title: Risk factors for anal HPV infection and anal precancer in HIV-infected men who have sex with men.
abstract: BACKGROUND
  Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM.
  
  
  METHODS
  Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer.
  
  
  RESULTS
  Low CD4 count (<350 cells/mm(3)) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28-10.40 and OR, 4.24; 95% CI, 1.16-15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43-5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection.
  
  
  CONCLUSIONS
  We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Schwartz
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.forename: Stephen
authors.initials: S
authors.lastname: Follansbee
authors.forename: Sylvia
authors.initials: S
authors.lastname: Borgonovo
authors.forename: Barbara
authors.initials: B
authors.lastname: Fetterman
authors.forename: Diane
authors.initials: D
authors.lastname: Tokugawa
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lorey
authors.forename: Vikrant V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.forename: Patricia
authors.initials: P
authors.lastname: Luhn
authors.forename: Julia C
authors.initials: JC
authors.lastname: Gage
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.forename: Nicolas
authors.initials: N
authors.lastname: Wentzensen
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000821:virology; D001005:Anus Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D018791:CD4 Lymphocyte Count; D002140:California / Q000453:epidemiology; D002690:Chlamydia Infections / Q000150:complications; D016001:Confidence Intervals; D003710:Demography; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006679:HIV Seropositivity; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D011230:Precancerous Conditions / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D012307:Risk Factors; D012725:Sexual Behavior; D012907:Smoking / Q000009:adverse effects; D055815:Young Adult
keywords: anal cancer; anal intraepithelial neoplasia (AIN); human immunodeficiency virus (HIV); human papillomavirus (HPV); men who have sex with men (MSM)
references.citation: J Natl Cancer Inst. 2005 Jun 15;97(12):896-905
references.pmid: 15956651
references.citation: J Infect Dis. 2013 Feb 1;207(3):392-401
references.pmid: 23162133
references.citation: Cancer. 2004 Jul 15;101(2):270-80
references.pmid: 15241823
references.citation: AIDS. 2012 Nov 13;26(17):2185-92
references.pmid: 23018436
references.citation: Cancer Cytopathol. 2011 Feb 25;119(1):5-19
references.pmid: 21319310
references.citation: Int J Cancer. 2009 Apr 1;124(7):1626-36
references.pmid: 19115209
references.citation: CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
references.pmid: 22237781
references.citation: J Acquir Immune Defic Syndr. 2011 Aug;57 Suppl 3:S217-24
references.pmid: 21857322
references.citation: J Acquir Immune Defic Syndr. 2008 Aug 1;48(4):491-9
references.pmid: 18614927
references.citation: PLoS One. 2012;7(6):e38731
references.pmid: 22723879
references.citation: J Infect Dis. 1998 Feb;177(2):361-7
references.pmid: 9466522
references.citation: Int J Cancer. 2012 Aug 15;131(4):949-55
references.pmid: 21960453
references.citation: Cancer Epidemiol Biomarkers Prev. 2009 Jan;18(1):113-20
references.pmid: 19124488
references.citation: Int J STD AIDS. 2009 Apr;20(4):262-4
references.pmid: 19304972
references.citation: AIDS Res Hum Retroviruses. 2012 Dec;28(12):1734-8
references.pmid: 22519744
references.citation: Curr Infect Dis Rep. 2012 Feb;14(1):61-6
references.pmid: 22125048
references.citation: J Natl Cancer Inst. 2011 May 4;103(9):753-62
references.pmid: 21483021
references.citation: Lancet Oncol. 2012 May;13(5):487-500
references.pmid: 22445259
references.citation: Am J Epidemiol. 2007 May 15;165(10):1143-53
references.pmid: 17344204
references.citation: AIDS Patient Care STDS. 2011 Apr;25(4):213-9
references.pmid: 21366437
references.citation: Am J Epidemiol. 2005 Oct 1;162(7):668-75
references.pmid: 16120706
references.citation: Cancer Epidemiol Biomarkers Prev. 2012 Jan;21(1):111-21
references.pmid: 22028398
references.citation: J Acquir Immune Defic Syndr. 2013 Aug 1;63(4):472-9
references.pmid: 23514956
references.citation: Clin Infect Dis. 2011 May;52(9):1174-81
references.pmid: 21364075
references.citation: Am J Med. 1997 May 5;102(5A):3-8
references.pmid: 9217656
references.citation: J Natl Cancer Inst Monogr. 1998;(23):15-20
references.pmid: 9709296
references.citation: Cancer Cytopathol. 2013 Feb;121(2):72-8
references.pmid: 22811048
references.citation: Ann Intern Med. 2008 May 20;148(10):728-36
references.pmid: 18490686
references.citation: J Clin Microbiol. 2012 Jan;50(1):61-5
references.pmid: 22075592
references.citation: AIDS Behav. 2013 Mar;17(3):1211-8
references.pmid: 22419454
references.citation: Gynecol Endocrinol. 2011 Aug;27(8):597-604
references.pmid: 21438669
references.citation: Clin Infect Dis. 2012 Apr;54(7):1026-34
references.pmid: 22291097
references.citation: Obstet Gynecol Clin North Am. 2009 Mar;36(1):187-200
references.pmid: 19344856
references.citation: JAMA. 2002 Apr 24;287(16):2114-9
references.pmid: 11966386
references.citation: Cancer Epidemiol Biomarkers Prev. 2013 Jan;22(1):42-9
references.pmid: 23155136
references.citation: J Infect Dis. 2011 Dec 1;204(11):1711-22
references.pmid: 21964400
references.citation: Int J STD AIDS. 2012 Feb;23(2):77-82
references.pmid: 22422679
references.citation: Lancet Oncol. 2012 Jul;13(7):e279-80; author rreply e280
references.pmid: 22748261
references.citation: Lancet Oncol. 2012 May;13(5):438-40
references.pmid: 22445258