History Of Receptive Anal Intercourse Research Articles

Preferences for Rectal Sexually Transmitted Infection Sample Collection and Sexual Behaviors Among Adolescent and Young Adult Women Accessing Primary Care Services.

High prevalence of asymptomatic rectal chlamydia and gonorrhea among women is increasingly recognized. Screening is controversial because of lack of natural history data. Barriers to screening may include reluctance to discuss anal sex and collect rectal samples. This study describes the prevalence of sexual contact exposing adolescent and young adult women to extragenital sexually transmitted infections and acceptability of self-collection and clinician collection of rectal samples, preference for self- versus clinician-collected rectal samples, and preference for home or doctor's office for sample collection. Participants were recruited from a primary care office and completed structured interviews assessing types of sexual contact and attitudes about rectal sampling. Differences were tested using χ2 and 2-sided Fisher exact test. Of 110 cisgender women (aged 14-22 years) enrolled, the average age was 18.4 years (SD, 1.7 years), 83% reported a history of extragenital contact, 22% reported history of receptive anal intercourse. A majority of participants reported self- and clinician-collected rectal samples to be acceptable (86% and 73%, respectively), with preferences for self-collection (71%) over clinician collection (29%, P < 0.001) and collection at the doctor's office (85%) over home (15%, P < 0.001). Adolescent and young adult (AYA) women engage in behaviors that increase the risk of rectal sexually transmitted infection (STI). Self- and clinician-collected rectal samples were acceptable. A majority of AYA women preferred to collect rectal samples in the doctor's office rather than at home. This may reduce adolescents' access to direct-to-consumer STI services. Offering in-clinic, self-collected rectal samples may improve uptake of rectal STI screening in adolescent girls.

Chronic Lymphogranuloma Venereum Proctocolitis Masquerading as Inflammatory Bowel Disease.

Rectal infection with the L1, L2, and L3 serovars of Chlamydia trachomatis can cause lymphogranuloma venereum (LGV) proctocolitis, particularly among men who have sex with men (MSM). Symptoms of this sexually transmitted infection include anal pain, rectal bleeding and discharge, tenesmus, constipation, and fever. Clinicians should consider LGV when there is a history of receptive anal intercourse and symptoms of proctocolitis. A positive nucleic acid amplification test (NAAT) on a rectal sample is diagnostic. This report describes a man with HIV and chronic proctocolitis in whom the diagnosis of LGV was delayed because the clinical picture mimicked inflammatory bowel disease.

Evaluation of hTERT Gene Expression and Chromosome 7 Copy Number Variation in Anal Squamous Intra-Epithelial Lesions: A Pilot Study.

Background:Akin to cervical squamous intra-epithelial neoplasia (CIN), anal squamous intra-epithelial lesion (a-SIL) is attributed to persistent infection with high-risk human papilloma virus infection. Amplification of human telomerase reverse transcriptase (hTERT) gene and aneuploidy are known to correlate with CIN evolution. It is plausible that the underlying genetic events in a-SIL are similar. We conducted this cross-sectional analytical study with the objective of determining expression of hTERT gene expression and chromosome 7, as marker of cell ploidy in a-SIL.Methods:Conventional anal cytology was performed in 86 adult consenting subjects with history of receptive anal intercourse (RAI) and 4 controls without history of RAI. Cases with a-SIL and controls were subjected to fluorescent in-situ hybridization (FISH) to evaluate hTERT gene and chromosome 7 expression, as marker of cell ploidy. Results were expressed as number of abnormal nuclei (≥3 respective signals), maximum degree of amplification, mean signals/nucleus and proportion of cases showing abnormal nuclei.Results:Twenty cases showed a-SIL; with 15 atypical squamous cells of undetermined significance (ASCUS), 3 low grade squamous intra-epithelial lesion (LSIL) and 2 cases of high-risk cytology. Expression of both hTERT gene and chromosome 7 increased from controls to ASCUS to LSIL with concomitant increase in proportion of cases having abnormal hTERT gene and chromosome 7 expression.Conclusions:Positive association of hTERT gene with a-SIL suggests its possible role in evolution of anal squamous abnormalities. Increase in chromosome 7 also correlated positively with a-SIL. These findings corroborate the similarities between squamous carcinogenesis in CIN and a-SIL.

