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.
Highlights
Over the last few decades there has been an increase in the incidence of anal cancer due, in large part, to the increase in risk groups such as males who have sex with males (MSM), the immunocompromised and, especially, patients with HIV infection [1].The incidence of anal cancer in HIV-positive patients varies between 40 and 137 per 100,000 person/years, which is much higher than in the general seronegative population, with a predominance of males with AIDS staging [2,3]
Within the cohort, 77.1% were being treated with anti-retroviral therapy (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
In our cohort, ART has a protective effect against dysplastic anal lesions
Summary
The incidence of anal cancer in HIV-positive patients varies between 40 and 137 per 100,000 person/years, which is much higher than in the general seronegative population, with a predominance of males with AIDS staging [2,3]. One of the principal risk factors associated with the appearance of this neoplasm is the chronic infection with high-risk genotypes of the human papilloma virus (HR-HPV), termed oncogenic genotypes [4]. This infection in HIV patients is favored by specific factors such as low levels of CD4 [5], previous chlamydia infection, smoking habit [6] or being MSM [1]. The progression from AIN1 to AIN 2-3 is estimated at 62% within approximately 24 months, and that the progression from AIN3 to invasive carcinoma is around 913% within 5 years [9]
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