title: Determinants of macroscopic anal cancer and precancerous lesions in 1206 HIV-infected screened patients.
abstract: OBJECTIVE
  Anal screening is recommended in HIV-positive patients, especially men who have sex with men (MSM), due to an increased incidence of anal cancer. The optimal screening methods are not generally agreed.
  
  
  METHODS
  Screening for anal lesions by anorectal examination, including anoscopy, was offered to HIV-positive outpatients in a tertiary care university hospital regardless of gender or sexual orientation.
  
  
  RESULTS
  Among the 1206 screened patients (701 MSM, 247 heterosexual men, 258 women), 311 (26%) had histologically proven lesions related to human papilloma virus (HPV) (34% MSM, 14% heterosexual men, 14% women); 123 (10%) had low-grade dysplasia and 70 (6%) high-grade dysplasia. Seven anal cancers were also diagnosed. Determinants of any lesion were age < 45 years [OR = 1.56 (95% CI, 1.16-2.11)], a CD4 count of < 200/mm3[OR = 2.54 (1.71-3.78)], receptive anal intercourse [OR =3.03 (2.06-4.47)], sub-Saharan African origin [OR = 0.53 (0.33-0.85)], and history of HPV-related lesion [OR = 1.84 (1.35-2.51)]. These determinants were similar for all different grades of dysplasia. In patient subgroup analysis, receptive anal intercourse, the CD4 cell count and a history of HPV lesions were determinants of HPV-positivity in all patients, whereas age was only a determinant in men.
  
  
  CONCLUSIONS
  Anoscopy is an alternative method for anal screening in an HIV-positive population. This screening has to be compared with other tools in populations at high risk of anal cancer.
authors.affiliation: AP-HP, Department of Gastroenterology and Proctology, Bichat University Hospital, Paris, France. laurent.abramowitz@bch.aphp.fr.
authors.forename: L
authors.initials: L
authors.lastname: Abramowitz
authors.affiliation: AP-HP, Department of Gastroenterology and Proctology, Bichat University Hospital, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Benabderrahmane
authors.affiliation: Department of Anatomopathology, Bichat University Hospital, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Walker
authors.affiliation: Department of Infectious and Tropical Diseases, Bichat University Hospital, Paris, France.|Paris 7 Denis Diderot University, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Yazdapanah
authors.affiliation: Department of Infectious and Tropical Diseases, Bichat University Hospital, Paris, France.|Paris 7 Denis Diderot University, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Yéni
authors.affiliation: Department of Infectious and Tropical Diseases, Bichat University Hospital, Paris, France.|Paris 7 Denis Diderot University, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Rioux
authors.affiliation: AP-HP, Department of Dermatology, Bichat University Hospital, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Bouscarat
authors.affiliation: AP-HP, Department of Gastroenterology and Proctology, Bichat University Hospital, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Lafferre
authors.affiliation: Paris 7 Denis Diderot University, Paris, France.|Department of Biostatistics, Bichat University Hospital, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Mentré
authors.affiliation: Inserm, CIC 1425, Clinical Investigation Center, Bichat University Hospital, Paris, France. xavier.duval@bch.aphp.fr.|Inserm, IAME UMR 1138, Bichat University Hospital, Paris, France. xavier.duval@bch.aphp.fr.
authors.forename: X
authors.initials: X
authors.lastname: Duval
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging; D001004:Anus Diseases / Q000175:diagnosis* / Q000821:virology; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000821:virology; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000821:virology; D011351:Proctoscopy / Q000379:methods*; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners
keywords: 
  HIV
  ; anal canal; anal cancer; anal dysplasia; human papilloma virus