Prevalência e fatores de risco associados à infecção pelo papilomavírus humano 16 e 18 em canal anal de pacientes com doença de Crohn

Abstract

Background: Crohn’s disease (CD) is characterized by chronic inflammation, immune dysregulation, and frequent exposure to immunosuppressive therapies, factors that may favor persistent human papillomavirus (HPV) infection and the development of HPV-related anal neoplasia. However, data regarding anal HPV infection in patients with CD remain limited and inconsistent. Objective The aim of this study was to determine the prevalence of anal HPV types 16 and 18 infection in patients with Crohn’s disease treated at a tertiary referral center and to evaluate potential associated risk factors. Methods: In this cross-sectional study, 100 patients with CD and 50 healthy controls underwent standardized interviews, anal cytology, and anal HPV detection by real-time polymerase chain reaction (qPCR). Participants with positive qPCR results and/or abnormal anal cytology underwent high-resolution anoscopy with biopsy when indicated. Female participants also received gynecological evaluation. Results: High-risk anal HPV was detected by qPCR in 6.0% of patients with CD and 8.0% of controls. Abnormal anal cytology was observed in 5.3% and 10.2% of participants, respectively. The combined prevalence of positive qPCR and/or abnormal cytology was 9.6% in the CD group and 18.4% in controls. No statistically significant associations were identified between HPV positivity and age, disease duration, sexual behavior, immunosuppressive therapy, or perianal disease. Smoking demonstrated the strongest trend toward HPV positivity, although statistical significance was not reached. Despite the low prevalence of HPV infection, some high-grade anal intraepithelial lesions were identified in both groups. Conclusions: Anal HPV types 16 and 18 infections was uncommon among patients with CD and healthy controls, with no significant difference between groups. Classical risk factors were not associated with HPV positivity. Additional prospective studies are needed to establish evidence-based screening strategies for this population.