Effect of Human papilloma virus and Human Immunodeficiency virus on Langerhans' cells in human anal mucosa

I. Sobhani, MD, PhD; F Walker , T Aparicio , L Abramowitz, Dominique Henin, AC Cremieux, JCL Soule

Background & Aim. The incidence of anal cancer is higher in patients with anal condyloma, a sexually-transmitted disease, than in the general population. HIV increases this risk. We compared anal mucosa in normal individuals, HPV infected patients with respect to HIV, immunity status and HPV types. Patients & Methods. In 155 consecutive patients (102 HIV-positive, 53 HIV-negative) with anal condyloma, lesions were cured and specimens of normal anal mucosa were compared to anal mucosa obtained in consecutive HIV-negative patients after hemorrhoid surgery (control). Anal dysplasia, Langerhans' cells (LC), intraepithelial T-lymphocytes in normal anal mucosa were quantified and viruses (EBV, CMV, HSV1, various HPV types) characterized. HIV load and CD4 T-lymphocyte counts in serum were determined in HIV-positive patients. Results. In control individuals, no dysplasia, no HPV was observed on histology when in patients with anal condyloma it showed anal dysplasia in 19 HIV-positive and 4 HIV-negative individuals (4 and 1 cases of HGD, respectively; P=0.07). LC/mm in anal tissue (median; extremes) were significantly higher in HIV-negative patients with condylomas (30; 2-130) compared to HIV-positive patients (15; 0-100) or to the control (17; 4-35). In HIV-negative individuals, having anal condyloma, was linked with LC/mm increase in anal tissue. Among patients with anal condyloma, several factors differed significantly between HIV-positive and -negatives : LC/mm anal tissue (15 vs 30), oncogenic HPV (26% vs 8%), other current anal infections (35.6% vs 5%), male sex (93% vs 74%). Whereas multivariate regression analysis (Odds ratio, CI95%) identified only HIV (6, 2.28-16.1; P<0.001) as risk factor for anal LC decrease. Among HIV-positive patients, serum HIV load (4.9, 1.1-21.4; P<0.03) but not CD4 T-Ly was predictive risk factor for having less than 17 LC/mm tissue. Conclusion. HPVs increase LC in anal mucosa only in HIV-negative individuals. HIV is responsible for alteration of anal tissue immunity which may be involved in anal condyloma relapse and carcinogenesis.

KEY WORDS: Key words HIV, condyloma, Langerhans' cells, anal immunity.

For more information, contact iradj.sobhani@bch.ap-hop-paris.fr

Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Viral Oncogenesis.

http://www.cancerprev.org/Journal/Issues/26/101/996/4344