Screening-Related Factors in Anal Canal Lesions in HIV-Positive Patients

Abstract

The incidence of anal dysplasia in HIV-positive men who have sex with men (MSM) is increasing. This dysplasia is described as either high-grade anal intraepithelial (HAIN) or low-grade anal intraepithelial (LAIN). Anal squamous cell carcinoma (ASCC) is more frequent in HIV-positive patients and is related to human papillomavirus (HPV) infections, conditions of low systemic immunity and long use of highly active antiretroviral therapy. The anal Pap smear protocol and high-resolution anoscopy seem to be effective for screening for anal dysplasia and early anal cancer. The aim of this study was to identify some factors that could raise the risk of HAIN and LAIN among HIV-positive patients. We evaluated 134 HIV-positive and HIV-negative patients who had previously had anal intercourse, at CRT/AIDS Sao Paulo from October 2011 to March 2012. HIV-negative patients and HIV-positive patients without recent CD4 lymphocyte counts were excluded. All of the patients underwent the anal Pap smear protocol and high-resolution anoscopy. The anal lesions were treated with 90% trichloroacetic acid (TCA) and 5% imiquimod for 12 weeks. The patients with residual lesions were operated. The statistical analysis was performed using Student’s t test and the significance level was set at less than 5%. 101HIV-positive patients were evaluated (91 males and 10 females), among whom 31 had warts and 3 had LAIN and warts. One patient was operated after the treatment with 90% TCA and 5% imiquimod. In conclusion, HIV-positive patients with anal warts presented low CD4 lymphocyte counts and anal dysplasia.