BACKGROUND: The incidence of anal cancer among HIV-infected patients is higher than that in other populations. Anal high-grade squamous intraepithelial lesions are considered precursors to invasive squamous-cell carcinomas and are strongly associated to high-risk human papillomavirus infection.
OBJECTIVE: The aim of this study is to determine the prevalence of anal high-grade squamous intraepithelial lesions through screening based on cytology and high-resolution anoscopy with biopsy in a cohort of HIV-infected men who have sex with men.
DESIGN: This investigation is an observational cross-sectional cohort study.
SETTING: The study was conducted in the HIV unit of a tertiary hospital in Spain.
PATIENTS: Three hundred HIV-infected men who have sex with men participated. Physical examination led to a diagnosis of perianal squamous-cell carcinoma and high-grade squamous intraepithelial lesions in 2 patients who were then excluded.
INTERVENTIONS: Anal liquid cytology was performed. Patients with cytological abnormalities underwent high-resolution anoscopy and biopsy.
MAIN OUTCOME MEASURE: The primary outcome measured was biopsy-proven high-grade squamous intraepithelial lesions.
RESULTS: The median age was 41 ± 10.5 years. The mean and nadir CD4 cell counts were 651 ± 205 cells/mm3 (interquartile range, 438–800) and 273 ± 205 cells/mm3 (interquartile range, 131–362). High-risk human papillomavirus was detected in 80.9% of patients, and human papillomavirus 16 was detected in 35.9% of patients. The mean number of human papillomavirus genotypes was 4.6 ± 2.9 (CI, 2–6). Anal cytology was abnormal in 40.9% of patients (n = 122/298; interquartile range, 35.4%–46.6%). High-resolution anoscopy and biopsies were performed in 119 patients. The results of histological analyses were as follows: normal, 7.7% (n = 23); condyloma, 4.3% (n = 13); anal intraepithelial neoplasia 1, 5.7% (n = 17); anal intraepithelial neoplasia 2, 14% (n = 42); and anal intraepithelial neoplasia 3, 8% (n = 24). The overall prevalence of high-grade squamous intraepithelial lesions among patients with abnormal cytology was 54% (95% CI, 45.1%–62.8%). A diagnosis of high-grade squamous intraepithelial lesions was associated with human papillomavirus 16 and human papillomavirus 51 infection, and with detection of a higher number of human papillomavirus genotypes.
LIMITATIONS: High-resolution anoscopy was only performed in patients with abnormal cytology.
CONCLUSIONS: The prevalence of high-risk human papillomavirus infection and high-grade squamous intraepithelial lesions is high in our cohort. Physical examination enabled straightforward diagnosis of perianal high-grade squamous intraepithelial lesions and squamous-cell carcinoma in 2 patients.
1Department of Dermatology, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
2Department of Colorectal Surgery, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
3Department of Internal Medicine (HIV section), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
4Department of Pathology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
Funding/Support: This study was funded in part through a grant from the Instituto de Investigaciones Sanitarias del Hospital Universitario La Paz (IdiPAZ) and Red de Investigacion en SIDA” (AIDS Research Network) (RIS) RD07/0006/2007.
Financial Disclosure: None reported.
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.
Correspondence: Elena Sendagorta, M.D., Department of Dermatology, Hospital Universitario La Paz, IdiPAZ, Castellana 261, 28046 Madrid, Spain. E-mail: email@example.com