Papilomaviry (HPV) u homosexuálů

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Pavel Čermák

Lidské papilomaviry jsou zodpovědné za 90 – 99 % případů rakoviny děložního čípku a 70 – 100 % případů rakoviny konečníku.

Jejich genetická informace je kódovaná v DNA a jsou známé pod anglickou zkratkou HPV (Human papillomavirus).

Dnes jsou zmapované genetické sekvence více než 170 typů lidských papilomavirů, které se dělí do pěti rodů: Alphapapillomavirus, Betapapillomavirus, Gammapapillomavirus, Mupapillomavirus a Nupapillomavirus.

Kromě toho bylo zjištěno přinejmenším dalších 200 domnělých typů virů, které teprve čekají na zmapování svého genomu a klasifikaci.

Wikipedie nabízí následující přehled onemocnění způsobených papilomaviry a u nich vždy čísla typů , které je vyvolávají:

Onemocnění	Typ HPV
Common warts	2, 7, 22
Plantar warts	1, 2, 4, 63
Flat warts	3, 10, 8
Anogenital warts	6, 11, 42, 44 and others^[13]
Anal dysplasia (lesions)	6, 16, 18, 31, 53, 58^[14]
Genital cancers	Highest risk:^[13] 16, 18, 31, 45 Other high-risk:^[13]^[15] 33, 35, 39, 51, 52, 56, 58, 59 Probably high-risk:^[15] 26, 53, 66, 68, 73, 82
Epidermodysplasia verruciformis	more than 15 types
Focal epithelial hyperplasia (oral)	13, 32
Oral papillomas	6, 7, 11, 16, 32
Oropharyngeal cancer	16
Verrucous cyst	60
Laryngeal papillomatosis	6, 11

DNA papilomavirů však byla zjištěna také v periferní krvi u 8,3 % zdravých dárců krve.

V další studii (Carlo Foresta) byly bílkoviny HPV nalezeny v lymfocytech Cd20+ a Cd56+ v periferní krvi a spermatu. Nález souvisel s infekcí spermatu papilomavirem typu 16.

Informace o nepřehledném počtu typů lidských papilomavirů a jejich výskytu v různých typech lidských tkání zde uvádím úmyslně, aby bylo jasné, o jak složitou problematiku se jedná a kolik toho ještě zbývá prozkoumat, protože jednotlivé typy virů se geneticky i chováním v organismu poměrně výrazně liší.

Nechci však vyvolávat paniku. S papilomaviry se během života setká každý a velká část z nich je pokládána za neškodné. Lidský organismus se jich většinou dokáže po infekci zbavit sám a vážné onemocnění způsobí jen v některých případech.

Na druhé straně se však nejedná o zanedbatelnou problematiku, jak vidíme z mohutné kampaně podporující očkování proti některým typům papilomavirů. Základní informaci o papilomavirech je možné nalézt například v článku, který napsal MUDr Fait. http://www.hpv-guide.cz/clanek-mudr-tomas-fait-phd-co-dokazi-lidske-papilomaviry

Papilomaviry u homosexuálů

Výskytem papilomavirové infekce u mužů kteří mají sex s muži (MSM) se zabývá studie, kterou publikoval Stephen Goldstone a další autoři. Průměrný věk byl 22 let a do studie byli úmyslně vybráni muži, kteří nebyli nakaženi HIV (virem AIDS).

Přítomnost typů papilomavirů 6, 11, 16 nebo 18 byla zjištěna u 30 % MSM (mužů kteří mají sex s muži) v porovnání s 8 % heterosexuálních mužů. Tato studie pracovala s mladými muži o průměrném věku 22 let a tak je počet nakažených relativně nízký v porovnání s jinými studiemi.

Peter Newman a spoluautoři provedli metaanalýzu více studií a uvádějí, že anální infekce papilomaviry se vyskytuje u 15 % heterosexuálních mužů, 60 % MSM kteří jsou HIV negativní a téměř 95 % MSM HIV+ (mužů kteří mají sex s muži a jsou nakaženi virem působícím AIDS).

Vysoký výskyt anální infekce HPV souvisí se zvýšeným výskytem rakoviny konečníku, který je u MSM 44krát vyšší, než v běžné populaci. V případě MSM, kteří jsou nakaženi HIV je výskyt rakoviny konečníku dokonce 60krát vyšší.

Infekce papilomaviry, které patří k nejrozšířenějším původcům sexuálně přenosných nemocí, se tedy vyskytuje přibližně čtyřikrát častěji u mužů, kteří mají sex s muži, než u heterosexuálních mužů. Z toho vyplývají podobná varování jako u jiných pohlavních nemocí. Toto varování se týká v první řadě všech mužů, kteří mají někdy sex s jiným mužem (MSM). Týká se však také žen, které by měly být zvláště ostražité kdykoli mají podezření, že muž který o ně projevuje zájem je homosexuál, bisexuál, nebo má někdy homosex za peníze. Důsledky jsou jasné i pro případné dárcovství krve nebo jiných orgánů homosexuály.

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