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Use of Highly Active Antiretroviral Therapy Is Associated With Lower Prevalence of Anal Intraepithelial Neoplastic Lesions and Lower Prevalence of Human Papillomavirus in HIV-Infected Men Who Have Sex With Men

van der Snoek, Eric M. MD, PhD*; van der Ende, M. E. MD, PhD; den Hollander, J. C. MD; Schutten, M. PhD§; Neumann, H. A. M. MD, PhD*; van Doornum, G. J. J. MD, PhD§

Sexually Transmitted Diseases: July 2012 - Volume 39 - Issue 7 - p 495–500
doi: 10.1097/OLQ.0b013e31825aa764
Original Study

Background: The incidence of anal intraepithelial neoplasia (AIN) and anal cancer is increased in HIV-positive men who have sex with men (MSM). Persistent high-risk human papillomavirus (HPV) infection is an important etiologic agent.

Methods: In this study, a group of 250 HIV-positive MSM was included to determine the prevalence of AIN and to investigate the role of highly active antiretroviral therapy (HAART), high-risk HPV, and other risk factors possibly associated with this prevalence.

Results: Among patients included, 108 (43.2%) had lesions suspicious for AIN. Histologic analyses showed AIN 1 in 24 patients (22.2%), AIN 2 in 6 patients (5.6%), and AIN 3 in 10 patients (9.3%). In multivariable analyses, the use of HAART was associated with the absence of AIN (P = 0.045). In MSM without HAART, HPV infection was detected significantly more often compared with those who used HAART (P = 0.010). AIN was associated with HPV types 16 and 6.

Conclusions: In this cross-sectional study in 250 HIV-positive MSM, the use of HAART was associated with lower prevalence of AIN and a significantly lower prevalence of HPV. This association between the prevalence of AIN and the absence of HAART may contribute to the current debate on when to start HAART in HIV-infected individuals.

From the Departments of *Dermatology, Internal Medicine, Pathology, and §Virology, Erasmus MC, Rotterdam, The Netherlands

The authors thank J.G. den Hollander, Department of Internal Medicine, Maasstadziekenhuis, Rotterdam; F.P. Kroon, Department of Infectious Diseases, Leiden University Medical Center, Leiden; and R. Vriesendorp, Department of Internal Medicine, Haaglanden MC, The Hague, for their contribution in this project. They thank C.G. Copra for excellent technical assistance. They thank Innogenetics NV, Gent, Belgium for the gift of part of the Inno-Lipa HPV Genotyping Extra tests.

Supported by a grant of Fonds NutsOhra, project 0602–01 (“no proprietary of financial interest in outcome of the study”). Competing interests: none.

Correspondence: Eric M. van der Snoek, Department of Dermatology and Venereology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail:

Received for publication October 3, 2011, and accepted January 25, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association