducted of 150 women aged 25 to 59 years (average age 37.3 ± 8.0 years) in prison (FKU IK No. 35, Mariinsk). High oncogenic risk HPV DNA (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 genotypes) was detected using real-time PCR. After collecting clinical and anamnestic data and analyzing medical documentation, it was found that 33.3% (50/150) were HIV-infected. Among HIV-infected women, 92% (46/50) suffered from drug addiction. Only 22% (11/50) of women were taking antiretroviral therapy (ART).

The study was carried out in accordance with ethical standards in accordance with the Declaration of Helsinki of the World Medical Association “Ethical Principles for Conducting Medical Research Involving Human Subjects” as amended in 2013 and the “Rules of Clinical Practice in the Russian Federation” approved by Order of the Ministry of Health of Russia No. 266 of June 19. 2003 with mandatory informed consent of the subjects.

To prove the statistical significance of the study results, the IBM SPSS Statists v software package was used. 24 (license agreement No. 20160805-1). To present qualitative characteristics, relative indicators (proportions, %) were used. Quantitative statistical data are presented in the form of average values ​​(M) and their standard deviations (5). The effect of each risk factor for HPV infection was assessed according to

ORIGINAL ARTICLE

Feature HIV “+” (n=32) HIV “+” (n=32) HIV “-” (n= 23) HIV “-” (n= 23) P

Age, M ± o, years Age, mean ± SD, yrs 32.2 ± 7.4 40.8 ± 10.4 0.003

Age of onset of sexual activity, M ± o,

years Age of first sexual intercourse, mean ± SD, yrs 16.4 ± 1.5 17.1 ± 1.5 0.066

Number of sexual partners, M ± o Number of sexual partners, mean ± SD 4.7 ± 3.6 4.1 ± 3.4 0.401

Smoking, n (%) Smoking, n (%) 32 (100.0) 20 (87.0) 0.067

Drug addiction, n (%) Drug addiction, n (%) 28 (87.5) 4 (17.4)< 0,001

Age< 29 лет, n (%) Age < 29 years, n (%) 12 (37,5) 3 (13,0) 0,042

Sexual debut at age< 16 лет, n (%) First sexual intercourse at < 16 years, n (%) 19 (59,4) 7 (30,4) 0,065

> 3 sexual partners, n (%) > 3 sexual partners, n (%) 28 (87.5) 15 (65.2) 0.051

Use of barrier contraception, n (%) Use of barrier contraception, n (%) 6 (18.7) 4 (17.4) 0.593

STI, n (%): 1

Sexually transmitted infections, n (%): Syphilis Syphilis 5 - 0.058

Trichomoniasis Trichomoniasis 8 4 0.369

Hepatitis C Hepatitis C 24 2< 0,001

Table 1.

Comparative characteristics of HIV-positive and HIV-negative patients infected with HPV

Clinicopathological features of HIVpositive and HIVnegative HPV-infected patients

odds ratio (OR) indicator. To assess the statistical significance of qualitative characteristics, we used the analysis of contingency tables (Pearson x2 test). Differences were considered statistically significant at p<0,05.

results

In a group of imprisoned women without HIV infection, HR-HPV was detected in 23% of cases (23/100). Among HIV-infected women, the incidence rate is significantly higher - 58.2% (32/50; x2 = 24.13, p<0,001). В таблице 1 приведены данные по сравнению клини-ко-анамнестических характеристик в группе ВИЧ-позитивных и ВИЧ-негативных пациенток с ВПЧ-инфекцией.

Thus, HIV-positive women infected with HPV were statistically significantly younger (p=0.003) and more likely to use drugs (p<0,001). По частоте курения, использованию барьерного метода контрацепции, возрасту полового дебюта и количеству половых партнеров группы не имели различий (р>0.05). Among sexually transmitted infections (STIs), the patient

Women in both groups denied a history of chlamydia and gonorrhea. Women with HIV infection were significantly more likely to be infected with hepatitis C (p<0,001).

