Fatores de risco associados ao câncer de ânus em pessoas vivendo com HIV em uma cidade do Nordeste do Brasil

Abstract

Anal cancer has a high potential for morbidity and mortality in affected people. This incidence is related to the same risk factors for human papillomavirus (HPV) infection due to the induction of pre-malignant intraepithelial lesions. The risk is even greater in HIV-infected patients. Specialized services for tracking, diagnosing, and treating these lesions are scarce in the public healthcare system in Brazil and non-existent in Fortaleza. This research aims to access the prevalence of risk factors related to anal canal neoplasia in a significant sample of volunteers at two specialized STI/AIDS care centers in Ceará. This is a cross-sectional study carried out in two healthcare institutions in Fortaleza, Ceará; where 223 volunteers living with HIV were submitted to a standardized questionnaire, proctological examination, and collection of material in the anal canal. This material is later analyzed for genetic typing of eleven HPV subtypes, analysis of E6 and E7 oncoprotein expression, and anal cytology. Patients with any alterations suggesting intraepithelial lesions underwent high-resolution anoscopy. Of the 223 volunteers, 51 are from the Walter Cantídio University Hospital, and 172 are from NAMI/Unifor. The average age is 37 years, and that of lifetime sexual partners is 20. 82.95% identify as homosexual cisgender men, and 31.84% have higher education. The sample showed 94,6% positivity for HPV in the anal canal, where 72,91% are positive for high-risk HPV subtypes and 61,29% have multiple HPV infections.The most common high-risk subtype is 16 (22.92%). 94 volunteers (42.15%) showed E6 and E7 oncoprotein expression, but only 16 (7.17%) of all volunteers hadany abnormal findings in cytology. The sample has statistical significance in representing people living with HIV in Ceará, reflecting the high prevalence of high-risk HPV infection in this population.