Project: The Epidemiology of Human Papillomavirus and Associated Disease in HIV Positive Men in South Africa

Acronym	TEHSA (Reference Number: TMA 2015 CDF - 1032)
Duration	01/06/2017 - 31/05/2020
Project Topic	Globally, the incidence of human papillomavirus (HPV) associated anal and oropharyngeal cancers (OPCs) in men are increasing. Anogenital warts (AGWs) cause significant morbidity in men and result in high medical costs worldwide. Fewer data exist for men in Sub-Saharan Africa (SSA) including South Africa (SA) due to paucity of research and poor quality cancer registries. Thus quantification of the burden of disease in SSA is of significant importance. There is enough data suggesting that HPV infection is a primary underlying cause of AGWs and these cancers. Available data from other settings suggests that HIV alters the susceptibility and the natural history of HPV-associated diseases, leading to higher rates of pre-cancerous lesions. Studies suggest that antiretroviral therapy (ART) increases the regression of Cervical Intraepithelial Neoplasia (CIN) lesions, indicating immune reconstitution; however the incidences for Anal Intraepithelial Neoplasia (AIN) and oropharyngeal lesions seem continuously increase despite ART initiation. It is therefore important to additionally understand the natural history of anogenital and oral HPV infection in HIV positive men and factors associated with HPV disease progression. Screening programmes for AIN are not widely available due to high costs of high resolution anoscopy which is required to obtain anal biopsies and their benefits in SSA setting are unclear as some of the lesions regress spontaneously. Biomarkers such as HPV viral load to identify men at high risk of progression to cancer are important but require further investigation. HPV DNA testing could be used to screen for OPCs, however the best sampling method for oropharyngeal HPV DNA infection is yet to be agreed on. The work we intend to carryout will answer the following objectives (i) describe and report on the epidemiology of anogenital and oropharyngeal cancer patterns and trends in men including incidence and mortality rates and differences by ethnicity in SA between 1994 and 2010. Furthermore, explore the influence of HIV status on epidemiology of these cancers, (ii) determine the prevalence of anogenital and oropharyngeal HPV infection, genotype distribution and associations with anogenital disease, according to HIV-related factors and exposure to antiretroviral treatment (ART) and (iii) determine the incidence, persistence, and clearance of type-specific anogenital and oropharyngeal HPV infection and anal cytological lesions over 18 months and the effects of HIV related factors and concomitant exposure to ART on these outcomes.
Network	EDCTP2
Call	Training and Mobility Awards: Career Development Fellowships

Project partner

Number	Name	Role	Country
1	Wits Health Consortium (Pty) Ltd	Coordinator	South Africa