In the study groups, the frequency of occurrence of various HR HPV genotypes was also analyzed (Figure 1).

The diagram shows that in HIV-infected women the 16th (51.6%), 39th (41.9%) and 52nd (38.7%) genotypes of HPV-HR were more likely to prevail, but statistically significantly more often Only genotype 39 was found (p = 0.026). Among HIV-negative patients, the 16th (36.3%), 33rd (31.8%) and 52nd (31.8%) genotypes were more common. There were no statistically significant differences in the frequency of mono- and co-infection (detection of >2 HPV genotypes) between HIV-positive and HIV-negative women (x2 = 0.13, p = 0.718) (Figure 2).

When analyzing the number of identified genotypes during co-infection, it was found that the simultaneous presence of >4 types of HPV was statistically significantly higher in the group of women infected with HIV (p = 0.043). The data are presented in Figure 3. Among HIV-positive

Picture 1.

Frequency of different HR-HPV genotypes among HIV-positive and HIV-negative women

Prevalence of high-risk HPV strains among HIV-positive and HIV-negative women

Figure 2.

Frequency of mono- and co-infection in HIV-positive and HIV-negative women

The frequency of mono- and co-infection in HIVpositive and HIVnegative women

HIV + (n=3l) HIV- (n=22)

Note: *p=0.026 *p = 0.026

HPV"+"HIV"-" (n=22)

35 39 45 51 52 56 58 HPV-HR genotypes

HPV"+"HIV"+" (n=31)

I Monoinfection

I Monoinfection

HPV"+"HIV"-" (n=13)

HPV"+"HIV"-" (n=13)

Figure 3.

Number of genotypes for co-infection in the study groups

Number of HPV strains in women with co-infection

positive patients were not identified stages I and II, explaining their decision with a large number of

HIV infection, stage III was registered in 78.1%, stage IV in 21.9% of cases. HPV-positive women infected with HIV used drugs in 87.5%. In most cases, patients refused ART,

side effects from taking these drugs. Only 9.4% of women (3/32) were taking ART. Comparative characteristics of HPV-positive/negative HIV-infected women are shown in Table 2.

ORIGINAL ARTICLE

Characteristics Feature HPV “+” HIV “+” (n=32) HPV “-” HIV “-” (n=18) P

Abs. n % % Abs. n % %

HIV stage HIV stage III 25 78.1 15 83.3 0.479

IV 7 21.9 3 16.7

Taking ART Use of antiretroviral treatment 3 9.4 8 44.4 0.006*

Drug addiction Drug addiction 28 87.5 18 100.0 0.156

Duration of drug addiction, mean ± SD, yrs 7.5±5.3 8.2±6.4 0.991

Duration of HIV infection, M±o, years Duration of HIV-infection, mean ± SD, yrs 5.2 ± 3.7 2.5 ± 1.8 0.005*

Table 2.

Comparative characteristics of HIV-infected women with positive and negative results of HPV testing

HIV-related and drug addiction-related features in HIVpositive and HIVnegative women

Note: * - statistically significant differences (p<0,05)

HPV-positive HIV-infected women had a longer duration of HIV infection (p=0.005). It was found that taking ART statistically significantly reduces the risk of HR-HPV infection (OR = 0.13; 95% CI =; p = 0.006). The length of drug addiction, drug dependence and stage of HIV infection did not significantly affect the frequency of HPV infection (p>0.05).

