Lower genital tract premalignant lesions, HPV infection and immunodepression: morphological-molecular detection, immunological aspects and management in female and in male partner.

A. Torrisi M.D., D.M. Paternoster M.D., D. Minucci M.D.

In this study we examined the incidence-prevalence of premalignant genital lesions and HPV-genotypes in 178 HIV positive women (group 1), in 59 HCV positive (group 2) vs. 210 HIV-HCV negative (group 3) and in 196 male partners, at least since 6 months, 40 were of group 1, 26 of group2 130 of the group3. The work wants to evaluate the more appropriate technologies and intervention strategies in the prevention-early diagnosis. All the women underwent, pap-test, colposcopy, cytological sample for HPV-DNA testing by PCR with MY09/MY11 primers, eventually target biopsies, gynaecological examination, performed by the same gynaecologist; all the male partners: cytological samples of urethral meatus and balano-preputial fold, genital colposcopic examination, HPV-DNA testing of penile cells samples and semen, performed by the same gynaecologist. Molecular diagnosis was carried out by the Department of Oncological Sciences (Dir. Prof. L. Chieco-Bianchi) and by Department of Virology (Dir. Prof. G. Palù). Using the chi-square test a significant statistical difference in incidence was found both in colposcopic ANTZ and SIL (p<0.001) in HIV+ vs. HIV-HCV negative, not in HCV+ vs. group 3. Among the HIV+ women CD4+ count was <300 cells/ml and viral load >40,000 copies in HSIL associated with persistent HR-HPV. In group 2 patients the CD4+/CD8+ ratio was significantly related to a detectable viraemia but not to HCV-genotypes. The women with high-grade lower genital tract lesions underwent excissional surgical therapy and appropriate morphological-molecular follow-up. In male partners subclinical HPV-genital lesions were detected in a fairly good percentage of cases, PIN in few cases. HPV sequences in both samples, penile and semen, with complete concordance in typing, were diagnosed in few cases. We detected the major concordance between female and male partners in low-risk HPV-genotypes. The authors underline the utility of integrate morphological-molecular diagnosis in the couple for a better prevention-early diagnosis-management precancerous lesions-HPV infection. Both partners control is also particularly important to give adequate counseling for STDs and psychological assistance.

KEY WORDS: Cytology-Colposcopy, Female-Male.

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/26/101/996/4361