title: Prolonged antiretroviral therapy is associated with fewer anal high-grade squamous intraepithelial lesions in HIV-positive MSM in a cross-sectional study.
abstract: OBJECTIVE
  HIV-positive men who have sex with men (MSM) are at increased risk of anal cancer. We evaluate the risk factors for anal high-grade squamous intraepithelial lesion (HSIL) (the precursor of anal cancer) in HIV-positive MSM.
  
  
  METHODS
  In this cross-sectional study within a cohort, 320 HIV-positive MSM were screened by anal cytology followed by high-resolution anoscopy (HRA) in case of abnormal cytology. Risk factors for anal HSIL were analysed.
  
  
  RESULTS
  Men were mostly middle-aged Caucasians with median CD4+ T lymphocytes of 638 cells/µL, 87% on combined antiretroviral therapy (cART) for a median of 5 years. 198 anal cytology samples were normal. In the 122 patients with abnormal cytology, HRA with biopsies were performed: 12% (n=15) normal, 36% (n=44) anal low-grade squamous intraepithelial lesion (LSIL) and 51% (n=63) anal HSIL. Comparing patients with or without anal HSIL (normal cytology or normal biopsy or LSIL), we found in multivariate analysis significantly fewer anal HSIL in patients with cART ≥24 months (OR 0.32 CI 95% 0.162 to 0.631, p=0.001).
  
  
  CONCLUSIONS
  Prolonged cART (≥24 months) is associated with fewer anal HSIL.
authors.affiliation: Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Agnès
authors.initials: A
authors.lastname: Libois
authors.affiliation: Department of Pathology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Francesco
authors.initials: F
authors.lastname: Feoli
authors.affiliation: Department of Gastroenterology, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Marcel
authors.initials: M
authors.lastname: Nkuize
authors.affiliation: Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Delforge
authors.affiliation: Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Deborah
authors.initials: D
authors.lastname: Konopnicki
authors.affiliation: Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Nathan
authors.initials: N
authors.lastname: Clumeck
authors.affiliation: Department of Infectious Diseases, University Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Stéphane
authors.initials: S
authors.lastname: De Wit
mesh_terms: D001003:Anal Canal / Q000473:pathology* / Q000821:virology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control* / Q000821:virology; D001530:Belgium / Q000453:epidemiology; D015415:Biomarkers; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control* / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control* / Q000821:virology; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008403:Mass Screening
chemical_list: D019380:Anti-HIV Agents; D015415:Biomarkers
keywords: ANOGENITAL CANCER; ANTIRETROVIRAL THERAPY; GAY MEN; HIV; HPV