Use of highly active antiretroviral therapy is associated with lower prevalence of anal intraepithelial neoplastic lesions and lower prevalence of human papillomavirus in HIV-infected men who have sex with men.
BACKGROUND
The incidence of anal intraepithelial neoplasia (AIN) and anal cancer is increased in HIV-positive men who have sex with men (MSM). Persistent high-risk human papillomavirus (HPV) infection is an important etiologic agent.


METHODS
In this study, a group of 250 HIV-positive MSM was included to determine the prevalence of AIN and to investigate the role of highly active antiretroviral therapy (HAART), high-risk HPV, and other risk factors possibly associated with this prevalence.


RESULTS
Among patients included, 108 (43.2%) had lesions suspicious for AIN. Histologic analyses showed AIN 1 in 24 patients (22.2%), AIN 2 in 6 patients (5.6%), and AIN 3 in 10 patients (9.3%). In multivariable analyses, the use of HAART was associated with the absence of AIN (P = 0.045). In MSM without HAART, HPV infection was detected significantly more often compared with those who used HAART (P = 0.010). AIN was associated with HPV types 16 and 6.


CONCLUSIONS
In this cross-sectional study in 250 HIV-positive MSM, the use of HAART was associated with lower prevalence of AIN and a significantly lower prevalence of HPV. This association between the prevalence of AIN and the absence of HAART may contribute to the current debate on when to start HAART in HIV-infected individuals.
Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands. e.vandersnoek@erasmusmc.nl
Eric M
EM
van der Snoek
M E
ME
van der Ende
J C
JC
den Hollander
M
M
Schutten
H A M
HA
Neumann
G J J
GJ
van Doornum
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D018451:Homosexuality, Male; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012307:Risk Factors