Einstein/Rwanda DRC Consortium for Research in HIV/HPV Malignancies

爱因斯坦/卢旺达刚果民主共和国 HIV/HPV 恶性肿瘤研究联盟

• 批准号: 10084655
• 负责人: Kathryn M. Anastos
• 金额: $ 25.88万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-21 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10084655
• 关键词: AIDS related cancer; Africa South of the Sahara; Age; Anal canal; Anatomy; Anogenital Human Papilloma Virus Infection; Antibodies; Anus; Area; Blood; Central Africa; Cervical; Cessation of life; Collaborations; Colorectal Cancer; Country; Data; Democratic Republic of the Congo; Developed Countries; Development; Disease; Enrollment; Environment; Exposure to; Gastrointestinal tract structure; General Population; Genotype; Goals; Grant; HIV; HIV Infections; HPV-High Risk; Human Papilloma Virus Vaccination; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Human papilloma virus infection; Immune response; Impairment; Incidence; Individual; Inflammatory Bowel Diseases; Investigation; Knowledge; Lesion; Link; Low Prevalence; Malignant Neoplasms; Malignant Vaginal Neoplasm; Malignant neoplasm of anus; Malignant neoplasm of cervix uteri; Malignant neoplasm of penis; Malignant neoplasm of vulva; Measures; Medical; Natural History; Pathogenesis; Persons; Policies; Population; Populations at Risk; Prevalence; Prevention strategy; Primary Prevention; Prospective Studies; Research; Resolution; Risk; Risk Factors; Rwanda; Secondary Prevention; Source; Squamous intraepithelial lesion; System; Time; Vaccinated; Vaccination; Virus Diseases; cancer prevention; cancer risk; cohort; cost; design; dysbiosis; follow-up; high risk; high risk behavior; high risk men; high risk population; infection rate; infection risk; innovation; malignant oropharynx neoplasm; men; men who have sex with men; microbial; microbial community; microbiome; normal microbiota; penis; premalignant; prophylactic; virtual

Abstract: High-risk types of human papillomavirus (HPV) cause virtually all cervical cancer, most anal, vulvar, vaginal, and penile cancer, and a significant proportion of oropharyngeal cancer. Men who have sex with men (MSM) are at an elevated risk of anal cancer because of high-risk behaviors for acquiring HPV, and those living with HIV (MSM-LWH), are at the highest risk of anal cancer due to also having an impaired immune response to HPV. Understanding the prevalence and incidence of anogenital HPV infection and precancerous lesions and their associated risk factors in at-risk populations is particularly important since, unlike most other cancers, HPV- related cancers are likely preventable. Prevention of these cancers may be accomplished through primary prevention (vaccination) or potentially through secondary prevention by identifying and treating precancerous lesions. In general, little is known about the prevalence and incidence of anal and penile HPV infection, and anal and penile squamous intraepithelial lesions (SIL) among MSM who live in sub-Saharan Africa (SSA). We previously completed a study of HPV in Rwandan MSM and surprisingly found an unexpected low prevalence of anal HPV and no difference in anal HPV prevalence between MSM-LWH and HIV-uninfected (HIV[-]) MSM. We propose to continue our investigations of anal and penile HPV in MSM by conducting a complementary study in MSM living in the Democratic Republic of Congo (DRC). We hypothesize that Congolese MSM are likely to have higher hrHIV prevalence than do Rwandan men because of different cultural and sexual practices. The proposed study is designed to provide data on the prevalence and incidence of anal and penile HPV infection and HPV-associated lesions at these anatomic sites, and to describe associated risk factors for Congolese MSM, and compare these findings to those in our prior MSM study in Rwanda. After conducting formative research to reach the target MSM population and build local capacity to conduct the proposed research in DRC, we will enroll and follow 300 Congolese MSM, 150 MSM-LWH and 150 HIV[-] MSM, every 6 months for 18 months, as we did for the first 18 months of our Rwanda study. Moreover, we will extend our follow-up of the Rwandan MSM cohort to for two additional years to assess incidence of precancerous lesions. We will measure current HPV infections using a low-cost, robust HPV genotyping system that we have already introduced into Rwanda and will, as part of this grant, introduce into DRC, and past exposures by measuring anti-HPV antibodies circulating in the blood. We will also measure the anal microbiome to determine whether certain microbiotic environments influence the anal HPV natural history as they seem to for cervical HPV. Our (long-term) goal is to establish a cohort of MSM in both countries to study the natural history of anal and penile HPV in MSM living in SSA. This contribution is significant as it will establish the extent of exposure to HPV and at what ages, which can be used to guide policy on what age to target MSM for prophylactic HPV vaccination. The proposed research is innovative as it leverages and expands the local research and medical capacity in Rwanda and DRC, and creates a south-south collaboration, to conduct a state-of-the-art natural history of anal and penile HPV and related abnormalities, and their corresponding risk factors, which is poorly described in MSM-LWH and HIV[-] MSM living in SSA.

