title: Prevalence of abnormal anal cytology and high-grade squamous intraepithelial lesions among a cohort of HIV-infected men who have sex with men.
abstract: BACKGROUND
  The incidence of anal cancer among HIV-infected patients is higher than that in other populations. Anal high-grade squamous intraepithelial lesions are considered precursors to invasive squamous-cell carcinomas and are strongly associated to high-risk human papillomavirus infection.
  
  
  OBJECTIVE
  The aim of this study is to determine the prevalence of anal high-grade squamous intraepithelial lesions through screening based on cytology and high-resolution anoscopy with biopsy in a cohort of HIV-infected men who have sex with men.
  
  
  METHODS
  This investigation is an observational cross-sectional cohort study.
  
  
  METHODS
  The study was conducted in the HIV unit of a tertiary hospital in Spain.
  
  
  METHODS
  Three hundred HIV-infected men who have sex with men participated. Physical examination led to a diagnosis of perianal squamous-cell carcinoma and high-grade squamous intraepithelial lesions in 2 patients who were then excluded.
  
  
  METHODS
  Anal liquid cytology was performed. Patients with cytological abnormalities underwent high-resolution anoscopy and biopsy.
  
  
  METHODS
  The primary outcome measured was biopsy-proven high-grade squamous intraepithelial lesions.
  
  
  RESULTS
  The median age was 41 ± 10.5 years. The mean and nadir CD4 cell counts were 651 ± 205 cells/mm(3) (interquartile range, 438-800) and 273 ± 205 cells/mm(3) (interquartile range, 131-362). High-risk human papillomavirus was detected in 80.9% of patients, and human papillomavirus 16 was detected in 35.9% of patients. The mean number of human papillomavirus genotypes was 4.6 ± 2.9 (CI, 2-6). Anal cytology was abnormal in 40.9% of patients (n = 122/298; interquartile range, 35.4%-46.6%). High-resolution anoscopy and biopsies were performed in 119 patients. The results of histological analyses were as follows: normal, 7.7% (n = 23); condyloma, 4.3% (n = 13); anal intraepithelial neoplasia 1, 5.7% (n = 17); anal intraepithelial neoplasia 2, 14% (n = 42); and anal intraepithelial neoplasia 3, 8% (n = 24). The overall prevalence of high-grade squamous intraepithelial lesions among patients with abnormal cytology was 54% (95% CI, 45.1%-62.8%). A diagnosis of high-grade squamous intraepithelial lesions was associated with human papillomavirus 16 and human papillomavirus 51 infection, and with detection of a higher number of human papillomavirus genotypes.
  
  
  CONCLUSIONS
  High-resolution anoscopy was only performed in patients with abnormal cytology.
  
  
  CONCLUSIONS
  The prevalence of high-risk human papillomavirus infection and high-grade squamous intraepithelial lesions is high in our cohort. Physical examination enabled straightforward diagnosis of perianal high-grade squamous intraepithelial lesions and squamous-cell carcinoma in 2 patients.
authors.affiliation: 1Department of Dermatology, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain 2Department of Colorectal Surgery, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain 3Department of Internal Medicine (HIV section), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain 4Department of Pathology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Sendagorta
authors.forename: Pedro
authors.initials: P
authors.lastname: Herranz
authors.forename: Hector
authors.initials: H
authors.lastname: Guadalajara
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Bernardino
authors.forename: Jose María
authors.initials: JM
authors.lastname: Viguer
authors.forename: María José
authors.initials: MJ
authors.lastname: Beato
authors.forename: Damian
authors.initials: D
authors.lastname: García-Olmo
authors.forename: Jose María
authors.initials: JM
authors.lastname: Peña
mesh_terms: D000328:Adult; D052685:Alphapapillomavirus / Q000302:isolation & purification; D001003:Anal Canal / Q000473:pathology; D001005:Anus Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D001706:Biopsy; D002278:Carcinoma in Situ / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis; D011230:Precancerous Conditions / Q000175:diagnosis; D015995:Prevalence; D011351:Proctoscopy; D013030:Spain