Prevalence of Anal Intraepithelial Lesions in Patients with Inflammatory Bowel Disease

Abstract Introduction Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal canal associated with HPV, with a higher prevalence in immunosuppressed individuals. Patients with inflammatory bowel disease (IBD) are at potential risk for their development, due to the use of immunosuppressants and certain characteristics of the disease. Method This is a prospective, cross-sectional, and interventional study that included 53 patients with IBD treated at a tertiary outpatient clinic, who underwent anal smear for cytology in order to assess the prevalence of AIN and associated risk factors. Results Forty-eight samples were negative for dysplasia and 2 were positive (4%). Both positive samples occurred in women, with Crohn's disease (CD), who were immunosuppressed and had a history of receptive anal intercourse. Discussion The prevalence of anal dysplasia in IBD patients in this study is similar to that described in low-risk populations. Literature data are scarce and conflicting and there is no evidence to recommend screening with routine anal cytology in patients with IBD. Female gender, history of receptive anal intercourse, immunosuppression and CD seem to be risk factors.

293 Receptive Anal Sex in Women and Risk of Colorectal Cancer (2009–2014): A Retrospective Analysis of NHANES

INTRODUCTION: Risk factors for early presentation of colorectal cancer is a topic of particular current interest. Prevalence of receptive anal sex has not been well researched, although some studies suggest that it is increasingly popular. The objective of the current study is to examine if there is an increased risk for colorectal cancer in women who engage in receptive anal intercourse as compared to patients who have not engaged in receptive anal sex. METHODS: The National Health and Nutrition Examination Survey (NHANES) was considered for women who answered the sexual health questionnaire (SXQ) during the survey cycles that included a SXQ item referring to anal sex (2009–2014). The questionnaire assessed sexual health behaviors including history of receptive anal intercourse in women. Additional NHANES data was matched for demographics, including race, as well as medical diagnoses, such as colorectal cancer and HPV infection. Statistical analysis was conducted using the statistical software, R. RESULTS: A total of 7,781 women completed the NHANES SXQ between 2009 and 2014 but only 6,596 answered the question mentioning receptive anal intercourse. A total of 2,203 women (28.3%), stated that they had a history of receptive anal intercourse at least once. The rate of reported history of receptive anal intercourse did not significantly increase across the 3 cycles: 2009–2010 (789, 29.0%) to 2013–2014 (782, 29.6%). From 2009 to 2014, there were a total of 19 participants (0.29%) with a diagnosis of colorectal cancer, with 5 patients who had both a diagnosis of colorectal cancer and history of anal intercourse. The risk of a diagnosis of colorectal cancer with a history of receptive anal intercourse in women was 0.0023, whereas the risk of a diagnosis of colorectal cancer with no history of receptive anal intercourse was 0.0032. There was no significant evidence that receptive anal intercourse in women is associated with risk of colorectal cancer. There was insufficient data for concurrent HPV infection and CRC in those without a history of anal sex, thus we are unable to test for significant difference between risk of CRC for women with HPV as compared to women without HPV. CONCLUSION: Results from the questionnaire did not suggest an increasing trend of receptive anal intercourse from 2009 to 2014. No significant difference was found in relative risk of diagnosis of colorectal cancer in women who engaged in anal intercourse as compared to those who did not engage in anal intercourse.

P064 Receptive anal intercourse in patients with inflammatory bowel disease: The role of sexually transmitted infections

