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.
Wilkin
T J
TJ
Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, New York, New York 10011, USA. tiw2001@med.cornell.edu.
Palmer
S
S
Brudney
K F
KF
Chiasson
M A
MA
Wright
T C
TC
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