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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

Sexually Transmitted Diseases: February 2004 - Volume 31 - Issue 2 - p 96-99
doi: 10.1097/01.OLQ.0000109515.75864.2B

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.

A study of 45 HIV-infected men who have sex with men found a high prevalence of anal squamous intraepithelial lesions, including high-grade SIL, and anal HPV infection despite immune restoration under highly active antiretroviral therapy.

*Department of Immunology, INSERM U 430 and Université Pierre et Marie Curie, Hôpital Européen Georges Pompidou, Paris, France; the Departments of Pathology and Medicine, University of California, San Francisco, California; and the §Department of Pathology, Hôpital Européen Georges Pompidou, Paris, France

The authors thank Drs. Laurence Weiss, Gustavo Gonzalez-Canali, Dominique Batisse, Marina Karmochkine, Martin Buisson, and Didier Jayle for their help in enrolling patients in the study, and Helena Bonner and Daniel Felmlee for their technical assistance.

This work was supported by SIDACTION and Cytyc Corporation, France, and in part funds provided by the Division of Research Resources 5 mol/l01-RR-00079, U.S. Public Health Service.

Correspondence: Christophe Piketty, MD, PhD, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France. E-mail:

Received for publication June 12, 2003,

revised September 23, 2003, and accepted September 29, 2003.

© Copyright 2004 American Sexually Transmitted Diseases Association