BACKGROUND: Receptive anal intercourse (RAI) is a common practice in both men who have sex with men (MSM) and heterosexual populations. While inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), affects over 1 million people in the United States, there have been no studies linking IBD and sexually transmitted infections (STIs). IBD can lead to an inflamed and leaky colonic epithelial barrier, which may increase the risk of rectal STI acquisition. The increased risk of HIV seroconversion in MSM with untreated rectal gonorrhea (GC) and chlamydia (CT) may support this theory. CASES: Our first case is of a 24-year-old MSM who was diagnosed with left-sided UC at age 21 in the setting of bloody diarrhea and tenesmus. He was originally treated with topical and oral 5-ASA, and topical steroids, but developed a mesalamine-associated rash and consequently discontinued these agents. At 24, the patient presented to clinic with recurrence of bloody diarrhea and tenesmus, and on questioning was found to engage in RAI. Rectal swab and enteric pathogen PCR panel revealed rectal gonorrhea and shigella. The patient was treated with ceftriaxone and azithromycin and symptoms completely resolved. Our second patient is a 23-year-old MSM male with UC from rectum to 50 cm who had achieved deep remission on adalimumab monotherapy, and presented with tenesmus, increased mucous, and a history of RAI. The patient tested positive for rectal CT and was treated with doxycycline. The patient’s symptoms resolved completely after treatment. DISCUSSION: Rectal STIs may complicate IBD. Underlying IBD, especially the presence of active proctitis and the utilization of immunosuppression, may increase susceptibility to STI acquisition via RAI. These cases indicate the importance of careful history taking and frequent rectal STI testing in IBD patients who engage in RAI. Future studies are required to continue to explore the influence of STIs on IBD patients who engage in RAI, including qualitative data on how IBD patients navigate RAI and STIs and quantitative data to gauge how prevalent STIs are in IBD patients compare to the general population.

Are patients in the IBD clinic at risk of proctitis secondary to sexually transmitted infections?

ObjectiveTo gauge the potential risk of sexually transmitted infection (STI) as a cause of proctitis in a cohort of patients with inflammatory bowel disease (IBD) and to gauge whether this...

Patterns of Extragenital Chlamydia and Gonorrhea in Women and Men Who Have Sex With Men Reporting a History of Receptive Anal Intercourse.

Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men who have sex with men is risk based. Despite high frequencies of oral and receptive anal intercourse (RAI) among women, extragenital screening is not recommended. Women (n = 175) and men who have sex with men (n = 224) primarily recruited from a sexually transmitted infection clinic reporting a lifetime history of RAI completed a structured questionnaire and clinician-collected swab samples from the rectum, pharynx, vagina (women), and urine (men). CT and GC were detected using 2 commercial nucleic acid amplification tests (Aptima Combo 2; Hologic, Inc, Bedford, MA; Xpert CT/NG, Cepheid Innovation, Sunnyvale, CA). The median age of the population was 26 years, 62% were white, and 88% were enrolled from a sexually transmitted disease clinic. Men were more likely than women to have GC (22.8% vs. 3.4%) and CT (21.9% vs. 12.6%). In men versus women, GC was detected in 16.5% versus 2.3% of pharyngeal swabs, 11.6% versus 2.3% of rectal swabs, and 5.4% versus 2.9% of urine samples or vaginal swabs. C. trachomatis was detected in 2.2% versus 1.7% of pharyngeal swabs, 17.4% versus 11.4% of rectal swabs, and 4.5% versus 10.3% for urogenital sites in men versus women. Overall 79.6% of CT and 76.5% of GC in men and 18.2% of CT and 16.7% of GC in women were detected only in the pharynx or rectum. Reliance on urogenital screening alone misses most of GC and CT in men and more than 15% of infections in women reporting RAI.

Intractable Proctitis in a 46-Year-Old Man

46-year-old man was referred to the gastroenterAology clinic by the colorectal surgical team for medical management of presumed ulcerative proctitis. He had been investigated 1 year previously for bloody diarrhea when colonoscopy had revealed florid proctitis. Despite the initiation of oral and topical mesalamine, he continued to complain of the passage of blood per rectum associated with tenesmus and some recent weight loss. Repeat colonoscopy revealed a single, large ulcer in the rectum (Figures A and B) with a well-circumscribed, rolled edge that felt soft on biopsy. Examination was otherwise normal to the terminal ileum. The histology was atypical for inflammatory bowel disease but suggested a chronic ulcer without granulomata and with minimal crypt architectural distortion in the adjacent mucosa. Polymerase chain reaction of rectal biopsy confirmed infection with Chlamydia trachomatis and was consistent with lymphogranuloma venereum (LGV). On questioning, the patient reported a history of receptive anal intercourse. Human immunodeficiency virus (HIV) and syphilis serology were negative. The symptoms responded well to a 3-week course of doxycyline 100 mg twice daily, and repeat sigmoidosopy after 3 months confirmed ulcer healing (Figure C). Particularly in cases where the response to conventional treatment of ulcerative proctitis is poor, the possibility of infective proctitis should be considered and appropriate sexual history obtained. Several sexually transmitted infections including chlamydiosis, gonorrhea, syphilis, and herpesvirus can cause proctitis. Histology is usually nonspecific in the setting of LGV proctitis, and

