High incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men.
OBJECTIVE
The incidence of anal cancer among homosexual men exceeds that of cervical cancer in women, and HIV-positive homosexual men may be at even higher risk than HIV-negative men. Cervical cancer is preceded by high-grade squamous intra-epithelial lesions (HSIL) and anal HSIL may similarly be the precursor to anal cancer. In this study, we describe the incidence of and risk factors for HSIL in HIV-positive and HIV-negative homosexual and bisexual men.


METHODS
Prospective cohort study of HIV-positive and HIV-negative homosexual men.


METHODS
The University of California, San Francisco.


METHODS
346 HIV-positive and 262 HIV-negative men enrolled at baseline, 277 HIV-positive and 221 HIV-negative homosexual men followed after baseline.


METHODS
A questionnaire was administered detailing lifestyle habits, medical history and sexual practices. Anal swabs for cytology and human papillomavirus studies were obtained, followed by biopsies of visible lesions. Human papillomavirus testing was performed using polymerase chain reaction (PCR) and 'hybrid capture'. Blood was obtained for HIV testing and measurement of CD4 levels.


METHODS
Incident HSIL.


RESULTS
HIV-positive men were more likely to develop HSIL than HIV-negative men relative risk (RR), 3.7; 95% confidence interval (CI), 2.6-5.7. Life-table estimates of the 4-year incidence of HSIL was 49% (95% CI, 41-56) among HIV-positive men and 17% (95% CI, 12-23) among HIV-negative men. Among HIV-positive men, those with lower baseline CD4 counts (P = 0.007) and persistent infection with one or more human papillomavirus types, determined using PCR (P = 0.0001), were more likely to develop HSIL.


CONCLUSIONS
HIV infection, lower CD4 levels and human papillomavirus infection were associated with high rates of incident HSIL among homosexual men. However, high rates were found at all CD4 levels among HIV-positive men and among HIV-negative men.
Palefsky
J M
JM
Department of Laboratory Medicine, University of California San Francisco, 94143, USA.
Holly
E A
EA
Ralston
M L
ML
Jay
N
N
Berry
J M
JM
Darragh
T M
TM
D001003:Anal Canal / Q000473:pathology / Q000821:virology; D001005:Anus Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D001727:Bisexuality; D018791:CD4 Lymphocyte Count; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008297:Male; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012307:Risk Factors; D012495:San Francisco; D011795:Surveys and Questionnaires; D013997:Time Factors