High Prevalence of Anal Human Papillomavirus Infection and Anal Cancer Precursors among HIV-Infected Persons in the Absence of Anal Intercourse

18 March 2003 | Volume 138 Issue 6 | Pages 453-459

Background: Anal cancer and its precursor lesion, anal squamous intraepithelial lesions (SILs), are associated with human papillomavirus (HPV) infection. Anal HPV infection and anal SIL are common in HIV-positive men who have sex with men; receptive anal intercourse is presumed to be the mode of acquisition of HPV.

Objective: To assess the prevalence and risk factors for anal HPV infection and anal SIL in HIV-positive men with no history of anal intercourse.

Design: Cross-sectional study.

Setting: Hôpital Européen Georges Pompidou outpatient clinic, Paris, France.

Patients: 118 HIV-infected men.

Measurements: 50 HIV-positive heterosexual male injection drug users with no history of anal intercourse and 67 HIV-infected men who had sex with men were evaluated by using anal cytologic, anal histologic, and anal HPV DNA testing.

Results: 23 of the 50 heterosexual injection drug users (46%) had anal HPV infection. Low-grade SIL (LSIL) was found in 8 patients (16%) and high-grade SIL (HSIL) in 9 patients (18%). Among the 67 men who had sex with men, anal HPV infection was found in 57 patients (85%), LSIL in 33 patients (49%), and HSIL in 12 patients (18%). In univariate analysis, risk factors for abnormal anal cytologic or histologic findings in injection drug users included CD4⁺ cell counts less than 250 x 10⁶ cells/L (odds ratio, 5.7 [95% CI, 1.6 to 20.4]), plasma HIV RNA viral load greater than 1.7 log copies/mL (odds ratio, 8.9 [CI, 1.1 to 76.0]), previous AIDS-defining event (odds ratio, 4.3 [CI, 1.2 to 15.6]), and anal HPV detection (odds ratio, 5.7 [CI, 1.6 to 20.4]). Risk factors among men who had sex with men included having more than 10 lifetime receptive anal intercourse episodes (odds ratio, 5.6 [CI, 1.6 to 19.8]) and anal HPV detection (odds ratio, 8.7 [CI, 1.9 to 39.0]).

Conclusions: Anal HPV infection and anal SIL may be acquired in the absence of anal intercourse in HIV-positive men. The prevalence of HSIL is high among HIV-positive injection drug users. All HIV-positive men with CD4⁺ cell counts less than 500 x 10⁶ cells/L, regardless of history of anal intercourse, should be considered for anal cytologic screening; however, additional studies are needed to determine the efficacy of this procedure to prevent anal cancer in these populations.

Editors' Notes Context Anal cancer is associated with human papillomavirus (HPV) infection and receptive anal intercourse and is more common in HIV-positive than HIV-negative homosexual men. Little is known about HPV infection and anal lesions in HIV-positive men with no history of receptive anal intercourse. Contribution In this cross-sectional study of HIV-positive men, 46% of 50 heterosexual men who reported no history of receptive anal intercourse had anal HPV infection and 36% had anal squamous intraepithelial lesions. Low CD4+ cell counts were associated with an increased risk for anal lesions. Implications Anal HPV infection and precancerous lesions occur without receptive anal intercourse in HIV-positive men. –The Editors

 

Author and Article Information

From INSERM U 430 and Hôpital Européen Georges Pompidou, Paris, France; and University of California, San Francisco, San Francisco, California.

Acknowledgments: The authors thank Drs. Laurence Weiss, Gustavo Gonzalez-Canali, Dominique Batisse, Marina Karmochkine, Martin Buisson, and Didier Jayle for their help in enrolling patients in the study; Helena Bonner and Daniel Felmlee for their technical assistance; and Gilles Chatellier for his help in statistical analysis.

Grant Support: SIDACTION-ENSEMBLE CONTRE LE SIDA provided funding to design the study, collect the data, and send the samples from Paris to San Francisco; to perform the histologic, cytologic, and HPV PCR analyses; and to perform the statistical analysis. Cytyc Corp., France, provided vials of PreservCyt fixative fluid and TransCyt filters used in the study. The National Center for Research Resources, National Institutes of Health, U.S. Public Health Service (5 M01-RR-00079), provided additional funding for performing HPV PCR.

Requests for Single Reprints: Christophe Piketty, MD, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France; e-mail, Christophe.piketty{at}egp.ap-hop-paris.fr.

Potential Financial Conflicts of Interest:Consultancies: T.M. Darragh (Cytyc Corp.); Honoraria: T.M. Darragh (Cytyc Corp.); Grants received: T.M. Darragh (Cytyc Corp.), J. Palefsky (Cytyc Corp.); Other: T.M. Darragh (Speaker's Bureau for Cytyc Corp.).

Current Author Addresses: Drs. Piketty, Heard, and Kazatchkine: Department of Immunology, INSERM U 430 and Université Pierre et Marie Curie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.

Dr. Bruneval: Department of Pathology, INSERM U 430 and Université Pierre et Marie Curie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.

Dr. Palefsky and Ms. Da Costa: Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143.

Dr. Darragh: Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143.

Author Contributions: Conception and design: C. Piketty, I. Heard, J.M. Palefsky.

Analysis and interpretation of the data: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Drafting of the article: C. Piketty, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Critical revision of the article for important intellectual content: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Final approval of the article: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Provision of study materials or patients: C. Piketty, M.D. Kazatchkine.

Statistical expertise: C. Piketty.

Obtaining of funding: C. Piketty, M.D. Kazatchkine, J.M. Palefsky.

Administrative, technical, or logistic support: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.

Collection and assembly of data: C. Piketty, T.M. Darragh, M. Da Costa, P. Bruneval, I. Heard, M.D. Kazatchkine, J.M. Palefsky.