Discussion

A large number of studies on the prevalence of HPV infection among HIV-positive women have been conducted in African countries: Tanzania - 46.7%, Kenya - 64%, Rwanda - 72.2%. In India, the prevalence was 57.7%. In the present study, the incidence rate is 58.2%, while in the group of women without HIV infection it is 1.5 times less - 23%. The most common genotypes, according to the literature, are 16, 18, 35, 51 and 52, which generally does not differ from the general population. When analyzing the incidence of HPV among women in prison, genotypes 16, 33 and 52 and co-infection were found significantly more often. It has been shown that among HIV-infected women the most unfavorable prognosis (long-term)

high persistence of HPV, more rapid development of CIN and cervical cancer) in patients with the presence of HPV16/18 and a decrease in the CD4+ count<200 клеток/мкл. Возможность организма самостоятельно элиминировать ВПЧ у таких женщин снижается в 4-10 раз . В проспективном исследовании Konopnicki (Бельгия) продемонстрировано, что устойчивая супрессия репликации ВИЧ (вирусная нагрузка <50 копий/mL) >40 months and a CD4+ T cell count >500 cells/μL for >18 months is associated with a significant reduction in the risk of developing persistent cervical HPV infection (p<0,001) . Доказано, что своевременное применение адекватной АРВТ позволяет снизить риск инфицирования ВПЧ, замедлить прогрессию CIN, а, по некоторым данным способствует снижению тяжести дисплазии шейки матки .

Conclusion

This study showed that HIV-positive women are more often infected with HPV of high carcinogenic risk, have a co-infection, and of all genotypes, HPV39 is statistically significantly more common. HIV-infected women should be explained that taking antiretroviral therapy helps reduce the risk of HPV infection.

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24. Papasavvas E, Surrey LF, Glencross DK, Azzoni L, Joseph J, Omar T, et al. High-risk oncogenic HPV genotype infection associates with increased immune activation and T cell exhaustion in ART-suppressed HIV-1-infected women. Oncoimmunology. 2016; 5 (5): e1128612.

Kristina Vladimirovna Marochko, postgraduate student, Department of Obstetrics and Gynecology No. 2, Kemerovo State Medical University, Ministry of Health of Russia Kemerovo, Russia

Contribution to the article: development of the study design, questionnaires, analysis of medical documentation, collection of material for HPV testing, processing of study results, writing the article.

Artymuk Natalya Vladimirovna, Doctor of Medical Sciences, Professor, Head of the Department of Obstetrics and Gynecology No. 2, Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo, Russia

Contribution to the article: study design, article writing.

Dr. Kristina V. Marochko, MD, PhD student, Department of Obstetrics and Gynecology #2, Kemerovo State Medical University, Kemerovo, Russian Federation Contribution: conceived and designed the study; collected and processed the data; wrote the manuscript.

Prof. Natalia V. Artymuk, MD, PhD, Head of the Department of Obstetrics and Gynecology #2, Kemerovo State Medical University, Kemerovo, Russian Federation Contribution: conceived and designed the study; wrote the manuscript.

Address correspondence to:

Marochko Kristina Vladimirovna, 650056, Kemerovo, st. Voroshilova, 22a. Email: [email protected]

Article received: 06/26/17 Accepted for publication on August 30, 2017.

Corresponding

Dr. Kristina V. Marochko, Voroshilova Street 22a, Kemerovo, 650056, Russian Federation E-mail: [email protected]

Acknowledgments: There was no funding for this project.

In what cases a person becomes infected with HPV or becomes its carrier is easy to determine. Our immune system fights any foreign elements that enter the skin or body.

When a small amount of the virus enters a healthy body with good immunity, the immune cells destroy it and infection does not occur. But if a person is weakened, he has metabolic disorders.

Why is the human papillomavirus dangerous if it is so difficult to avoid infection with it?

Distinctive symptoms in men

For representatives of the stronger sex, HPV is not so dangerous. Although certain types of it can cause the development of cancer, this is extremely rare. In men (as in women), papillomavirus is often combined with other sexually transmitted infections.

In most cases, men are just hidden carriers. That is, HPV infection has occurred, but there are no warts on the body, and the pathology is diagnosed only during an examination, for example, cytology. At the same time, the man still becomes a carrier of the infection, that is, he can easily infect other people with it.

Pink or grayish growths are small in size. Condylomas can grow one at a time or form groups. Localized in the area of ​​the penis, they are quite easily injured, so sometimes the tumors bleed.

