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

Abstract

Background. 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). Methods. 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. Results. 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). Conclusions. 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.