SNFGE SNFGE
 
Thématique :
- Coloproctologie
Originalité :
Très original
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Vincent de PARADES
Coup de coeur :
 
 
Clinical Gastroenterology and Hepatology
  2018/11  
 
  2018 Nov;16(11):1768-1776.e5.  
  doi: 10.1016/j.cgh.2018.03.008.  
 
  High Prevalence of Anal Canal High-Risk Human Papillomavirus Infection in Patients With Crohn's Disease.  
 
  Vuitton L, Jacquin E, Parmentier AL, Crochet E, Fein F, Dupont-Gossart AC, Plastaras L, Bretagne CH, Mauny F, Koch S, Prétet JL, Mougin C, Valmary-Degano S  
  https://www.ncbi.nlm.nih.gov/pubmed/29551740  
 
 

Abstract
 

BACKGROUND & AIMS:

The increasing incidence of anal canal carcinomas requires better knowledge on anal human papillomavirus (HPV) infection. We aimed to assess anal canal HPV infection prevalence and risk factors among patients seen at a gastroenterology department in France.

METHODS:

We analyzed anal tissue samples collected from 469 consecutive patients (median age 54 years, 52% women), including 112 who received immunosuppressant therapies and 101 with inflammatory bowel disease (70 with Crohn's disease), who underwent colonoscopy examinations from April 1, 2012 to April 30, 2015. HPV was detected and genotyped using the INNO-LiPA assay, and we collected medical and demographic data from all subjects. Risk factors for any HPV, high-risk HPV (HR-HPV) and HPV16 infection were assessed by bivariate and multivariate analysis. The primary outcomes association of HR-HPV or HPV16 with medical and demographic features.

RESULTS:

We detected HPV DNA in anal tissues from 34% of the subjects and HR-HPV in 18%. HPV16 was the most prevalent genotype (detected in 7%), followed by HPV51, HPV52, and HPV39. HR-HPV was detected in a significantly higher proportion of samples from women (23.1%) than men (12.8%) (P = .0035); HR-HPV and HPV16 were detected in a significantly higher proportion of patients with Crohn's disease (30.0%) than without (18.1%) (P = .005). Female sex, history of sexually transmitted disease, lifetime and past year-number of sexual partners, active smoking, and immunosuppressive therapies were independent risk factors for anal HR-HPV infection in multivariate analysis.

CONCLUSION:

One third of patients who underwent colonoscopy at a gastroenterology department were found to have anal canal HPV infection. We detected HR-HPV infection in almost 20% of patients and in a significantly higher proportion of patients with Crohn's disease than without. Increasing our knowledge of HPV infection of anal tissues could help physicians identify populations at risk and promote prophylaxis with vaccination and adequate screening.

 

 
Question posée
 
Evaluer la prévalence de l’infection anale par Papillomavirus humain chez 469 patients pris en charge pour une coloscopie et en déterminer les facteurs de risque.
 
Question posée
 
La prévalence de l’infection anale par Papillomavirus était de 34,1 % et, chez les 101 patients atteints de MICI, de 34,7 %. Il s’agissait de sous-types à haut risque oncogène dans 30 % des cas de maladie de Crohn et 13,8 % des cas de RCH (p=0,007). Les facteurs de risque d’infection par Papillomavirus à haut risque oncogène étaient le sexe féminin, le tabagisme, un antécédent d’IST, un grand nombre de partenaires sexuels et la prise d’un traitement immuno-suppresseur.
 
Commentaires

Les patients atteints de maladie de Crohn sont particulièrement concernés par l’infection anale par Papillomavirus à haut risque oncogène. La vaccination semble donc très pertinente chez ces patients en sur-risque de cancer de l’anus.

 
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