title: Risk of progression to high-grade anal intraepithelial neoplasia in HIV-infected MSM.
abstract: OBJECTIVE
  To assess the value of several factors to predict the risk of progression to high-grade anal intraepithelial neoplasia (HGAIN) in a cohort of HIV-infected MSM.
  
  
  METHODS
  Longitudinal study of 556 HIV-infected MSM who underwent screening for anal dysplasia (include anal cytology and high-resolution anoscopy at each visit).
  
  
  METHODS
  Progression rate to HGAIN was estimated by Kaplan-Meier analysis. Predictors of progression were assessed by Cox-proportional hazards regression.
  
  
  RESULTS
  Sixty-eight incidents HGAIN cases over 649 person-years of follow-up were diagnosed, resulting in a progression rate of 10.5 cases/100 person-years [95% confidence interval (CI), 8.1-13.3). The cumulative incidence of HGAIN was 7.2% at 12 months (95% CI, 4.3-10.1) and 16.2% at 24 months (95% CI, 11.7-20.7). Independent risk factors for progression were as follows: abnormal cytology [hazard ratio (HR), 2.5 (95% CI, 1.2-4.9) if low-grade squamous intraepithelial lesion, HR 2.76 (95% CI, 1.4-5.3) if atypical squamous cells of uncertain significance and HR 7.73 (95% CI, 2.3-25.4) if high-grade squamous intraepithelial lesion], abnormal high-resolution anoscopy (HR 3.57; 95% CI, 2-6.4) and infection by 16 or 18 human papillomavirus (HR 1.63; 95% CI, 1-2.6). To be receiving HAART (HR 0.4; 95% CI, 0.2-0.7) and have stable sexual couple (HR 0.62; 95% CI, 0.4-0.9) were protective factors. Patients with favorable predictors had an incident rate of 2.86 cases/100 person-years (95% CI, 3.5-10.3).
  
  
  CONCLUSIONS
  The rate of progression to HGAIN varies according to different predictors that should be considered when assessing the particular risk of each patient. Patients with low risk of progression could be screened at longer intervals.
  
  
  METHODS
  We describe the risk of progression to HGAIN in a cohort of 556 HIV-infected MSM. The incidence rate of HGAIN varies widely according to different predictors. These factors should be considered when assessing the particular risk of each patient.
authors: aInfectious Diseases Department bAnatomical Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) cInternal Medicine Department, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Spain.
authors: Joaquin
authors: J
authors: Burgos
authors: Adria
authors: A
authors: Curran
authors: Natalia
authors: N
authors: Tallada
authors: Ana
authors: A
authors: Guelar
authors: Jordi
authors: J
authors: Navarro
authors: Stefania
authors: S
authors: Landolfi
authors: Judith
authors: J
authors: Villar
authors: Manel
authors: M
authors: Crespo
authors: Esteve
authors: E
authors: Ribera
authors: Vicenç
authors: V
authors: Falcó
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology*; D002278:Carcinoma in Situ / Q000453:epidemiology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment