title: Prospective study of high grade anal squamous intraepithelial neoplasia in a cohort of homosexual men: influence of HIV infection, immunosuppression and human papillomavirus infection.
abstract: OBJECTIVE
  To determine the risk of developing high grade anal squamous intraepithelial neoplasia (HG-AIN) in relation to HIV infection and immunosuppression, after controlling for the effects of human papillomavirus (HPV) infection.
  
  
  METHODS
  Prospective cohort study of 158 HIV-seropositive and 147 HIV-seronegative homosexual men presenting to a community-based clinic with initially negative anal cytologic and colposcopic findings.
  
  
  METHODS
  Subjects completed self-administered questionnaires, underwent cytologic screening, and standardized unaided and colposcopic examination of the proximal anal canal for presence of abnormalities suggestive of AIN. Anal specimens were screened for HPV DNA.
  
  
  RESULTS
  HG-AIN developed in eight (5.4%) and 24 (15.2%) HIV-seronegative and -seropositive men, respectively. Risk of HG-AIN among HIV-seronegative men was associated with detection of anal HPV types 16 or 18 by Southern transfer hybridization (STH), detection of HPV 16 or 18 at the lower levels by polymerase chain reaction but not by STH, and with number of positive HPV tests; HG-AIN risk among HIV-seropositive men was associated with detection of HPV 16 or 18 only by STH, detection of HPV types other than 16 or 18, CD4 count < or = 500 x 10(6)/l, and number of positive HPV tests. HIV-induced immunosuppression remained an independent predictor of HG-AIN after adjusting for type and level of detection of HPV; HIV infection predicted HG-AIN risk after adjustment for number of positive HPV tests.
  
  
  CONCLUSIONS
  The association of HG-AIN with HIV, independent of HPV type, level of HPV detection and number of positive HPV tests, suggests that this increased risk cannot be entirely explained by an effect of HIV on HPV detection. Future studies focusing on factors more specific to the local microenvironment in the anal canal should help clarify these issues.
authors.affiliation: Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle 98195, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Critchlow
authors.forename: C M
authors.initials: CM
authors.lastname: Surawicz
authors.forename: K K
authors.initials: KK
authors.lastname: Holmes
authors.forename: J
authors.initials: J
authors.lastname: Kuypers
authors.forename: J R
authors.initials: JR
authors.lastname: Daling
authors.forename: S E
authors.initials: SE
authors.lastname: Hawes
authors.forename: G M
authors.initials: GM
authors.lastname: Goldbaum
authors.forename: J
authors.initials: J
authors.lastname: Sayer
authors.forename: C
authors.initials: C
authors.lastname: Hurt
authors.forename: C
authors.initials: C
authors.lastname: Dunphy
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000209:etiology*; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008297:Male; D018307:Neoplasms, Squamous Cell / Q000209:etiology*; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000150:complications*