title: [CD4 lymphocytes as a protective factor against infection by oncogenic genotypes of human papillomavirus in the anal mucosa of men who have sex with human immunodeficiency virus positive men].
abstract: OBJECTIVE
  To analyze the prevalence of human papillomavirus (HPV) genotypes and anal dysplasia in a cohort of human immunodeficiency virus (HIV) infected men who have sex with men (MSM) from southern Spain, and the variables associated with the appearance of dysplastic lesions and oncogenic HPV genotypes.
  
  
  METHODS
  A cross-sectional study involving a prospective cohort of HIV-positive MSM included consecutively after signing an informed consent form. During the consultation 2 samples were taken from the anal mucosa: one for HPV detection using polymerase chain reaction (PCR), and the other for cytological evaluation; the Bethesda system was used to classify the cytology.
  
  
  RESULTS
  One hundred and thirty-four consecutive patients were included. 91.1% patients were colonized by HPV, 66.1% by high-grade types and 41.52% by genotypes of low and high-grade malignancy. The most prevalent genotypes were: 6, 11, 16, 18, 51 and 53. 72.2% samples sent for cytology showed dysplasia, of which 71.4% were low-grade squamous intraepithelial lesions, 23.1% were atypical squamous cell, and 0% was high-grade squamous intraepithelial lesions. The multivariate analysis of risk factors associated with the appearance of dysplasia revealed association with smoking (95% confidence interval [95% CI] 1.196-9.303; odds ratio [OR] 3.336; P=.02) and number of oncogenic HPV types (95% CI 1.387-3.811; OR 2.229; P=.001). With regard to the presence of oncogenic HPV genotypes the multivariate analysis showed a high CD4 cell count was a protective factor against infection by these viruses (95% CI 1.098-5.58; OR 2.48; P=.029).
  
  
  CONCLUSIONS
  The prevalence of anal dysplasia among HIV-positive MSM in this study is very high, fundamentally in smokers and a high number of oncogenic HPV genotypes. The presence of oncogenic HPV genotypes was associated with a lower CD4 cell count.
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, España. chidalgo72@hotmail.com
authors.forename: Carmen
authors.initials: C
authors.lastname: Hidalgo Tenorio
authors.forename: Mar
authors.initials: M
authors.lastname: Rivero Rodríguez
authors.forename: Ángel
authors.initials: Á
authors.lastname: Concha
authors.forename: Concepción
authors.initials: C
authors.lastname: Gil Anguita
authors.forename: Rodrigo
authors.initials: R
authors.lastname: López Castro
authors.forename: Mercedes
authors.initials: M
authors.lastname: López del Hierro
authors.forename: Miguel
authors.initials: M
authors.lastname: Ángel López Ruz
authors.forename: Juan
authors.initials: J
authors.lastname: Pasquau Liaño
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000821:virology*; D015496:CD4-Positive T-Lymphocytes / Q000502:physiology*; D003430:Cross-Sectional Studies; D005838:Genotype; D006679:HIV Seropositivity; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000821:virology*; D011446:Prospective Studies; D013030:Spain