A large proportion of virus variants do not threaten the lives of men. Sometimes infection causes Bowen's disease. A moist, clearly defined velvet plaque of a scarlet hue grows on the penis. Sometimes its size begins to grow, it can even degenerate into a malignant tumor.

HPV can remain silent for a long time. This does not mean that it is not contagious during this period. If there is a suspicion of infection with papillomavirus, or it has already been diagnosed in a man, then measures should always be taken to avoid infecting sexual partners.

Manifestations of the papilloma virus on the human body always cause inconvenience. They affect the physical and moral state of a person. In addition, there is a certain probability of skin lesions degenerating into oncological pathology, so it is better to consult a specialist and undergo treatment after examination.

Types of strains and diseases they cause

Several strains of HPV have been identified, each of them adapted to live in certain human cells. Many strains, for example 2, 4, 26, 29, 57, cause the development of common warts on the skin. Others are capable of causing the development of genital warts (6, 42, 11, 54), but at the same time, strains 6 and 11 can be detected in the respiratory tract or in cancer of the lungs, neck, and head.

The ability of a virus to increase the likelihood of developing a tumor by changing the cells of the human body is called oncogenicity. Therefore, among human papilloma viruses, there are strains that do not have this ability, and when infected, a person develops warts, papillomas on the skin and mucous membranes. They can also be dangerous, but are fairly easily treated with surgery. After their removal, they rarely recur and are therefore classified as benign neoplasms.

The human papillomavirus of a particularly high oncogenic type most often affects the reproductive organs of women. The strains that cause it are human papillomavirus types 16 and 18. Cancer-causing strains can also include 31, 39, 35, 33 and many other strains. Therefore, they are the ones who are trying to identify them in women when testing for HPV.

The presence of such strains in a woman’s body can lead to serious cancer, such as cervical cancer or squamous cell carcinoma.

How does HPV infection lead to the development of cervical cancer?

Although most HPV infections and precancerous conditions go away on their own, all women are at risk for HPV infection to become chronic and for precancerous conditions to develop into invasive cervical cancer.

Photos of papilloma on the chest using ointment for sexual treatment. Manufacturers of the vaccine and those promoting its immunity to the four most common. Boys should be vaccinated against cervical cancer along with girls.

The human papillomavirus in women affects the mucous membrane of the reproductive organs and the cervix. Sometimes polyps, the development of which is also associated with HPV, can also form in the uterine cavity, which can cause bleeding and infertility in young women. But an even greater danger is the ability of the virus to affect mucosal cells and change them.

Some highly oncogenic types of human papillomavirus in women are capable of changing mucosal cells in the cervix, which causes dysplasia and aplasia. This is uncontrolled reproduction, which in more than half of cases leads to the development of a malignant tumor. Most often, cancer of the cervix is ​​caused by human papilloma viruses type 16 or 18.

Viruses 6 and 11 are also often detected, which contribute to the formation of genital and flat condylomas - they are considered a precancerous disease, as they often precede dysplasia. Treatment consists of their mandatory removal, followed by histological examination of the tissue under a microscope.

The human papillomavirus is also dangerous during pregnancy. Although the virus does not penetrate the amniotic fluid and thus cannot infect the child, there is a high probability of infection if a woman has genital warts in her vagina. Then the child can become infected during childbirth, which leads to the development of papillomatosis of the oral cavity and pharynx.

Treatment against the papilloma virus is not carried out during pregnancy, since medications can have an adverse effect on the fetus. Only in the third trimester can certain antiviral drugs be prescribed. Therefore, if you are planning to become pregnant, you need to undergo an examination in advance and be tested for various infections so that this does not harm your baby.

Human papillomavirus is also common in men, but due to differences in the structure of the genital organs, it usually affects the skin around the anus and the rectal mucosa.

It is in these areas that the development of genital warts is observed, and they often lead to squamous cell carcinoma of the rectum.

From a millimeter or more: do not get carried away with soap and other disinfectants. Attention, in the armpits, if you need to remove papillomas on the neck, one of the main components is interferon, where there are patients with condylomatosis of the genital tract and oral cavity. Including in a solarium, worms can provoke diseases, methods of infection with the human papillomavirus, in the groin, in addition.