Anal intraepithelial neoplasia in a sexually transmitted diseases outpatient clinic: correlation with cytological screening

High-grade anal intraepithelial neoplasia (AIN) is currently considered a precursor of anal cancer. The population most susceptible to AIN is men who have sex with men (MSM), especially if they are infected by HIV. We analysed the population diagnosed with AIN and evaluated anal cytology as a method of screening the at-risk population. We undertook a retrospective review of patients diagnosed with AIN by means of a surgical biopsy between 2008 and 2010. We analysed the risk factors of the population affected and the degree of agreement with the cytology performed previously. During the study period 41 patients were diagnosed with AIN and seven with anal canal carcinoma in situ; 77% were men, most MSM. A history of receptive anal intercourse was found in 81% of the patients and in 71% there was an association with anogenital warts; 32 patients were HIV-positive, most of them men. Of the patients with anal dysplasia of any type in the cytology, 90% had some grade of AIN or carcinoma in situ in the later biopsy. The degree of agreement between the cytology and the biopsy was 94% in the high-grade dysplasias and 50% in the low-grade dysplasias. Anal cytology in at-risk populations has a high degree of agreement with the biopsy when performed surgically, though less in low-grade dysplasias, which must always be studied. More studies evaluating the degree of progression of AIN to anal cancer are necessary.

4. High prevalence of anal HPV infection among HIV-positive male subjects in the absence of anal intercourse

Background The risk of progression to cancer from HPV infection is increased in HIV-positive subjects. Anal HPV infection is a concern among men who have sex with men (MSM), especially in the setting of HIV infection. Methods: Cross-sectional study including 62 HIV-positive injection drug users (IDUs) without history of receptive anal intercourse and 110 HIV-positive MSM. All patients were receiving HAART with HIV-RNA &lt;37 copies/mL. Patients answered a self-administered questionnaire investigating their sexual habits. Participants underwent anal brushing collecting samples for cytology examination (Bethesda 2001 criteria for cervical cytology) and high resolution anoscopy collecting samples for histological classification. HPV-DNA polymerase chain reaction (PCR) identification was performed. Results: Of the IDUs, 62.5% showed CD4 nadir &lt;200 cell/mmc compared with 12% of MSM (P &lt; 0.05), the actual CD4+ T-cells count did not show a statistical difference. HPV-DNA PCR tested positive in 52% of IDUs and 69% of MSM (P &lt; 0.05). Presence of high-risk genotypes did not show significant difference between the groups (38% of IDUs and 31% of MSM). LSIL prevalence was higher among MSM than IDUs (38% v. 23%), HSIL was higher among IDUs than MSM (26% v. 21%). The prevalence of anal cancer was similar in the two populations (3% in each group). All patients, except for men presenting with anal cancer, were completely asymptomatic. Conclusions: Anal HPV infection and anal SIL may be acquired in the absence of anal intercourse in HIV-infected men. The prevalence of HSIL is high among HIV-positive IDUs. All HIV-infected men, regardless of history of anal intercourse, should be considered for anal cytology screening.

Use of Nucleic Acid Amplification Testing for Diagnosis of Anorectal Sexually Transmitted Infections

Nucleic acid amplification testing (NAAT) has become the preferred method to detect Chlamydia trachomatis and Neisseria gonorrhoeae, but no commercial tests are cleared by the U.S. Food and Drug Administration for use with rectal swab samples. This study evaluated the performance of strand displacement amplification (SDA) and transcription-mediated amplification (TMA) to detect C. trachomatis and N. gonorrhoeae and to determine if TMA could also detect Mycoplasma genitalium and Trichomonas vaginalis in men and women reporting a history of receptive anal intercourse. Discordant results between the NAATs were reevaluated using the Aptima CT or Aptima GC assay, each of which targets primers other than those targeted by the Aptima Combo 2 (AC2) assay, as the confirmatory test. Of 497 evaluable participants, 41 (8.2%) were positive for C. trachomatis, 21 (4.2%) were positive for N. gonorrhoeae, 26 (5.2%) were positive for T. vaginalis, and 47 (9.5%) were positive for M. genitalium. The sensitivity and specificity of the C. trachomatis test were 100% and 99.8% for AC2 and 56.1% and 100% for SDA, respectively. The sensitivity and specificity of the N. gonorrhoeae test were 100% and 100% for AC2 and 76.2% and 100% for SDA, respectively, while culture was only 23.8% sensitive. Of the 114 participants who had a positive result for any of the four infectious agents, 16 were positive for two pathogens and 3 were positive for three pathogens. These data suggest that rectal infection is common and that the AC2 is superior to SDA for the detection of C. trachomatis and N. gonorrhoeae from rectal swab samples.

