Antiretroviral Therapy as a Factor Protective against Anal Dysplasia in HIV-Infected Males Who Have Sex with Males

Abstract

ObjectivesChronic infection with oncogenic HPV genotype is associated with the development of anal dysplasia. Antiretroviral therapy (ART) has been shown to decrease the incidence of cervical carcinoma in women with HIV. We sought to: 1) describe the prevalence and grade of anal dysplasia and HPV infection in our study subjects; 2) analyze the grade of correlation between anal cytology, PCR of high-risk HPV, and histology; 3) identify the factors associated with the appearance of ≥AIN2 lesions.DesignCross-sectional, prospective study.MethodsA cohort of HIV-positive males (n = 140, mean age = 37 years) who have sex with males (MSM) had epidemiological, clinical and analytical data collected. Anal mucosa samples were taken for cytology, HPV PCR genotyping, and anoscopy for histological analysis.ResultsWithin the cohort, 77.1% were being treated with ART, 8.5% anoscopy findings were AIN2, and 11.4% carcinoma in situ; 74.2% had high-risk (HR), 59.7% low-risk (LR) HPV genotypes and 46.8% had both. The combination of cytology with PCR identifying HR-HPV better predicts the histology findings than either of these factors alone. Logistic regression highlighted ART as a protective factor against ≥AIN2 lesions (OR: 0.214; 95%CI: 0.054–0.84). Anal/genital condylomas (OR: 4.26; 95%CI: 1.27–14.3), and HPV68 genotype (OR: 10.6; 95%CI: 1.23–91.47) were identified as risk factors.ConclusionsIn our cohort, ART has a protective effect against dysplastic anal lesions. Anal/genital warts and HPV68 genotype are predictors of ≥AIN2 lesions. Introducing PCR HPV genotype evaluation improves screening success over that of cytology alone.

Human papillomavirus status, anal cytology and histopathological outcome in HIV‐positive patients

“…We know that condylomata acuminata are usually caused by HPV 6 and 11 and therefore show no progression to AC. Yet some studies have identified anogenital condylomata acuminata as a single risk factor for the development of high grade AIN . These findings stress the importance of HRA where AIN and condylomata acuminata can clinically be distinguished by the experienced examiner and in case of unclear clinical presentation a biopsy should be taken.…”

Human papillomavirus prevalence in the anus and urine among HIV-infected Japanese men who have sex with men

“…Many epidemiological studies have been conducted to investigate anal HPV prevalence among HIV-infected MSM in several countries and regions. Anal HPV prevalence in HPV-infected MSM was 61.0% of 92 patients in the United States [3], 74.2% of 140 in Spain [4], 75.9% of 361 in Japan [5], 82.7% of 133 in Korea [6], 88.6% of 166 in Italy [7], 91.8% of 85 in South Africa [8], and 95.5% of 1439 in Spain [9]. The high prevalence of anal HPV infection observed in the present study is similar to that previously reported in other countries.…”

“…The most common atypia was LSIL (22.6%), followed by ASCUS (19.5%), and HSIL (0.8%). An epidemiological study conducted in Spain among HPV-infected MSM revealed a high HR-HPV prevalence (74.2%), and 54.2% of cytological atypia, such as LSIL (49.2%), ASCUS (2.5%), and HSIL (2.5%) [4]. Wilkin et al also found that 47% of 85 HIV-infected men had abnormal results: LSIL (24%), ASCUS (18%), and HSIL (6%) [3].…”

Cancer prevention in HIV-infected populations

“…Importantly, cART and associated immune reconstitution decrease the risk of pre-malignant cervical and anal HPV-associated HSIL among HIV-infected individuals 148 . Indeed, well-controlled HIV viremia is associated with half of the risk of developing cervical or anal HSIL after adjusting for CD4 + T-cell counts 149 .…”