To avoid serious consequences, condylomas can be lubricated with solcoderm preparations, the spaces between the fingers and the back of the palm, a wide tape, the virus penetrates into the cells of the squamous epithelium and remains there indefinitely. Today, the possibilities of cosmetologists and surgeons are unlimited; a person becomes a lifelong carrier of the virus: the gallbladder or ducts, flesh-colored.

Human papillomavirus has some features in its manifestations in women and men. Since this disease is quite often transmitted through sexual intercourse, you should always take care not to infect your partner.

A risk factor for contracting viral infections is immunodeficiency, which develops with HIV infection, immunosuppressive therapy after organ transplantation, etc. The causative agents of a number of viral infections are various types of human papillomavirus (HPV). HPV infection occurs through contact (healthy skin - diseased skin). Minor skin injuries contribute to the penetration of infection.

Infections caused by the human papillomavirus (HPV) in HIV-infected people.

Epidermodysplasia verruciformis.

Epidermodysplasia verruciformis or congenital warts are a viral disease of unknown etiology with a hereditary predisposition. Human papillomaviruses play an important role in the occurrence of the disease. The elements of the rash are elements that are very similar to flat warts, but they are very large in size, numerous and merge with each other. As a result, large foci are formed that are very similar to a geographical map.

In places where skin damage has occurred, linear rashes of elements appear. It is possible to develop squamous cell carcinoma, both in situ and invasive. Usually the rash is located on the skin of the face, hands, arms, legs, and the front surface of the torso. Precancerous diseases and squamous cell carcinoma most often affect the skin of the face. Patients with HIV infection are characterized by widespread rashes on the skin of the arms and legs, especially on the face, in the mouth, on the genitals, and in the perianal area. Treatment: keratolytics, electrocoagulation, cryodestruction, laser therapy.

Condylomas caused by HPV types 6 and 11, less commonly by types 16, 18, 31, 33 (the last 4 types also cause squamous cell carcinoma). Infection occurs through contact, including sexual contact; 90-100% of sexual partners of sick women become infected. In most cases, the infection is asymptomatic and continues throughout the patient's life. The contagiousness of the disease is quite high during periods of exacerbation, when genital warts appear. The incubation period ranges from several weeks to several years.

The rash is characterized by nodules ranging from 0.1 mm to tumor-like formations that resemble cauliflower in appearance. On the genitals of men and women, the rash is not always visualized; to detect it, a test with 5% acetic acid is performed, after which small white papules appear. Typically, condylomas have a soft consistency, pink or red color, and their shape can be warty, thread-like, sessile (on the genitals).

Single condylomas are rare; they are usually numerous and arranged in groups (resembling cauliflower or bunches of grapes). Perianal genital warts form vegetations the size of an apple or a walnut.

Differential diagnosis is carried out with secondary syphilis, molluscum contagiosum, bowenoid papulosis, squamous cell carcinoma, lichen planus, scabies lymphoplasia. During the development of HIV infection, condylomas spread and large lesions appear that are poorly treated. HPV types 16, 18, 31, 33 are the cause of cervical dysplasia, squamous cell carcinoma of the cervix, bowenoid papulosis, Queyra's erythroplasia, etc.

Bowenoid papulosis.

Bowenoid papulosis is very similar in its histological features to Bowen's disease (carcinoma in situ), but has a benign course. This disease affects the skin and mucous membranes of the genital organs, the perianal area where spots, nodules and plaques appear. It occurs 6-8 times more often in HIV-infected women than in other women. The causative agent is HPV types 16,18, 31, 33. The route of infection is sexual. Treatment: cryodestruction, electrocoagulation, laser therapy, fluorouration in the form of an ointment locally.

Molluscum contagiosum.

