Anal intraepithelial neoplasia in heterosexual and homosexual HIV-positive men with access to antiretroviral therapy.
BACKGROUND
Studies of human immunodeficiency virus (HIV)-positive men have demonstrated high rates of anal intraepithelial neoplasia (AIN), a precursor to anal carcinoma, mostly in white homosexual men and men not receiving effective antiretroviral therapy (ART).


METHODS
Ninety-two participants--53% Latino, 36% African American, and 40% without a history of receptive anal intercourse (RAI)--were evaluated with a behavioral questionnaire, liquid-based anal cytological testing, Hybrid Capture 2 human papillomavirus (HPV) DNA assay and polymerase chain reaction, and anal colposcopy with biopsy of lesions.


RESULTS
High-risk HPV DNA was identified in 61%, and this was associated with a history of RAI (78% vs. 33%; P<.001); 47% had abnormal cytological results, and 40% had AIN on biopsy. In multivariate analysis, both were associated with a history of RAI (odds ratio [OR], 10 [P<.001] and OR, 3.6 [P=.02], respectively) and lower nadir CD4(+) cell counts (P=.06 and P=.01). Current ART use was protective (OR, 0.09; P<.01 and OR, 0.18; P=.02).


CONCLUSIONS
Although anal infections with high-risk HPV and AIN in HIV-positive men are associated with a history of RAI, both conditions are commonly identified in HIV-positive men without this history. Both lower nadir CD4(+) cell counts and lack of current ART were associated with AIN but not with the detection of anal HPV.
Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, New York, New York 10011, USA. tiw2001@med.cornell.edu.
T J
TJ
Wilkin
S
S
Palmer
K F
KF
Brudney
M A
MA
Chiasson
T C
TC
Wright
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001004:Anus Diseases / Q000453:epidemiology; D001005:Anus Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D018791:CD4 Lymphocyte Count; D002278:Carcinoma in Situ / Q000150:complications / Q000473:pathology / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D020010:Heterosexuality; D006716:Homosexuality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000821:virology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States
D019380:Anti-HIV Agents; D004279:DNA, Viral