Ana P. Ortiz (Puerto Rico)
Comprehensive Cancer Center Poblational SciencesPresenter of 2 Presentations
FUNGAL BIOMES AND THEIR RELATIONSHIP WITH HPV INFECTION IN ANOGENITAL MUCOSA OF WOMEN IN PUERTO RICO: A POPULATION-BASED APPROACH (ID 459)
Abstract
Introduction
The characterization of bacterial biomes has revealed bacterial populations associated to HPV infection and dysplasia, however, there are several unanswered questions. Fungi are a major neglected part of the human microbiome, which can form biofilms in the host’s mucosa, and likely modify the epithelial microenvironment. We performed an unprecedented assessment of anogenital fungal diversity and its association with anal and cervical HPV infections in order to shed light on the complex interkingdom microepithelial interactions.
Methods
We used ITS-2 gene sequencing from anogenital samples from a cross-sectional population-based study of women aged 16-64 from the San Juan metropolitan area of Puerto Rico (253 women). Women self-collected cervical and anal samples, and anthropometric measurements were taken to determine body mass index (BMI). HPV typing was done with MY09/MY11 consensus HPV L1 primers. Positive specimens were typed by dot-blot hybridization. Yeast were characterized taxonomically using the UNITE database, and analyzed according to HPV and BMI status of the patients with QIIME and R.
Results
The prevalence of cervical and anal HPV infections (low-risk [LR] and high-risk [HR] combined) was 19.8% and 24.5%, respectively. We found no significant changes in the community structure according to HPV infection status. Candida was the most dominant yeast in both the cervix and anus, decreasing its relative abundance in obese and HPV-positive women. A significant abundance of Malassezia (p<0.05) was also found in HR-HPV+ women, in those obese and in postmenopausal women.
Conclusions
Findings reveal a polymicrobial colonization of yeast in all women, regardless of HPV positivity and BMI, especially Candida. Malassezia, a lipophilic yeast, were mostly found in obese patients and those HPV-positive, indicating a likely pathogenic role. The revealed mycoses may represent a major therapeutic challenge. This study represents a tremendous potential of mycobiome-related processes to be used in anogenital cancer prevention and diagnostics.
ASSESSMENT OF THE VALIDITY OF ANAL CYTOLOGY AND HPV TYPING IN THE DETECTION OF ANAL HSIL IN A CLINIC-BASED POPULATION IN PUERTO RICO (ID 635)
Abstract
Introduction
Anal cytology tends to underestimate lesion grade when compared to high-resolution anoscopy (HRA). We assessed the validity of anal cytology and high-risk (HR) HPV typing against HRA in the detection of anal high-grade squamous intraepithelial lesions (HSIL).
Methods
Cross-sectional analysis of the baseline visit of men and women that attended the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Cancer Center (2014-2019). Eligible patients (n=406) completed an anal cytology and HRA with biopsy. HR-HPV detection was done with the Cobas 4800 test. Weighted-kappa coefficient, sensitivity, specificity, and positive and negative predictive values were calculated using HRA with biopsy as the gold standard test.
Results
68.2% of patients were men, 77.1% were HIV-positive, and 76.9% had anal HR-HPV infection; prevalence of HPV-16 (33.7%) was higher than for HPV-18 (16.9%). Squamous intraepithelial lesions were detected with anal cytology and histology in 70.7% and 83.0% of patients, respectively. Weighted-kappa statistic between the tests (cytology and histology) was 0.26 (p<0.001). Measured against the results from histology, the sensitivity and specificity of anal cytology alone to detect histologically confirmed anal HSIL was 82.3% (95% CI: 75.6%-87.8%) and 37.2% (95% CI: 31.1%-43.6%), respectively. The HPV test had higher sensitivity (92.7%, 95% CI=87.6%-96.2%) than the cytology, with slightly lower specificity (33.9%, 95% CI=27.9%-40.2%). The two tests combined (positive results to anal cytology or HR-HPV) had the best sensitivity to detect anal HSIL (97.6%, 95% CI: 87.6%-99.3%), although the specificity decreased (18.2%, 95% CI: 13.5%-23.6%). Similar results were seen in analyses stratified by sex and HIV-status.
Conclusions
While anal cytology in combination with HR-HPV typing improved the detection of histologically, confirmed anal HSIL in this Hispanic population, HR-HPV testing by itself had better performance in the detection of anal HSIL as compared to cytology alone. Findings support the importance of HPV testing in anal screening. AMC-NCI Grant# UM1 CA121947.