Association between human papillomavirus infection and ocular surface squamous neoplasia in South Africa

Abstract

Background: Ocular surface squamous neoplasia (OSSN) is an epithelial tumour of the conjunctiva. Risk factors for developing this tumour include ultraviolet-B (UVB) exposure, human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection. Aim: The aim of this study is to describe the prevalence of HPV infection in OSSN in an urban South African context. Setting: The study was conducted in Johannesburg, South Africa. Methods: A prospective cross-sectional case-control study was conducted. Cases were recruited from patients with OSSN undergoing surgical excision and controls from patients undergoing surgery where the conjunctiva was found to be normal. Tissue was submitted for polymerase chain reaction (PCR) testing, which included mucosal and cutaneous HPV subtypes. Results: Sixty-two participants were included in the study, 32 with OSSN (cases) and 30 with normal conjunctiva (controls). Human papillomavirus was found in 21.8% of cases, where none of the controls had HPV (p = 0.011). Human papillomavirus infection was only found in patients with concomitant HIV infection, with no association found between cluster of differentiation 4 (CD4) count, viral load and antiretroviral treatment status. No association was found between the histological grade of OSSN and HPV infection. Conclusion: Our pilot study found a significant association between OSSN and HPV infection in a patient population with a high prevalence of HIV infection. Contribution: Our study shows that HPV may be a contributing factor in OSSN in South Africa.