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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2022.tde-18042022-111005
Document
Author
Full name
Aline Pozzebon Gonçalves
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Cecconello, Ivan (President)
Kimura, Cintia Mayumi Sakurai
Nadal, Sidney Roberto
Nahas, Caio Sergio Rizkallah
Title in Portuguese
A prevalência do papilomavírus humano no canal anal de portadores de retocolite ulcerativa justifica rastreamento de rotina para carcinoma anal?
Keywords in Portuguese
Canal anal
Colite ulcerativa
Doenças inflamatórias intestinais
HPV
Papilomavírus Humano
Proctocolite
Reação em cadeia da polimerase
Técnicas citológicas
Abstract in Portuguese
INTRODUÇÃO: A infecção anogenital pelo papilomavírus humano (HPV) é a doença viral sexualmente transmissível mais comum em todo o mundo. Um dos fatores de risco associados à infecção pelo HPV é a imunossupressão. A retocolite ulcerativa (RCU) é uma doença inflamatória crônica idiopática do cólon e reto. Seu tratamento inclui o uso de drogas imunossupressoras com diferentes mecanismos de ação. A contribuição da infecção pelo HPV nesse grupo de pacientes ainda é desconhecida, com poucos estudos na literatura. OBJETIVOS: Avaliar a prevalência, o tipo de HPV no canal anal e as lesões citológicas anais, provocadas pelo mesmo, em pacientes com RCU e comparar a controles; avaliar se a prevalência de HPV de alto risco oncogênico é maior naqueles portadores de RCU que usam imunossupressores e analisar se a prevalência das lesões citológicas pelo HPV no canal anal justificam rastreamento de rotina para carcinoma anal !" #$%#" &!#'!#" ()!*$)#+)%#" nos pacientes com RCU. MÉTODOS: O estudo foi transversal, observacional, com coleta prospectiva consecutiva, em único centro. Foram três grupos com 45 indivíduos cada, sendo um controle, um com pacientes portadores de RCU sem uso de imunossupressor e um terceiro em uso deste tipo de medicamento. Os grupos responderam um protocolo de pesquisa contendo dados clínicos; coleta de duas amostras para estudo citopatológico do canal anal e outra amostra para estudo do DNA viral pelo método de Linear Array®. RESULTADOS: O HPV foi detectado em 13,2% dos controles e 19,8% nos pacientes com RCU (p=0,579). A prevalência de HPV de alto risco foi igual (66,7%) entre os dois grupos de RCU vs. 85,7% no grupo controle (p=0,736). Os genótipos mais frequentes foram o 52 e 89 seguidos do 6 e 53 e todos esses mais frequentes nos que usavam imunossupressor ( 54,2% vs. 45,8% no grupo de RCU sem imunossupressor). Havia 44,4% do grupo de RCU em uso de imunossupressor com pelo menos dois genótipos, enquanto que grupo sem uso de imunossupressor somente 11,1%. As citologias anais dos pacientes com RCU estavam alteradas em 70,8% vs. 60,9% no grupo controle ( p= 0,204). CONCLUSÕES: Não houve diferença na prevalência do HPV, nem nos achados de citologia do canal anal dos portadores de RCU e grupo controle. O HPV 52 e o 89 foram os mais prevalente nos portadores de RCU. Não houve diferença na prevalência do HPV de alto risco oncogênico no canal anal, detectados pela PCR, em portadores de RCU em uso ou não de imunossupressores e controles. Nosso estudo não mostrou evidências suficientes para apoiar a necessidade de rotina de citologia anal em pacientes com diagnóstico de RCU, excluídos os fatores de riscos independentes para HPV já descritos na literatura
Title in English
Does the prevalence of human papillomavirus in the anal canal of patients with ulcerative colitis justifies routine anal cancer screening?
Keywords in English
Anal canal
Colitis
Cytological techniques
HPV
Human Papilloma Virus
Inflammatory bowel disease
Polymerase chain reaction
Proctocolitis ulcerative
Abstract in English
BACKGROUND: Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted viral disease worldwide. One of the risk factors associated with HPV infection is immunosuppression. Ulcerative colitis (UC) is a chronic idiopathic inflammatory disease of the colon and rectum. Its treatment includes the use of immunosuppressive drugs with different mechanisms of action. The contribution of HPV infection in this group of patients is still unknown, with few studies in the literature. PURPOSE: Assess the prevalence, type of HPV in the anal canal and anal cytological lesions caused by it, in patients with UC and compare to controls; whether the prevalence of high-risk oncogenic HPV is higher in those patients with UC who use immunosuppressants and to analyze whether the prevalence of cytological lesions caused by HPV justify routine anal cancer screening in patients with UC.METHODS: The study was cross-sectional, observational, with consecutive prospective collection, in a single center. There were three groups with 45 individuals each, one control, one with patients with UC without the use of immunosuppressants and a third using this type of medication. The groups responded to a research protocol containing clinical data; collection of two samples for cytopathological study of the anal canal and another sample for study of viral DNA by the Linear Array® method. RESULTS: HPV was detected in 13.2% of controls and 19.8% in patients with UC (p=0,579). The prevalence of high-risk HPV was equal (66.7%) between the two groups of UC versus 85.7% in the control group (p = 0.736). The most frequent genotypes were 52 and 89 followed by 6 and 53, all of which were more frequent in who used immunosuppressants (54.2% vs. 45.8% in the UC group without immunosuppressant). 44.4% of the RCU group using immunosuppressants had at least two genotypes, while the group without immunosuppressants only had 11.1%. Anal cytologies of patients with UC were altered in 70,8% vs. 60.9% in the control group (p = 0.204). CONCLUSION: There were no differences in the prevalence of HPV nor in the findings of cytology in the anal canal, detected by PCR in patients with UC using or not using immunosuppressants and the control group. HPV 52 and 89 were the most prevalent in patients with UC. There were no differences in the prevalence of high-risk oncogenic HPV in the anal canal, detected by PCR in patients with UC using or not using immunosuppressants and controls. Our study did not show enough evidence to propose anal cytology routine in patients with diagnosis of RCU, whether or not using immunosuppressants, excluding the independent risk factors for HPV already described in the literature
 
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Publishing Date
2022-04-18
 
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