Distribution of Cell-Free and Cell-Associated HIV Surrogates in the Colon After Simulated Receptive Anal Intercourse in Men Who Have Sex With Men

Describing the distribution and clearance of HIV surrogates within the gastrointestinal tract to inform rectal microbicide development. Radiolabeled simulated HIV-infected semen was administered, imaged, and biopsied to simulate and measure colonic HIV distribution after anal intercourse. Healthy male subjects with a history of receptive anal intercourse and experience with the use of anal sex toys were recruited to this study. Apheresis isolated leukocytes were collected before simulated intercourse. These autologous leukocytes, radiolabeled with 9.25 MBq (111)Indium-oxine (cell-associated HIV surrogate), and sulfur colloid particles, labeled with 37 MBq (99m)Technectium (cell-free HIV surrogate), were mixed in 3 mL autologous seminal plasma. This simulated HIV-infected semen was administered to subjects via an artificial phallus with urethra after 5 minutes of simulated intercourse. Postdosing dual isotope Single photon emission computed tomography coupled with traditional computed tomography (SPECT/CT) images were acquired at 1, 4, 8, and 24 hours. At 5 hours postdosing, colon biopsies were collected, CD4 cells were extracted, and samples analyzed for radioactivity. SPECT/CT images showed similar luminal distribution for both surrogates, with migration limited to the rectosigmoid colon in all subjects. SPECT showed at least 75% overlap in distribution of both surrogates up to 4 hours after dosing. Biopsies indicate that 2.4% of CD4 cells extracted from rectosigmoid colon tissue were exogenously administered. Our HIV surrogates stayed within the rectosigmoid colon for 24 hours. Exogenously dosed autologous lymphocytes and HIV-sized particles migrate to similar locations and associate with the colonic tissue in the lumen.

Description of a Pilot Anal Pap Smear Screening Program Among Individuals Attending a Veteran's Affairs HIV Clinic

Despite the higher risk of anal cancer among HIV-infected individuals currently there are no national or international guidelines for anal dysplasia screening. We assessed acceptance and feasibility of screening for anal intraepithelial neoplasia (AIN), the rate of abnormalities, and relationship between the presence of AIN and a history of receptive anal intercourse. Eighty-two percent of HIV-patients approached during routine clinic visit agreed to participate in the study with anal Pap smear collection; 53% had abnormal cytology results and among those undergoing high-resolution anoscopy with biopsy, 55% had high-grade AIN, including 2 cases of carcinoma in situ. Anal cytology was well accepted and it was feasible to be incorporated into HIV primary care practice. Abnormal cytology was not significantly associated with history of anal intercourse (p = 0.767). The high rate of abnormal results reinforces the need for further evaluation of the role of systematic anal Pap smear screening for HIV patients.

HIV- positive anal cancer: an update for the clinician.

Anal cancer used to be a rare cancer traditionally associated with elderly women. There are approximately 5260 cases per year in the U.S. (1). The onslaught of the Human Immunodeficiency Virus (HIV) virus has led to a change in anal cancer demographics. Anal cancer is on the rise in the U.S and the number of anal cases documented has quadrupled in the past 20 yrs correlating with the rise of the HIV epidemic. The incidence of anal cancer is 40 to 80 fold higher in the HIV positive (HIV+) population when compared to the general population (2). With the advent of highly active antiretroviral therapy (HAART), HIV+ patients are living longer as less are progressing to AIDS. As a consequence non AIDS defining cancers such as anal cancer are on the rise. Factors implicated in the etiology of anal cancer in HIV+ patients include (Human papillomavirus) HPV virus status, sexual habits, and a history of smoking. HPV 16 and receptive anal intercourse (RAI) increase the risk of anal cancer by 33% over the general population. In the general population, the rate of anal cancer is approximately 0.9 cases per 100,000. In patients with a history of RAI, the rate approaches 35 cases per 100,000 which is equivalent to the prevalence of cervical cancer (3). Smokers are eight times more likely to develop anal cancer. There has been much discussion about tailoring treatment decisions in HIV+ patients with anal cancer. This review focuses on squamous cell carcinomas of the anal canal which comprise 80 to 90% of all anal cancers diagnosed and highlight key issues in the management of HIV+ anal cancer patients including recent clinical trials.