Molluscum contagiosum is a viral infection of the epidermis. A risk factor is HIV infection. In patients with AIDS, the course of the disease is severe. Infection occurs upon contact (sick skin - healthy skin). The primary morphological element is a papule (1-2 mm), in some cases large nodes. Molluscum contagiosum occurs in 20% of HIV-infected people. Characteristic signs are numerous nodules, nodules with a diameter of more than 1 cm. Location: facial skin, neck, skin folds. In HIV-infected people, after removal of the mollusk, relapses are inevitable.

Hairy leukoplakia.

One of the earliest diagnostic signs of AIDS is hairy leukoplakia. This disease occurs exclusively in HIV-infected people and is a poor prognostic sign. If hairy leukoplakia is diagnosed before AIDS is diagnosed, the chance of developing AIDS within 16 months is 48%, and within 30 months it is 83%. Hairy leukoplakia is a benign hyperplasia of the oral mucosa caused by the Epstein-Barr virus.

On the mucous membranes of the cheeks and tongue, whitish or gray plaques with clear boundaries are formed; these elements have villi from several millimeters to 2-3 cm. The mucous membrane looks like “corrugated paper” or has the appearance of a “shaggy” mucous membrane. This is especially clearly visible along the periphery or on the lateral surfaces of the tongue.

Differential diagnosis: hyperplastic candidiasis, genital warts, geographic tongue (desquamative glossitis), lichen planus, secondary syphilis. Treatment: zidovudine, acyclovir, ganciclovir, foscarnet. Local application of podophyllin (25% solution).

HIV vs HPV

HIV stands for human immunodeficiency virus and HPV stands for human papillomavirus. HIV is an RNA virus, whereas HPV is a DNA virus. Transmission of HIV mainly occurs through sexual contact as a result of the transfer of fluids from one person to another. Transmission for HPV occurs through the skin, mainly from abrasive surfaces and sexual contact.

People infected with HIV get various forms of infections. One of them is HPV. HPV is difficult to treat in HIV-positive patients. HPV can be treated, whereas HIV-infected individuals are not free of the disease for life.

People infected with HIV have a compromised immune system and hence any disease can easily affect them. When HPV enters the body, it is not easily recognized by the body's immune system because it is compromised, and it affects the individual more often in patients with HIV.

HIV is life-threatening, whereas HPV, when it occurs alone, is not life-threatening. HPV occurs in people with HIV when the CD4 cell count decreases and the viral load increases. Complications of HPV include warts seen in the hands, genital areas, feet and oral area. As HIV infection becomes more complicated, it becomes an immunodeficiency disease and ultimately leads to death.

Treatment for HPV includes both oral and topical antiviral medications. Topical applications should be given to the area of ​​the wart, and sometimes surgical removal of the wart may be done. Treatment for HIV includes anti-HIV drugs that simply reduce the level of the virus and improve a person's life. There is no permanent cure for HIV.

HPV can be completely resolved, but sometimes complications such as cervical cancer may occur, whereas with HIV, there is no regression of the disease, but instead worsens with an increase in viral load, decreased immunity and an advanced stage of the disease that acquires the immunodeficiency virus, leading to death.

HPV does not cause any symptoms, but in some cases symptoms such as warts may appear. It is more common in the genitals, but in some cases it can also occur in the throat, which is called recurrent respiratory papillomatosis. At first, the wart appears small and the cauliflower has a similar appearance. It may grow at later stages. It can be either raised or flat. This occurs after several days of sexual intercourse. Mostly it regresses, but in some cases it can increase in size and number. Few cases of HPV show cervical cancer. HIV eventually develops all types of infections due to decreased immunity.

SUMMARY: 1. HIV is an RNA virus, and HPV is a DNA virus. 2. Many infections occur with HIV, while HPV shows warts and in some cases does not cause any symptoms at all. 3. Treatment for HPV is an antiviral drug, mainly in the topical form, and for HIV - an anti-HIV drug. 4. Complete regression of HPV is possible, while only the quality of life improves with HIV. 5. The complication of HPV is cervical cancer, while for HIV it is AIDS, leading to death.