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Systematic Evaluation and Description of Anal Pathology in HIV-Infected Patients During the HAART Era

Abramowitz, Laurent M.D.1; Benabderrahmane, Dalila M.D.1; Baron, Gabriel Ph.D.2; Walker, Francine M.D., Ph.D.3; Yeni, Patrick M.D., Ph.D.4; Duval, Xavier M.D., Ph.D.4,5,6

Diseases of the Colon & Rectum: June 2009 - Volume 52 - Issue 6 - p 1130-1136
doi: 10.1007/DCR.0b013e3181a65f5f
Original Contributions

PURPOSE: This study aimed to determine the prevalence of macroscopic anal lesions and associated factors in HIV-infected outpatients during the era of highly active antiretroviral therapy.

METHODS: A randomly selected sample of patients with HIV-infection receiving follow-up care in the infectious diseases department of Bichat University Hospital was invited to participate in a systematic screening program consisting of anal examination with anoscopy and a standardized questionnaire.

RESULTS: Of 516 patients, 473 (92 percent) participated. Overall, 208 patients (44 percent) had at least one anal macroscopic lesion: 108 patients (22.8 percent) had human papilloma (HPV)-related lesions (condyloma with or without dysplasia), 67 (14.2 percent) had hemorrhoidal disease, 50 (10.6 percent) had anal fissures, and 44 (9.3) percent had other anal lesions. Independent significantly associated factors for anal condyloma were history of anal condyloma (OR, 2.09) and median number of episodes of sexual intercourse per month (OR, 1.03) in men who have sex with men; history of genital condyloma (OR, 26.74), and unprotected sexual intercourse (OR, 7.47) in heterosexual men; and CD4 cell count below 200/mm3 (OR, 6.02), receptive anal intercourse (OR, 6.37), and history of anal condyloma (OR, 16.69) in women. Neither sexual behavior nor characteristics related to HIV infection were associated with hemorrhoidal disease or anal fissure.

CONCLUSIONS: Because patients with HIV infections have a high prevalence of unreported anal lesions that may be highly contagious, involve risk of anal neoplasia, or negatively affect quality of life, systematic anal screening should be conducted in the HIV-infected population.

1 AP HP, Department of Gastroenterology and Proctology, Bichat University Hospital, Paris, France

2 AP-HP, Department of Biostatistics, Bichat University Hospital, Paris 7 University, Paris, France

3 AP-HP, Department of Anatomopathology, Bichat University Hospital, Paris, France

4 AP-HP, Department of Infectious and Tropical Diseases, Bichat University Hospital, Paris 7 University, Paris, France

5 AP-HP, Infectious Diseases Laboratory, Bichat University Hospital, Paris 7 University, Paris, France

6 INSERM Clinical Investigation Center 007, INSERM 738, Bichat University Hospital, AP-HP, Paris, France

Read at the meeting French Gastroenterological Week, Paris, France, March 18 to 22, 2006.

Address of correspondence: Laurent Abramowitz, M.D., Service de Gastroentérologie, Hôpital universitaire Bichat Claude Bernard, 46 rue Henri Huchard, 75877 Paris, CEDEX 18, France. E-mail:

© The ASCRS 2009