Plasmablastic Lymphoma Masquerading as Perianal Abscess in a Homosexual Man

Perianal abscess is a common condition treated surgically with early incision and drainage. It is commonly associated with bowel flora and less often with skin flora. However, in individuals with history of receptive anal intercourse, sexually transmitted infections like gonorrhea should also be considered. We report a case of a 46-year-old HIV-positive homosexual man who presented with features of a perianal abscess. However, no organisms were obtained on cultures. Instead, tissue biopsy revealed plasmablastic lymphoma-a very rare and highly aggressive variant of non-Hodgkin lymphoma. The unique features in our patient were the very unusual presentation in the form of acute perianal swelling mimicking an abscess and the absence of advanced HIV disease (his CD4 count was 973 cells/μL). In HIV-positive individuals presenting with features of perianal abscesses, the differential diagnosis should be expanded to include not only sexually transmitted infections but also malignancies like lymphoma.

Anal intraepithelial neoplasia in a multisite study of HIV-infected and high-risk HIV-uninfected women

To study anal intraepithelial neoplasia and its associations with anal and cervical human papillomavirus (HPV), cervical neoplasia, host immune status, and demographic and behavioral risk factors in women with and at risk for HIV infection. Point-prevalence analysis nested within a prospective study of women seen at three clinical centers of the Women's Interagency HIV Study. In 2001-2003 participants were interviewed, received a gynecological examination, anal and cervical cytology testing and, if abnormal, colposcopy-guided or anoscopy-guided biopsy of visible lesions. Exfoliated cervical and anal specimens were assessed for HPV using PCR and type-specific HPV probing. Logistic regression analyses were performed, and odds ratios (ORs) estimated risks for anal intraepithelial neoplasia. Four hundred and seventy HIV-infected and 185 HIV-uninfected women were enrolled. Low-grade anal intraepithelial neoplasia was present in 12% of HIV-infected and 5% of HIV-uninfected women. High-grade anal intraepithelial neoplasia was present in 9% of HIV-infected and 1% of HIV-uninfected women. In adjusted analyses among HIV-infected women, the risk factors for low-grade anal intraepithelial neoplasia were younger age [OR = 0.59, 95% confidence interval (CI) = 0.36-0.97], history of receptive anal intercourse (OR = 3.2, 95% CI = 1.5-6.8), anal HPV (oncogenic types only OR = 11, 95% CI = 1.2-103; oncogenic and nononcogenic types OR = 11, 95% CI = 1.3-96), and cervical HPV (oncogenic and nononcogenic types OR = 3.5, 95% CI = 1.1-11). In multivariable analyses among HIV-infected women, the only significant risk factor for high-grade anal intraepithelial neoplasia was anal HPV infection (oncogenic and nononcogenic types OR = 7.6, 95% CI = 1.5-38). Even in the era of highly active antiviral therapy, the prevalence of anal intraepithelial neoplasia was 16% in HIV-infected women. After controlling for potential confounders, several risk factors for low-grade anal intraepithelial neoplasia differed from risk factors for high-grade anal intraepithelial neoplasia.

Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa

Objectives:To demonstrate the value of routine, basic sexually transmitted infection (STI) screening at enrolment into an HIV-1 vaccine feasibility cohort study and to highlight the importance of soliciting a history...

Anal intraepithelial neoplasia in heterosexual and homosexual HIV-positive men with access to antiretroviral therapy.

