title: Condylomata, cytological abnormalities and human papillomavirus infection in the anal canal in HIV-infected men.
abstract: BACKGROUND
  Genital infections with low-risk (LR) and high-risk (HR) human papillomavirus (HPV) genotypes are associated with ano-genital condylomata and anal squamous cell cancer. HPV-related pathologies in HIV-infected men are a serious concern. In this study, the prevalence of anal condylomata and their association with cytological abnormalities and HPV infection in the anal canal in HIV-infected men [men who have sex with men (MSM) and heterosexuals] were estimated.
  
  
  METHODS
  This was a cross-sectional study based on the first visits of patients in the Can Ruti HIV-positive Men (CARH·MEN) cohort. Anal condylomata were assessed by clinical and proctological examination. Samples from the anal canal were collected for HPV genotyping and cytological diagnoses.
  
  
  RESULTS
  A total of 640 HIV-infected men (473 MSM and 167 heterosexuals) were included in the study. The overall prevalence of anal condylomata was 25% [157 of 640; 95% confidence interval (CI) 21-28%]; in MSM it was 28% and in heterosexuals it was 15% [odds ratio (OR) 2.2; 95% CI 1.4-3.5]. In patients with anal condylomata, HPV infection in the anal canal was more prevalent (92% vs. 67% in those without anal condylomata; OR 8.5; 95% CI 3.2-22). This higher HPV prevalence involved at least two HPV genotypes (OR 4.0; 95% CI 2.2-7.1), mainly HR genotypes (OR 3.3; 95% CI 1.7-6.4). Similarly, the cumulative prevalence of HPV-6 and HPV-11 was higher in patients with anal condylomata (63% vs. 19% in those without anal condylomata). Having anal condylomata was associated with higher prevalences of cytological abnormalities (83% vs. 32% in those without anal condylomata; OR 6.9; 95% CI 3.8-12.7) and high-grade squamous intraepithelial lesions (HSILs) (9% vs. 3% in those without anal condylomata; OR 9.0; 95% CI 2.9-28.4) in the anal canal.
  
  
  CONCLUSIONS
  HIV-infected men with anal condylomata were at risk of presenting HSILs and harbouring multiple HR HPV infections in the anal canal. Although MSM presented the highest prevalence of anal condylomata, heterosexual men also had a clinically important prevalence. Our findings emphasize the importance of screening and follow-up for condylomata in the anal canal in HIV-infected men.
authors.affiliation: Retrovirology Laboratory IrsiCaixa Foundation, Barcelona, Spain. laila.darwich@uab.cat
authors.forename: L
authors.initials: L
authors.lastname: Darwich
authors.forename: M P
authors.initials: MP
authors.lastname: Cañadas
authors.forename: S
authors.initials: S
authors.lastname: Videla
authors.forename: J
authors.initials: J
authors.lastname: Coll
authors.forename: M
authors.initials: M
authors.lastname: Piñol
authors.forename: P
authors.initials: P
authors.lastname: Cobarsi
authors.forename: R A
authors.initials: RA
authors.lastname: Molina-López
authors.forename: S
authors.initials: S
authors.lastname: Vela
authors.forename: F
authors.initials: F
authors.lastname: García-Cuyás
authors.forename: M
authors.initials: M
authors.lastname: Llatjos
authors.forename: G
authors.initials: G
authors.lastname: Sirera
authors.forename: B
authors.initials: B
authors.lastname: Clotet
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology* / Q000821:virology; D001004:Anus Diseases / Q000235:genetics / Q000473:pathology* / Q000821:virology; D003218:Condylomata Acuminata / Q000235:genetics / Q000473:pathology* / Q000821:virology; D003430:Cross-Sectional Studies; D005838:Genotype; D006679:HIV Seropositivity / Q000235:genetics / Q000473:pathology* / Q000821:virology; D020010:Heterosexuality / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000235:genetics / Q000473:pathology* / Q000821:virology; D015995:Prevalence; D011446:Prospective Studies; D012725:Sexual Behavior; D013030:Spain / Q000453:epidemiology; D055815:Young Adult