High prevalence of anal human papillomavirus infection and anal cancer precursors among HIV-infected persons in the absence of anal intercourse.
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.
Piketty
Christophe
C
INSERM U 430 and Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. Christophe.piketty@egp.ap-hop-paris.fr
Darragh
Teresa M
TM
Da Costa
Maria
M
Bruneval
Patrick
P
Heard
Isabelle
I
Kazatchkine
Michel D
MD
Palefsky
Joel M
JM
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
D012367:RNA, Viral