Citologia em meio líquido e pesquisa de genótipos de HPV por RT-PCR de amostras cervicais e intra-anais em pacientes de transplante renal

Abstract

Human papillomavirus (HPV) is responsible for the sexually transmitted disease (STD) more common and one of the micro-organisms that cause most infections in immunosuppressed individuals. The DNA HPV is present in 99.7% of all cervical cancer cases. Furthermore, when dealing with anal cancer, HPV is found in lesion sites in over 90% of cases. It is estimated that transplanted women undergoing immunosuppression therapies have up to fourteen times more likely to develop cervical cancer and a hundred times more likely to develop anal cancer compared to normal women. The cytology is the screening method of the uterus and cervix anal lesions. Currently, there are several methods of molecular biology, including the polymerase chain reaction in real time (RT-PCR), which stands out for its high sensitivity and individually detect the HPV types. Thus, the purpose of this study was to evaluate the frequency of HPV infection in cervical and anal canal of kidney transplanted patients (TR) through cytology in liquid medium and RT-PCR. It is a cross-sectional study conducted at the General Hospital of Fortaleza (HGF) in the period from March to September 2015. We included 31 women with TR, where the collection of cervical and anal material for cytology was performed on a net basis and RT-PCR. They were noted socio-behavioral data and the frequencies of the cytology and RT-PCR in colon and anus in Excel spreadsheet. To assess significance and relative risk Fisher's exact test was used. The average age of patients was 42.6 (± 10.4) years and the average number of partners was 2.4 (± 1.8), the first sexual intercourse was refried an average of 19.7 (± 3.8) years, the average number of pregnancies 1.9 (± 1.7). Among the cases 45.2% of women reported anal intercourse. No woman said smoking, use of alcohol or other drugs. The atypical cervical cytology and atypical intra-anal cytology occurred in 25.4% of women undergoing kidney transplantation. The high-risk HPV research by RT-PCR was positive in the cervix in 22.6% of cases. In the anus has identified high-risk HPV in 35.5%. The cervix type 16 was observed in 6.6% and the 18 in 16.1% of women, while the anus type 16 was observed in 18.8 % and 18 in 6.6% of women. In 70.9% of cases there was agreement diagnostic cytologic atypia of cervical and anal canal and in 67.8% of cases there was agreement HPV genotypes between cervical and anal canal. The relative risk for cytology in atypical intra-anal liquid medium as abnormal cervical cytology was about 4 times higher, while the presence of high-risk HPV PCR in colon showed no increased risk and intra-anal HPV identified was associated a relative risk about 10 times higher. It follows that the atypical cytology cervical and anal and the presence of HPV DNA in both high-risk sites was relatively frequent and important relative risk for atypia from atypical cervical cytology and high risk HPV positive anus.