Anal intraepithelial neoplasia in the highly active antiretroviral therapy era among HIV-positive men who have sex with men.
OBJECTIVE
The incidence of anal cancer among men who have sex with men (MSM) has continued to increase since the introduction of highly active antiretroviral therapy (HAART). The prevalence of the putative anal cancer precursor, anal intraepithelial neoplasia (AIN) was high among HIV-positive MSM prior to the availability of HAART but little is known about AIN since HAART was introduced. We characterized the prevalence of AIN among HIV-positive MSM and examined the association between AIN and various factors including use of HAART.


METHODS
A baseline point-prevalence analyses in a prospective cohort study of AIN was performed at a university-based research clinic. A total of 357 HIV-positive MSM with no history of anal cancer completed a questionnaire detailing behaviors and medical history, anal cytology and human papillomavirus (HPV) testing, and high-resolution anoscopy with biopsy for detection of AIN.


RESULTS
Eighty-one percent of participants with available CD4+ cell counts at baseline had AIN of any grade; 52% had AIN 2 or 3; and 95% had anal HPV infection. In multivariate analysis, detection of > or = 6 HPV types [odds ratio (OR), 36; 95% confidence interval (CI), 7.4-171) and use of HAART (OR, 10; 95% CI, 2.6-38) were associated with AIN after adjustment for length of time participants were HIV-positive, CD4+ cell count and HIV viral load.


CONCLUSIONS
The prevalence of AIN has remained high among HIV-positive MSM after the introduction of HAART. Our data indicate that HAART is not associated with a reduced prevalence of AIN and support measures to prevent anal cancer among HIV-positive MSM whether or not they are using HAART.
Palefsky
Joel M
JM
Department of Medicine, University of California, San Francisco, California 94143, USA. joelp@medicine.ucsf.edu
Holly
Elizabeth A
EA
Efirdc
Jimmy T
JT
Da Costa
Maria
M
Jay
Naomi
N
Berry
J Michael
JM
Darragh
Teresa M
TM
D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000276:immunology / Q000821:virology*; D018791:CD4 Lymphocyte Count; D002278:Carcinoma in Situ / Q000276:immunology / Q000821:virology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D030361:Papillomavirus Infections / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D019562:Viral Load
D019380:Anti-HIV Agents