Human Papillomavirus Infection Is Not Associated with Dysplasia and Squamous Carcinoma of the Conjunctiva in a Cohort of Young Patients in South Africa.
Martin J Hale, Sharlene Naidoo, Sibongile M Muthabeni. University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
Background: Conjunctival dysplasia and squamous carcinoma are associated with exposure to ultraviolet radiation. Typically, these changes are seen in older patients who have lived for extended periods in tropical regions. The disease has been associated with human immunodeficiency virus (HIV) infection and there is evidence that the demographic profile of patients with this condition is becoming younger, particularly in sub-Saharan Africa as a consequence. It has been suggested that conjunctival infection by human papillomavirus (HPV) may be associated with dysplasia and squamous carcinoma, but there is conflicting evidence for this.
Design: The archives of the Division of Anatomical Pathology at Chris Hani Baragwanath were searched for all conjunctival biopsies in 2007 and 2008 showing dysplasia or squamous carcinoma. Patients 35 years or younger were identified and their pathological changes stratified according to severity of dysplasia and invasive carcinoma. Evidence of HPV infection of the conjunctiva was then sought in this cohort of young patients using the polymerase chain reaction to amplify the L1 region of the HPV genome which yields a 150bp product usng the GP5+ / GP6+ primers, which are generic to all HPV subtypes. PCR amplification for HPV was also performed on conjunctival biopsies from 10 patients showing no evidence of dysplasia as a control group.
Results: A total of 418 patients with conjunctival biopsies were found, 116 being aged 35 years or younger. Of this group, 51 (44%) showed evidence of dysplasia or invasive carcinoma stratified as follows: 5 patients had mild dysplasia, 13 moderate dysplasia, 26 severe dysplasia / carcinoma in situ and 7 invasive squamous carcinoma. Dysplastic changes were commoner in the female gender, 34 (66%) as compared to the male, 17 (34%). There was no evidence of HPV infection in any of the 51 patients with dysplasia or squamous carcinoma, or in the 10 patients without dysplasia.
Conclusions: Increasing numbers of younger patients are presenting with conjunctival dysplasia and squamous carcinoma of the conjunctiva in South Africa, particularly in the female gender. Furthermore, there is no evidence to support the notion that human papillomavirus virus plays an aetiological role in this disease in the region. This finding does not exclude the possibility that HIV infection contributes to the neoplastic process either as a sole initiator or in association with an as yet unidentified infectious agent.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 227, Wednesday Afternoon