title: High prevalence of anal human papillomavirus infection and anal cancer precursors among HIV-infected persons in the absence of anal intercourse.
abstract: BACKGROUND
  Anal cancer and its precursor lesion, anal squamous intraepithelial lesions (SILs), are associated with human papillomavirus (HPV) infection. Anal HPV infection and anal SIL are common in HIV-positive men who have sex with men; receptive anal intercourse is presumed to be the mode of acquisition of HPV.
  
  
  OBJECTIVE
  To assess the prevalence and risk factors for anal HPV infection and anal SIL in HIV-positive men with no history of anal intercourse.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Hôpital Européen Georges Pompidou outpatient clinic, Paris, France.
  
  
  METHODS
  118 HIV-infected men.
  
  
  METHODS
  50 HIV-positive heterosexual male injection drug users with no history of anal intercourse and 67 HIV-infected men who had sex with men were evaluated by using anal cytologic, anal histologic, and anal HPV DNA testing.
  
  
  RESULTS
  23 of the 50 heterosexual injection drug users (46%) had anal HPV infection. Low-grade SIL (LSIL) was found in 8 patients (16%) and high-grade SIL (HSIL) in 9 patients (18%). Among the 67 men who had sex with men, anal HPV infection was found in 57 patients (85%), LSIL in 33 patients (49%), and HSIL in 12 patients (18%). In univariate analysis, risk factors for abnormal anal cytologic or histologic findings in injection drug users included CD4+ cell counts less than 250 x 10(6) cells/L (odds ratio, 5.7 [95% CI, 1.6 to 20.4]), plasma HIV RNA viral load greater than 1.7 log copies/mL (odds ratio, 8.9 [CI, 1.1 to 76.0]), previous AIDS-defining event (odds ratio, 4.3 [CI, 1.2 to 15.6]), and anal HPV detection (odds ratio, 5.7 [CI, 1.6 to 20.4]). Risk factors among men who had sex with men included having more than 10 lifetime receptive anal intercourse episodes (odds ratio, 5.6 [CI, 1.6 to 19.8]) and anal HPV detection (odds ratio, 8.7 [CI, 1.9 to 39.0]).
  
  
  CONCLUSIONS
  Anal HPV infection and anal SIL may be acquired in the absence of anal intercourse in HIV-positive men. The prevalence of HSIL is high among HIV-positive injection drug users. All HIV-positive men with CD4+ cell counts less than 500 x 10(6) cells/L, regardless of history of anal intercourse, should be considered for anal cytologic screening; however, additional studies are needed to determine the efficacy of this procedure to prevent anal cancer in these populations.
authors.affiliation: INSERM U 430 and Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. Christophe.piketty@egp.ap-hop-paris.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Piketty
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.forename: Maria
authors.initials: M
authors.lastname: Da Costa
authors.forename: Patrick
authors.initials: P
authors.lastname: Bruneval
authors.forename: Isabelle
authors.initials: I
authors.lastname: Heard
authors.forename: Michel D
authors.initials: MD
authors.lastname: Kazatchkine
authors.forename: Joel M
authors.initials: JM
authors.lastname: Palefsky
mesh_terms: D000328:Adult; D001004:Anus Diseases / Q000453:epidemiology* / Q000821:virology; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000821:virology; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D006678:HIV / Q000235:genetics; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D030361:Papillomavirus Infections / Q000453:epidemiology*; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000821:virology; D014412:Tumor Virus Infections / Q000453:epidemiology*; D019562:Viral Load
chemical_list: D012367:RNA, Viral