title: Disagreement in high-grade/low-grade intraepithelial neoplasia and high-risk/low-risk HPV infection: clinical implications for anal cancer precursor lesions in HIV-positive and HIV-negative MSM.
abstract: Anal condylomata are common in HIV-positive individuals and among men who have sex with men (MSM). Generally attributable to infection by low-risk human papillomaviruses (HPVs), condylomata are considered benign low-grade squamous intraepithelial lesions (SILs). However, anal condylomata have occasionally been linked to high-grade SIL and to oncogenic, high-risk HPVs. Here we describe the range of intraepithelial lesions and of the associated HPVs in heterosexual men and women and MSM. Perianal and anal condylomata were collected from 243 patients (56 heterosexual women, 61 heterosexual men and 126 MSM, including 41 HIV-positive MSM). We assessed lesion histology and HPV genotype. Prevalence estimates and Poisson models were used. Irrespective of HIV infection status, MSM showed a higher proportion of condylomata as high-grade SILs compared to heterosexual men/women. High-grade SILs were also more prevalent in anal than in perianal lesions in all patient groups. HIV-positive MSM exhibited increased prevalence ratio (4.6; 95% confidence interval 2.1-10.0) of perianal low-grade SILs containing only high-risk HPVs compared to HIV-negative MSM. In addition, more than 64% of anal SILs with a high-grade component, regardless of HIV infection, were exclusively associated with low-risk HPVs. In anal condylomata, both high-grade and low-grade SILs can be associated with high-risk and/or low-risk HPVs. Particularly, low-grade perianal SILs associated with high-risk HPVs were common in HIV-positive MSM, while presence of only low-risk HPVs in high-grade SILs were common in both MSM groups. Our findings sound a note of caution for the common clinical practice for the treatment of anal condylomata as benign lesions in MSM and HIV-positive patients.
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain. Electronic address: vnikolai@iconcologia.net.
authors.forename: V N
authors.initials: VN
authors.lastname: Pimenoff
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Félez-Sánchez
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Tous
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Clavero
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Godínez
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Klaustermeier
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Saunier
authors.affiliation: DDL Diagnostic Laboratory, Rijswijk, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Molijn
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Alemany
authors.affiliation: DDL Diagnostic Laboratory, Rijswijk, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Quint
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.
authors.forename: F X
authors.initials: FX
authors.lastname: Bosch
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: de Sanjosé
authors.affiliation: Sexual Health Clinic, Royal Perth Hospital, School of Laboratory and Pathology Medicine, University of Western Australia, Perth, Australia.
authors.forename: J
authors.initials: J
authors.lastname: McCloskey
authors.affiliation: Infections and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.
authors.forename: I G
authors.initials: IG
authors.lastname: Bravo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D002278:Carcinoma in Situ / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D006651:Histocytochemistry; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology*; D015995:Prevalence; D018570:Risk Assessment; D055815:Young Adult
keywords: Anal; HIV; benign proliferation; cancer; condyloma; human papillomaviruses; malignant proliferation; multiple infections; perianal; sexually transmitted infection