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Prevalence and Risk Factors Associated With Anal Intraepithelial Neoplasia Among HIV-Positive Men in Brazil

Melo, Victor Hugo MD, DSc1; Guimaraes, Mark Drew Crosland MD, DSc2; Rocha, Gustavo Machado MD, MPH3; Araujo, Angela Cristina Labanca DSc4; Carmo, Ricardo Andrade MD, DSc4; Grinsztejn, Beatriz DSc5; Pilotto, José Henrique MD, DSc6; Palefsky, Joel Michael MD7

Journal of Lower Genital Tract Disease: April 2014 - Volume 18 - Issue 2 - p 128–135
doi: 10.1097/LGT.0b013e31829ee855
Original Articles

Objective This study aimed to assess the prevalence of, and associated factors with, anal intraepithelial neoplasia (AIN) among HIV-positive men evaluated at public health services in Brazil.

Materials and Methods This is a multicenter cross-sectional study of HIV-positive male patients attending 6 public AIDS referral clinics in urban Brazil. Participants were interviewed for sociodemographic and behavioral characteristics. Anal swab specimens were collected for anal cytology and HPV DNA testing using L1 polymerase chain reaction. Univariate and multivariate analyses were performed to evaluate risk factors associated with the presence of low-grade squamous intraepithelial lesion (LSIL) and/or high-grade squamous intraepithelial lesion (HSIL).

Results Anal swabs were collected from 343 participants. Prevalence of LSIL/HSIL was 24.8%. The majority (60.1%) reported sexual intercourse with both men and women in their lifetime. At least 36.7% had 1 or more oncogenic HPV types. Four variables were independently associated with the presence of LSIL/HSIL in multivariate analysis: history of sex with both men and women (odds ratio [OR] = 4.8) or men only (OR = 6.2) compared with those having sex with women only; current cigarette smoking (OR = 2.2); current CD4+ level between 200 and 500 cells/mm3 (OR = 2.9) or below 200 cells/mm3 (OR = 3.8) compared with CD4+ level above 500 cells/mm3; and presence of oncogenic anal HPV infection (OR = 9.6).

Conclusions We found a high prevalence of AIN among HIV-positive men in Brazil. This population may serve as an important bridge population to women with implications for anogenital HPV infection in both men and women. Our findings confirm the need to assess screening programs for AIN among high-risk groups, similar to those used to prevent cervical cancer.

Sex with men only or with men and women, cigarette smoking, low CD4+ count, and oncogenic HPV are correlated with anal intraepithelial neoplasia in HIV-positive Brazilian men.

Departments of 1Obstetrics and Gynecology and 2Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte; 3Federal University of São João del-Rei, Divinópolis; 4Department of Health Services, Belo Horizonte; 5Laboratório de Pesquisa Clinica em DST/AIDS, Instituto de Pesquisa Clinica Evandro Chagas, Fiocruz, Rio de Janeiro; 6Hospital Geral de Nova Iguaçu and AIDS and Molecular Immunology Laboratory, Fiocruz, Rio de Janeiro, Brazil; and 7University of California, San Francisco, CA

Reprint requests to: Victor Hugo Melo, MD, DSc, Faculty of Medicine, Federal University of Minas Gerais, Av Alfredo Balena 190, 2th floor, Belo Horizonte, MG, Brazil 30130-100. E-mail:

This work was carried out by the Federal University of Minas Gerais with technical and financial support of the Ministry of Health/Secretariat of Health Surveillance/Department of STD, AIDS, and Viral Hepatitis through the Project of International Technical Cooperation 914/BRA/1101 between the Brazilian Government and the United Nations Educational, Scientific, and Cultural Organization. Additional financial support was also provided by the Merck Investigator Studies Program.

Dr Palefsky has received research grant and travel funding from Merck and Co and sits on Merck scientific advisory boards. He also participates in scientific advisory boards for Pharmajet and Aura Biosciences. For the remaining authors, no conflicts of interest are declared.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology