Anal squamous intraepithelial lesions and condyloma in HIV-infected heterosexual men, homosexual men and women: prevalence and associated factors.
OBJECTIVE
To assess the prevalence of and factors associated with squamous intraepithelial lesions and condyloma [human papillomavirus (HPV)-related lesions) in HIV-infected patients.


METHODS
A cross-sectional study in a tertiary-care university hospital conducted in 516 consecutive outpatients.


METHODS
A systematic examination for macroscopic HPV-related lesions through anoscopy with histological confirmation, evaluation of dysplasia and HPV typing. Sexual behaviours were assessed using a semi-directive questionnaire.


RESULTS
Of 473 patients examined, (200 homosexual men, 123 heterosexual men, 150 women), 108 (23%) had histologically confirmed anal HPV-related lesions (36, 15 and 11% of the respective populations), including 51 (47%) with only endoanal localization. Among these 108 patients, histological dysplasia of grades I or II and grade III were noted in 59 and two patients, respectively, invasive endoanal cancer in one; three patients also had high-risk oncogenicity HPV without dysplasia. Independent identified associated factors of HPV-related condyloma were the number of incidents of sexual intercourse per month [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.06], CD4 cell count below 200 x 10 cells/l (OR 3.22; 95% CI 1.37-7.60), history of anal HPV lesion (OR 4.57; 95% CI 2.13-9.81), and receptive anal intercourse (OR 2.30; 95% CI 1.11-4.77). The two latter factors remained associated with histological dysplasia (OR 2.82; 95% CI 1.38-5.76 for history of anal condyloma, and OR 4.29; 95% CI 2.18-8.44 for receptive anal intercourse).


CONCLUSIONS
The high rate of condyloma and histological dysplasia seen argues for a systematic screening for these lesions in HIV-infected individuals.
Abramowitz
Laurent
L
Department of Gastroenterology and Proctology, Bichat Hospital, Paris, France. laurent.abramowitz@bch.aphp.fr
Benabderrahmane
Dalila
D
Ravaud
Philippe
P
Walker
Francine
F
Rioux
Christophe
C
Jestin
Christine
C
Bouvet
Elisabeth
E
Soulé
Jean-Claude
JC
Leport
Catherine
C
Duval
Xavier
X
D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000821:virology; D001004:Anus Diseases / Q000473:pathology / Q000821:virology*; D001005:Anus Neoplasms / Q000473:pathology / Q000821:virology*; D002278:Carcinoma in Situ / Q000473:pathology / Q000821:virology*; D003218:Condylomata Acuminata / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000473:pathology / Q000821:virology*; D020010:Heterosexuality; D006716:Homosexuality; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010212:Papilloma / Q000175:diagnosis / Q000473:pathology / Q000821:virology; D015995:Prevalence; D012306:Risk; D012725:Sexual Behavior