title: Prevalence and risk factors associated with anal intraepithelial neoplasia among HIV-positive men in Brazil.
abstract: OBJECTIVE
  This study aimed to assess the prevalence of, and associated factors with, anal intraepithelial neoplasia (AIN) among HIV-positive men evaluated at public health services in Brazil.
  
  
  METHODS
  This is a multicenter cross-sectional study of HIV-positive male patients attending 6 public AIDS referral clinics in urban Brazil. Participants were interviewed for sociodemographic and behavioral characteristics. Anal swab specimens were collected for anal cytology and HPV DNA testing using L1 polymerase chain reaction. Univariate and multivariate analyses were performed to evaluate risk factors associated with the presence of low-grade squamous intraepithelial lesion (LSIL) and/or high-grade squamous intraepithelial lesion (HSIL).
  
  
  RESULTS
  Anal swabs were collected from 343 participants. Prevalence of LSIL/HSIL was 24.8%. The majority (60.1%) reported sexual intercourse with both men and women in their lifetime. At least 36.7% had 1 or more oncogenic HPV types. Four variables were independently associated with the presence of LSIL/HSIL in multivariate analysis: history of sex with both men and women (odds ratio [OR] = 4.8) or men only (OR = 6.2) compared with those having sex with women only; current cigarette smoking (OR = 2.2); current CD4(+) level between 200 and 500 cells/mm(3) (OR = 2.9) or below 200 cells/mm(3) (OR = 3.8) compared with CD4(+) level above 500 cells/mm(3); and presence of oncogenic anal HPV infection (OR = 9.6).
  
  
  CONCLUSIONS
  We found a high prevalence of AIN among HIV-positive men in Brazil. This population may serve as an important bridge population to women with implications for anogenital HPV infection in both men and women. Our findings confirm the need to assess screening programs for AIN among high-risk groups, similar to those used to prevent cervical cancer.
authors.affiliation: Departments of 1Obstetrics and Gynecology and 2Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte; 3Federal University of São João del-Rei, Divinópolis; 4Department of Health Services, Belo Horizonte; 5Laboratório de Pesquisa Clinica em DST/AIDS, Instituto de Pesquisa Clinica Evandro Chagas, Fiocruz, Rio de Janeiro; 6Hospital Geral de Nova Iguaçu and AIDS and Molecular Immunology Laboratory, Fiocruz, Rio de Janeiro, Brazil; and 7University of California, San Francisco, CA.
authors.forename: Victor Hugo
authors.initials: VH
authors.lastname: Melo
authors.forename: Mark Drew Crosland
authors.initials: MD
authors.lastname: Guimaraes
authors.forename: Gustavo Machado
authors.initials: GM
authors.lastname: Rocha
authors.forename: Angela Cristina Labanca
authors.initials: AC
authors.lastname: Araujo
authors.forename: Ricardo Andrade
authors.initials: RA
authors.lastname: Carmo
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.forename: José Henrique
authors.initials: JH
authors.lastname: Pilotto
authors.forename: Joel Michael
authors.initials: JM
authors.lastname: Palefsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D002278:Carcinoma in Situ / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications*; D006651:Histocytochemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D027383:Papillomaviridae / Q000302:isolation & purification; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D004279:DNA, Viral