Incidence and Predictors of Abnormal Anal Cytology Findings Among HIV-Infected Adults Receiving Contemporary Antiretroviral Therapy.
BACKGROUND
Anal cancer rates are higher for human immunodeficiency virus (HIV)-infected adults than for uninfected adults. Limited published data exist characterizing the incidence of precursor lesions detected by anal cytology.


METHODS
The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy was a prospective cohort of 700 HIV-infected participants in 4 US cities. At baseline and annually thereafter, each participant completed a behavioral questionnaire, and healthcare professionals collected anorectal swabs for cytologic examination and human papillomavirus (HPV) detection and genotyping.


RESULTS
Among 243 participants with negative baseline results of anal cytology, 37% developed abnormal cytology findings (incidence rate, 13.9 cases/100 person-years of follow-up; 95% confidence interval [CI], 11.3-16.9) over a median follow-up duration of 2.1 years. Rates among men having sex with men, among women, and among men having sex with women were 17.9 cases/person-years of follow-up (95% CI, 13.9-22.7), 9.4 cases/person-years of follow-up (95% CI, 5.6-14.9), and 8.9 cases/person-years of follow-up (95% CI, 4.8-15.6), respectively. In multivariable analysis, the number of persistent high-risk HPV types (adjusted hazard ratio [aHR], 1.17; 95% CI, 1.01-1.36), persistent high-risk HPV types except 16 or 18 (aHR, 2.46; 95% CI, 1.31-4.60), and persistent types 16 or 18 (aHR, 3.90; 95% CI, 1.78-8.54) remained associated with incident abnormalities.


CONCLUSIONS
The incidence of abnormal anal cytology findings was high and more likely to develop among persons with persistent high-risk HPV.
Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention.
Lois J
LJ
Conley
Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention.
Timothy J
TJ
Bush
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia University of California-San Francisco.
Teresa M
TM
Darragh
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia University of California-San Francisco.
Joel M
JM
Palefsky
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia University of California-San Francisco.
Elizabeth R
ER
Unger
Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention.
Pragna
P
Patel
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia University of California-San Francisco.
Martin
M
Steinau
Miriam Hospital, Providence, Rhode Island.
E Milu
EM
Kojic
Park-Nicollet Clinic, Minneapolis, Minnesota.
Harold
H
Martin
University of Alabama School of Medicine, Birmingham.
E Turner
ET
Overton
Miriam Hospital, Providence, Rhode Island.
Susan
S
Cu-Uvin
Denver Infectious Disease Consultants, Colorado.
John
J
Hammer
Hennepin County Medical Center, Minneapolis, Minnesota.
Keith
K
Henry
Cerner, Vienna, Virginia.
Kathleen
K
Wood
Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention.
John T
JT
Brooks
D000328:Adult; D001003:Anal Canal / Q000166:cytology*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D019380:Anti-HIV Agents
HIV; HPV; abnormal anal cytology; incidence; persistence