Studies of human immunodeficiency virus (HIV)-positive men have demonstrated high rates of anal intraepithelial neoplasia (AIN), a precursor to anal carcinoma, mostly in white homosexual men and men not receiving effective antiretroviral therapy (ART). Ninety-two participants--53% Latino, 36% African American, and 40% without a history of receptive anal intercourse (RAI)--were evaluated with a behavioral questionnaire, liquid-based anal cytological testing, Hybrid Capture 2 human papillomavirus (HPV) DNA assay and polymerase chain reaction, and anal colposcopy with biopsy of lesions. High-risk HPV DNA was identified in 61%, and this was associated with a history of RAI (78% vs. 33%; P<.001); 47% had abnormal cytological results, and 40% had AIN on biopsy. In multivariate analysis, both were associated with a history of RAI (odds ratio [OR], 10 [P<.001] and OR, 3.6 [P=.02], respectively) and lower nadir CD4(+) cell counts (P=.06 and P=.01). Current ART use was protective (OR, 0.09; P<.01 and OR, 0.18; P=.02). Although anal infections with high-risk HPV and AIN in HIV-positive men are associated with a history of RAI, both conditions are commonly identified in HIV-positive men without this history. Both lower nadir CD4(+) cell counts and lack of current ART were associated with AIN but not with the detection of anal HPV.

PROGRESSION OF ANAL SQUAMOUS INTRAEPITHELIAL LESIONS IN HIV-POSITIVE AND HIV-NEGATIVE HOMOSEXUAL/BISEXUAL MEN

Background: Men with a history of receptive anal intercourse have been shown to be at increased risk of anal cancer compared to the general population, and HIV+ men may be at particularly high risk. Like cervical cancer, anal cancer may be preceded by precancerous disease known as high-grade squamous intraepithelial lesion(HSIL). Little is known about incidence of anal HSIL and associated risk factors. This study was designed to characterize progression of anal disease and incidence of HSIL in a prospective cohort study of HIV+ and HIV− homosexual/bisexual men. Methods: 346 HIV+ and 262 HIV− men were enrolled at baseline in this study, which included an extensive interview, anal cytology, anoscopy with biopsy of visible disease, anal HPV testing and CD4 measurement. Subjects with no anal disease were followed every 6 to 12 months. Subjects with anal disease defined as atypical squamous cells of undetermined significance or low-grade squamous intracpithelial lesion (LSIL) were assessed every 3 months, with development of HSIL as the endpoint. HPV was sought using the polymerase chain reaction with the HPV L1 consensus primers and probes in a dot-blot format, followed by specific typing for 39 different HPV types. Results: Compared to HIV− subjects, HIV+ subjects had a higher incidence of HSIL within 2 years of followup (RR-2.2, Cl 1.6-3.1). Of the 87 HIV+ men who were normal at baseline, 28 (32%) progressed to LSIL and 17 (20%) progressed to HSIL within 2 years. Of the 137 HIV− men who were normal at baseline, 12 (9%) progressed to LSIL and 11 (8%) progressed to HSIL within 2 years. Of the 55 HIV+ men with LSIL at baseline, 34 (62%) progressed to HSIL and of the 14 HIV− men with LSIL, 5 (36%) progressed to HSIL within 2 years. Defining disease progression as movement from one anal disease state to a higher grade within 2 years, lower CD4 counts among HIV+ subjects were associated with disease progression (p for trend<0.001). Among HIV+ subjects, the RR for anal progression was 1.6 for presence of a single HPV type and 2.0 for multiple types when compared to HIV+ men without HPV infection (p for trend 0.002). Among the HIV− subjects, the RR for anal disease progression was 3.7 for presence of a single HPV type and 5.1 for multiple types when compared to HIV− men without HPV infection(p for trend < 0.0005). Lifestyle risk factors such as smoking, alcohol and recreational drug use, and amount of receptive anal intercourse were not associated with anal disease progression in HIV+ or HIV− men. Conclusions: HIV+ homosexual/bisexual men had a high estimated two-year incidence of HSIL. HIV− men had a lower, but still appreciable incidence of HSIL. The primary risk factors for anal discase progression among HIV+ men included lower CD4 counts and infection with multiple HPV types. Among HIV− men, the primary risk factor was infection with multiple HPV types. Although the progression rate from HSIL to invasive cancer is not known, both HIV+ and HIV− homosexual/bisexual men with HSIL should be considered at risk for developing anal cancer. Supported by grant number R01 CA54053.