Distribution of Human Papillomavirus Genotypes in Anal Cytological and Histological Specimens from HIV-Infected Men Who Have Sex with Men and Men Who Have Sex with Women

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Abstract

BACKGROUND:

Anal cancer is caused by human papillomavirus (HPV). Moreover, human immunodeficiency virus (HIV) is an additional risk factor for anal cancer. Therefore, when designing preventive protocols for HIV-infected men, it is important to detect high-risk (HR) oncogenic HPV genotypes present in their anal canals. However, most studies have focused only on men who have sex with men (MSM).

OBJECTIVE:

To estimate the prevalence of HPV and describe its genotype distribution using anal cytology and histology specimens from HIV-infected populations of MSM and men who have sex with women (MSW).

DESIGN:

Crosssectional study of the CARH·MEN cohort.

SETTING:

Single-center prospective cohort of HIV-infected men attending the Outpatient HIV Clinic of Hospital Germans Trias i Pujol (Spain), where they undergo annual screening for HPV infection of the anus, penis and mouth.

PATIENTS:

Four hundred eighty-three HIV-infected men (341 MSM, 142 MSW) with no current or previous history of anal condylomata.

MAIN OUTCOME MEASURES:

HPV genotypes detected (multiplex-PCR), cytology results (Papanicolaou test) and histology results (biopsy-based).

RESULTS:

Cytological abnormalities were detected in 40% of MSM (129/321; 95%CI, 35–46) and 20% of MSW (26/131; 95%CI, 13–28) (OR=2.7; 95%CI, 1.7–4.4). All high-grade squamous intraepithelial lesions (HSIL) were positive for HR-HPV in both groups. High-resolution anoscopy was performed in 146 patients (120 MSM, 26 MSW) with abnormal cytological diagnoses. Lesions were visualized in 80 MSM (67%) and 14 MSW (54%) (OR=1.7 [95%CI, 0.7–4.0]). Histological diagnosis was anal intraepithelial neoplasia (AIN)-1 in 51 MSM (64%) and 6 MSW (43%), AIN-2 in 9 MSM (11%) and 3 MSW (21%), AIN-3 in 7 MSM (9%) and 1 MSW (7%), and normal in 13 MSM (16%) and 4 MSW (29%). HPV16 was the most prevalent HR genotype.

LIMITATIONS:

Study limitations include its crosssectional design.

CONCLUSIONS:

Anal cancer screening should be offered to all HIV-infected men, regardless of their sexual orientation.

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