title: Human Papillomavirus at Multiple Sites Associated with Anal Squamous Intraepithelial Lesions in HIV-Seropositive Individuals.
abstract: OBJECTIVE
  HIV-Seropositive patients have higher risk of HPV infection even on anti-retroviral therapy. Infection with high-risk HPV genotypes can cause dysplasia leading to cancer. This study assessed HPV at different anatomical sites in HIV-seropositive individuals and factors associated with anal squamous intraepithelial lesions (ASIL).
  
  
  METHODS
  Specimens were obtained from multiple anatomical sites for each participant in conjunction with routine screening for anal dysplasia. Female specimens included cervical and anal cytologies and oral wash. Male specimens included anal cytologies, oral wash, and exfoliated cells from penile head, penile shaft, scrotum, and from uncircumcised subjects, inner foreskin. Demographic and clinical characteristics were recorded. Following DNA extraction, HIV DNA copy was assessed by qPCR; HPV was genotyped. Statistical analyses included calculation of odds ratios (OR) and 95% confidence intervals (CI), t-tests or Mann-Whitney tests.
  
  
  RESULTS
  Males were more likely to have ASIL: 29/50 (58%) compared to 1/11 females (9%) (OR=13.81, 95% CI: 1.64-116.32). HPV 6 or 11 in anal specimens was significantly associated with ASIL (OR= 6.29, 95% CI: 1.49-26.44). Number of HPV genotypes in anal specimens was also significant: ASIL+ (3.4 ± 3.1) versus ASIL- (1.6 ± 3.1) (p=0.009). Among 44 males, HPV was detected from at least one anatomical site for 33 participants (75%): 27 anus (61%), 19 oral wash (44%), 17 penile shaft (39%), 11 scrotum (26%), 10 penile head (23%), 0 foreskin. Detection of HPV in penile shaft specimens was significantly associated with ASIL (OR=6.79, 95% CI: 1.57-29.36) as was number of HPV genotypes in penile shaft specimens: ASIL+ (2.4 ± 4.0) versus ASIL- (0.6 ± 1.7) (p=0.025). Only 1/11 females had ASIL; only 1/11 females had cervical dysplasia: OR was not estimable due to small numbers.
  
  
  CONCLUSIONS
  Males were more prone to ASIL than females. HPV at anal as well as non-anal sites may be indicative of ASIL.
authors.affiliation: Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, USA; Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii, USA.
authors.forename: Eleanore
authors.initials: E
authors.lastname: Chuang
authors.affiliation: Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, USA.
authors.forename: Eunjung
authors.initials: E
authors.lastname: Lim
authors.affiliation: Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, USA.
authors.forename: Cris
authors.initials: C
authors.lastname: Milne
authors.affiliation: University of Hawaii Cancer Center, USA.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, USA; Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Agsalda
authors.affiliation: University of Hawaii Cancer Center, USA; Department of Pathology, John A. Burns School of Medicine, University of Hawaii, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Killeen
authors.affiliation: Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii, USA.
authors.forename: F DeWolfe
authors.initials: FD
authors.lastname: Miller
authors.affiliation: Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii, USA; University of Hawaii Cancer Center, USA; Department of Pathology, John A. Burns School of Medicine, University of Hawaii, USA.
authors.forename: Brenda Y
authors.initials: BY
authors.lastname: Hernandez
authors.affiliation: Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, USA; Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Shiramizu
keywords: Anal cancer; Anal dysplasia; HIV; HPV; Human immunodeficiency virus; Human papillomavirus