抽象的： 高风险的人乳头瘤病毒（HPV）几乎所有宫颈癌，大多数肛门，外阴，阴道，阴道， 和阴茎癌，以及大部分的口咽癌。与男人发生性关系的男人是 由于获得HPV的高风险行为，患肛门癌的风险较高，患有艾滋病毒的人 （MSM-LWH），由于对HPV的免疫反应受损，肛门癌的风险最高。 了解肛门生殖器HPV感染和癌前病变的患病率和发病率及其 高危人群中的相关危险因素尤其重要，因为与大多数其他癌症不同，HPV- 相关的癌症可能是可以预防的。预防这些癌症可能是通过主要的 预防（疫苗接种）或潜在地通过二次预防来识别和治疗癌前 病变。 通常，关于肛门和阴茎HPV感染的患病率和发病率，以及 生活在撒哈拉以南非洲（SSA）的MSM中的肛门和阴茎鳞状上皮内病变（SIL）。我们 先前在卢旺达MSM中完成了HPV的研究，令人惊讶地发现了意外的低患病率 MSM-LWH和HIV未感染（HIV [ - ]）MSM之间的肛门HPV和肛门HPV患病率无差异。 我们建议通过进行互补来继续对MSM中的肛门和阴茎HPV进行调查 居住在刚果民主共和国（DRC）的MSM研究。我们假设刚果MSM是 由于不同的文化和性，可能比卢旺达男人高的HRHIV患病率 实践。拟议的研究旨在提供有关肛门和阴茎发生率和发病率的数据 在这些解剖部位，HPV感染和HPV相关病变，并描述相关的风险因素 刚果MSM，并将这些发现与我们先前在卢旺达的MSM研究中的发现进行了比较。 在进行形成性研究以达到目标MSM人群并建立地方能力之后 在刚果民主共和国进行拟议的研究，我们将参加并关注300个刚果MSM，150 msm-lwh和 150 HIV [ - ] MSM，每6个月，持续18个月，就像我们在卢旺达研究的前18个月所做的那样。 此外，我们将将卢旺达MSM队列的后续行动扩展到另外两年来评估 癌前病变的发病率。我们将使用低成本，鲁棒的HPV测量电流HPV感染 我们已经引入卢旺达的基因分型系统，作为这笔赠款的一部分，将 DRC和过去通过测量血液中循环的抗HPV抗体来暴露。我们还将测量 肛门微生物组确定某些微生物环境是否影响肛门HPV自然历史 正如它们似乎是宫颈HPV的那样。 我们（长期）的目标是在两国建立MSM的队列，以研究 居住在SSA的MSM中的肛门和阴茎HPV。这项贡献很重要，因为它将确定 暴露于HPV和什么年龄，可以用来指导针对MSM的年龄的政策 预防性HPV疫苗接种。拟议的研究具有创新性，因为它利用并扩展了当地 卢旺达和刚果民主共和国的研究和医疗能力，并创建了南南的合作，以进行 肛门和阴茎HPV及相关异常的最新自然历史及其相应的风险 因素，在居住在SSA中的MSM-LWH和HIV [ - ] MSM中描述了。