Sexually Transmitted Diseases

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High Prevalence of Anal Squamous Intraepithelial Lesions in HIV-Positive Men Despite the Use of Highly Active Antiretroviral Therapy

Piketty, Christophe MD, PhD*; Darragh, Teresa M. MD†; Heard, Isabelle MD*; Da Costa, Maria MSc‡; Bruneval, Patrick MD§; Kazatchkine, Michel D. MD, PhD*; Palefsky, Joel M. MD‡

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Abstract

Background: The impact of highly active antiretroviral therapy (HAART) on the natural history of HPV infection and anal squamous intraepithelial lesions (SIL) in HIV-infected men who have sex with men (MSM) is poorly documented.

Goal: The goal of this study was to evaluate the prevalence of anal HPV infection and SIL inpatients under HAART.

Study Design: Forty-five HIV-infected protease inhibitor-experienced MSM were enrolled in a cross-sectional study. Each patient provided anal samples for anal cytology, histology, and human papillomavirus (HPV) DNA testing.

Results: The patients had previously received HAART for a median of 32 months. Anal cytology was abnormal in 32 of 45 (71%) patients, including high-grade SIL in 10 patients (22%), low-grade SIL in 19 patients (42%), and atypical squamous cells of undetermined significance in 3 patients (7%). HPV DNA was detected 36/45 men (80%). The prevalence of anal SIL and HPV infection were similar in patients exhibiting a significant increase in CD4+ cell count after HAART initiation compared with those who did not.

Conclusion: Our results demonstrate a high prevalence of anal SIL, including high-grade SIL, and anal HPV infection in HIV-infected MSM despite immune restoration under HAART.

ANAL CANCER IS ASSOCIATED with human papillomavirus (HPV) infection. 1,2 The prevalence and incidence of anal HPV infection and anal squamous intraepithelial lesions (ASIL) in HIV-positive men who have sex with men (MSM) have been studied in the pre-HAART era and both are more common in HIV-positive MSM than in HIV-negative MSM. 3–5 The prevalence and incidence of anal HPV infection and ASIL in HIV-positive MSM have also been found to increase with decreased CD4+ cell count. 3,5 Recent studies estimated the incidence of anal cancer to be 2-fold higher in HIV-infected MSM compared with HIV-negative MSM, 6 and the relative risk of developing anal cancer among HIV-positive MSM was shown to be 37-fold higher than in the general population. 7 To date, the impact of highly active antiretroviral therapy (HAART) on the natural history of HPV infection and ASIL is poorly documented. We report on the high prevalence of HPV infection and ASIL in a cohort of HIV-infected MSM receiving HAART despite a significant increase in CD4+ cell count since HAART initiation.

© Copyright 2004 American Sexually Transmitted Diseases Association

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